Does Five-year-old Really Need X-rays?

My son lost his front tooth in May, and he has still not replaced it with a permanent tooth. My new dentist says that it will come with time; however, how much time are we talking about?

Also, on this last visit to the dentist, they took x-rays of my son's teeth. He is five years old, and I felt that was unnecessary. What is the purpose of x-rays at this age? His teeth are perfectly spaced and straight, and he has been seeing a dentist since his first birthday. Our new dentist is not a pediatric dentist, but one we chose off a preferred insurance list.

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While it is true that pedodontists do have further training regarding children's dental treatment, general dentists are quite capable of providing good dental care for children. Certain situations do lend themselves better to pedodontic care, and some general dentists prefer not to treat children; these are two major reasons why pediatric dentists exist.

There are several reasons why radiographs may be needed for your five year old son. First of all, crowns of teeth have five sides. Clinically, a dentist can only see three sides: the top, the tongue side, and the cheek side. If spacing is present in the anterior teeth, it may be possible to see in between these teeth as well. Generally, the posterior teeth are too close together to be able to thoroughly examine them without radiographs. I generally begin taking radiographs on my patients when they are about 5 years old, unless they have had some type of trauma or I notice problems before this time. I have had quite a number of incidences when primary molars that appeared perfectly healthy on clinical exam revealed cavities in between the teeth upon radiographic examination.

Radiographs also enable us to see what is developing beneath the primary teeth within the bone. We can see if the permanent teeth are developing normally, if they are in the correct position, and if bone tissue appears normal. In this way, any abnormalities can be noted and treated, if necessary. Certain conditions, including decay, that are not visible upon clinical examination, can be detected and treated early. As you can see, there are many sound reasons for taking dental radiographs at this time.

Did the radiographs reveal the presence of the permanent tooth which has not yet erupted? If so, the position of the tooth and its proximity to the surface of the gum tissue should be visible. It is difficult to predict how much time it will take for the tooth to appear through the gum tissue. A radiograph of the area should help in determining some type of time frame. In addition to the position of the crown of the permanent tooth, the development of its root may also help determine a time frame. Generally, permanent teeth begin erupting when the root is 1/2 to 2/3 developed. If the tooth is present just beneath the surface of the gum (as determined by radiograph and palpation of the area), a small incision in the gum tissue will allow for initial eruption of the tooth. If the gingiva is extremely fibrous and/or keratinized, it may be difficult for the permanent tooth to erupt. I would only consider making an incision if the tooth was in correct position and only required some initial help to erupt.

Ask your dentist to show you the radiograph of the area so you can see the development and position of the permanent tooth. This may help you determine some type of time frame for eruption; it will also show if something is impeding eruption. If there is an impediment, consultation with an orthodontist or oral surgeon may be needed to determine the best treatment.

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