Loss of enamel on top front teeth

My son is five years old, and his top front teeth look awful. One is almost gone, and the enamel is coming off on the others. I took him to a dentist who said to just keep brushing them, wait for them fall out, and to be more concerned with the permanent teeth. Is this right, or should I really be worried and get them pulled?


Dear Kim,

This situation does present somewhat of a dilemma; there may be no right or wrong way to approach treatment. Your son's comfort and oral health should take priority. Function, and then esthetics, should then be considered. If your son has signs of infection, such as swelling and/or redness in the gum tissue around the teeth in question, or if he is in pain from these teeth, then they should probably be extracted. If the primary teeth are decayed and non-restorable, extraction should also be considered.

Radiographs of the area should be taken to assess the development and position of the permanent teeth. If the roots of the primary teeth are almost resorbed due to the eruption of the permanent teeth, then a decision will need to be made to either allow the primary teeth to exfoliate naturally or to extract them. The tooth which is "almost gone" may need to be extracted because of the difficulty in being able to "grab onto it." Otherwise, to reduce the possibility of any traumatizing events for your son, you may wish to allow the other teeth to exfoliate naturally. The exception may be if your son is experiencing sensitivity from the teeth which are missing enamel.

If it appears from the radiographs that the permanent teeth may not be erupting soon, you may wish to consider restoring the teeth which are possible to restore. Composite (tooth-colored filling material) may be used to rebuild some of the missing tooth structure to create a more esthetic look.

Discuss some of these possibilities with your dentist. If the dentist does not want to discuss treatment possibilities, including advantages and disadvantages, ask for a referral to another dentist (maybe even a pedodontist) instead of a general dentist. If you do decide just to let nature take its course, it is very important to keep your son's primary teeth as clean as possible. Good luck with your decision process.

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