Extracting two year-old's top front teeth

My 2 year old had lost the enamel on his 4 top front teeth. We took him to the dentist, and he says he needs to pull them. I am very concerned about doing this since he is so young. I would like to know if these teeth could be saved. He did not say they were infected, just that he could not save the teeth.


Dear Miriam,

Whether or not the teeth are restorable (savable) depends upon how much tooth structure currently remains. If very little tooth structure remains, or if decay exists well below the gumline, these teeth may not be restorable. If the teeth are restorable, pulp (nerve and blood vessels in the tooth) therapy may be necessary prior to placement of any restorative material. Any restorations a dentist may place will also be partially dependent upon the cooperation of the child.

Certain types of tooth-colored filling materials require keeping the teeth dry and isolated, which can be challenging with some children! Composite resins are generally the most technique-sensitive restorations. Occasionally, a restorative material called glass ionomer can be used. These are also tooth- colored, but may not be as durable as the composite resin. Stainless steel crowns may be another option to restore the front teeth. The esthetics of stainless steel crowns can be improved by using crowns that have tooth-colored facings.

If the teeth are extracted, you may wish to consider having the dentist make a "kiddie partial" to replace the missing teeth. This will help with cosmetics, chewing, and possibly phonetics as your son's speech develops.

The other aspect that should be addressed is the cause of tooth structure loss in the first place. Did the teeth develop this way? Is it due to decay? Is it due to acid reflux from his stomach? These issues need to be determined, discussed, and treated, if necessary. Otherwise, other teeth may be in jeopardy.

Discuss options with your dentist. Find out exactly why he wants to extract the teeth rather than restore them. You should also seek a second opinion. If you are seeing a general dentist, perhaps a pedodontist (children's dentist) may have some other insight. Ask for a referral from your dentist. A second opinion may help you feel more comfortable about treatment performed on your son.

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