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Bladers from Singapore asked a question

What should I do about a child's permanent tooth that's growing in the incorrect position? (photo)

My child's baby tooth decayed and only half of it fell off, and the other half is rooted still in the gums. Her permanent tooth recently started to grow out of the side of the gums, likely because the baby tooth refused to come off. Will the permanent tooth shift by itself lower down the gum, to the correct position? Currently it has already grown at the side of gum.

DOCTOR’S ANSWER (3)
Dr Sylvia Tan
Orthodontist
Singapore
(2 Ratings)
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Dr Sylvia Tan
Orthodontist
Singapore
(2 Ratings)
Answered on Sat Feb 17 2018 06:15:52 GMT+0000 (UTC)

Dear Bladers, if the other half of the decayed tooth is still in the gums it is better to get it extracted.

Permanent teeth can sometimes improve its position on its own providing there are no blockages.

The best thing is to get an xray done to check that there are no blockages (ie extra tooth or root remnants) that is preventing it from coming down in the correct position. 

If there are no blockages, the rotated tooth can be corrected with braces later on. I hope this helps.

Good luck. 

Best wishes; Dr Sylvia Tan 

0 576 views 0 Doctors agree Sat Feb 17 2018 06:15:52 GMT+0000 (UTC)
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Dr Jaclyn Toh
Dentist
Singapore
(7 Ratings)
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Dr Jaclyn Toh
Dentist
Singapore
(7 Ratings)
Answered on Sat Feb 17 2018 07:27:16 GMT+0000 (UTC)

Hi, I would usually not go digging around in the gum for the remnant of the baby tooth unless your child is showing signs of an infection (swollen gum, occasionally pus may drain out of the swelling which is called an abscess). 

This is for 2 reasons:

1) The baby tooth is usually resorbed by the continued root growth of the adult tooth as it erupts through the gum. 

This is something that is practiced in trauma cases where a baby tooth has fractured underneath the gum. Most of the time, the adult tooth eventually erupts normally despite leaving the baby tooth fragment inside. 

This process of eruption of the adult tooth can take about 3 years to complete. 

2) If the baby tooth fragment is completely embedded in the gum, your child will need a minor surgical procedure to remove the fragment and this can cause damage to the cells that are finishing up the development of the adult tooth's root. 

This procedure can also be quite traumatic for the child and we may lose cooperation for future dental treatments. It sounds like your child may have ongoing severe tooth decay and it is important to not lose sight of the bigger picture (getting the tooth decay under control and improving oral hygiene and diet practices in preparation for future orthodontic treatment). 

Whether it is better to leave the fragment alone of have it removed is a decision that should be made only after a proper assessment that includes X-rays, as Dr Sylvia has mentioned. 

Assessment of the adult tooth's alignment can be done on a continued basis at regular hygiene appointments and this is easily corrected with braces when your child is older.  Hope this helps! 

0 562 views 0 Doctors agree Sat Feb 17 2018 07:27:16 GMT+0000 (UTC)
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National Dental Centre
Singapore
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National Dental Centre
Singapore
Answered on Sun Mar 11 2018 13:26:13 GMT+0000 (UTC)

Dear Bladers,

Thank you for sharing your photo.

1) There are multiple reasons that can cause a permanent tooth to grow out into an incorrect position. One reason could be due to an obstruction in the path of eruption, such as a stubborn baby tooth root. As you mentioned, this may be the case for your child, although we are not able to say with certainty until a full examination is done.

2) Permanent teeth can sometimes spontaneously shift into a better position in the mouth.
More commonly, however, some form of orthodontic appliance is required to guide the teeth into a good position.

3) As your daughter has a broken decayed root in her mouth, it is advisable for her to see a dentist for an assessment. If she is attending a local primary school, she can get an appointment with her school dentist or with the School Dental Centre at the Health Promotion Board (https://www.hpb.gov.sg/schools/school-dental-centre).

The School Dental Centre also provides oral healthcare services to pre-school children.

For more information, you can also join us at our 'Smile.Sparkle.Shine' public forum at NDCS on the 24th of March 2018.  http://bit.ly/2DQuCh6

Hope this helps!

0 457 views 0 Doctors agree Sun Mar 11 2018 13:26:13 GMT+0000 (UTC)
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