Losing baby teeth at two?

My daughter is only two-years-old and she is starting to lose her baby teeth. Should I be worried?

Question:

Your child is quite young to be losing primary teeth! While the average age for natural primary (baby) teeth loss varies, the first primary teeth are usually lost about five to seven years after birth.

I do not want to worry you; however, it is important for you to know about some main causes of early tooth loss. There are local and systemic conditions which can lead to early tooth loss. These conditions may include severe periodontal disease, metabolic disturbances, or self-injury.

Gingivitis (gum disease) is common in children, but periodontal disease with bone loss is rare. Prepubertal and juvenile periodontitis are associated with several different types of bacteria including Actinobacillus actinomycetemcomitans, Provetella intermedia, and Eikenella corrodens.

These bacteria are usually associated with decreased immune defenses. Defects or a decrease in a certain type of blood cell known as a neutrophil can lead to several dental and systemic effects. For example, cyclic neutropenia is a condition in which there is a decrease in neutrophils every three to four weeks. During this period, a child is very susceptible to infection, including periodontal disease.

Papillon-Lefevre syndrome involves a defect in the neutrophil. This can lead to primary tooth loss soon after the teeth erupt. All primary teeth are lost prior to permanent teeth. Permanent teeth are then usually lost when they erupt.

Other conditions can also cause bone loss. Langerhans' cell histiocytosis involves a proliferation of cells called Langerhans' cells. With this condition, the bone supporting the teeth is resorbed causing premature loss of primary teeth. Typically all four quadrants of the mouth are involved, and the primary molars are most affected. The affected teeth have the appearance of "floating on air" when dental radiographs are viewed.

A condition called Ehlers-Danlos is a disorder involving collagen formation. This causes broken capillaries (small blood vessels), skin bruises, and hypermobile joints. Type VIII Ehlers-Danlos also presents with dental complications such as progressive periodontal disease leading to tooth loss.

I urge you to take your daughter to the pediatrician as soon as possible to determine if she has any of these conditions. Systemic and dental treatment will vary with each disease. Early diagnosis may aid in treatment.

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