My child has lost a baby tooth early. Is this a problem? Joint podcast with pediatric dentist Dr Tay.

December 9th, 2019 Andrew Chang

In keeping with the theme of space maintainers and our recent space maintainers blog on this, below is a written transcript of a recent podcast for parents of children with crowded teeth, where me and Dr Tay talk about how one may check if a baby tooth has been lost early, what to do and common questions that parents ask us.

Andrew Chang: (00:09)
How are you doing Diane? I’m very good, thanks. Good to have a chat to you again. Well, I’m really honored and appreciate you taking the time out to come to speak to our audience today. What I would like to cover today, I mean it’s really around the a child losing a baby tooth, that that’s the topic we’ll cover. I think at our last podcast we covered, what are the signs of crowding with baby teeth. So perhaps then maybe let’s start off with what is meant by when does a baby tooth get lost early? What do we mean by early? Can you let the audience know and then later we talk about some causes?

Diane Tay:(01:06)
No, it’s actually really one of the things they say and you know, and expect from experience, when we mean by baby teeth falling out, exfoliating or being lost early, or a baby tooth comes out before the time it’s supposed to come out. So you know, as parents and being a parent ourselves, we go online and you check and look what time or what age and stage your child should be losing teeth. And for instance, most people think, Oh baby teeth will fall out, by six or seven years old. But some of the back of baby teeth often times fall out, more than likely they usually fall between the ages of 10 to 12 sometimes up to 13 years old, however, more often than not, a lot of children present to dentists with a baby tooth already fallen out or requiring a baby tooth out, most commonly because either the tooth has a really bad cavity or decayed and the tooth has a abscess.

Diane Tay: (02:09)
And so the tooth has to be extracted or removed and hence it’s lost earlier than it’s meant to be. Other reasons or causes are because if the adult teeth or tooth is not sitting in the right position, it starts to dissolve away a baby tooth. I mean there’s a lot of variety of other reasons and causes as well, but these are some of the most common reasons, you know, that they can be lost and we know that baby teeth are, while most people think that, they are just baby teeth & it doesn’t matter, just take them out, remove them. The baby teeth are actually really important other than all the other things it does like help a child, speak and things like that.

Diane Tay: (02:56)
But more importantly, I always tell parents that it acts as a something to hold the space while the adult tooth is growing and developing. So that’s one of the really important functions of, you know, and why baby teeth are important and losing them early can cause a lot of issues or implications. And I’m sure Andrew, in your experience, usually when we, as pediatric dentists have to remove or extract a baby tooth and if lost early, often times we then refer on to an orthodontist to help us with these adult teeth. I mean, in your experience Andrew, if you could just share with us what happens at times when a baby tooth is lost early.

Andrew Chang: (03:44)
Diane, I’m a parent & I have three kids myself. And, if you ever wonder as a parent yourself out there and listen to these podcasts, whether a baby tooth is lost early, you would often find that, we have a similar amount of baby teeth on the left side versus the right side. And if you observe the baby tooth & there are lots on one side and the other side its much fewer, then they may be a reasonable chance that it may be lost early because baby teeth fall out within a few months of each side. In terms of the causes, one category could be your child would have some pain or he may say there is a pimple around the gums, in which case, the baby tooth would get loose and may fall out or he or she may see the dentist to have that removed.

Andrew Chang: (05:06)
And another one, which is a bit more, I would say a bit more sinister that parents would really need to look out for is one, when there’s no pain and that’s where the adjacent back adult molar just burrows into the baby tooth, and that is a slow yet progressive thing. And one day the baby tooth on one side just falls off. The child is not in any pain and the big tooth behind has burrowed into the baby tooth in front. And of course the parent would have no idea that there’s a lot of crowding there until they have an X- Ray taken. So when when kids come in, either referred from the dentist or they come in for an initial visit ,and I discussed that and I show them the crowding present, they become almost shocked in a sense that something really needs to be done because the baby tooth has moved far enough forwards that the adult teeth doesn’t have enough room or a lack of space for the big tooth to erupt.

Andrew Chang: (06:33)
I mean this is a kind of a segue into where, well, if they are not coming up properly, what are the problems with this? So Diane, perhaps you may want to cover some of that.

Diane Tay: (06:48)
you’ve definitely raised really good points Andrew. those are very common scenarios actually that do present in practice and with the implications as you were saying. And often times we see when for instance, as you have said, we have to remove a tooth because of an abscess or an infection. So the teeth on either side of the tooth that we are removing, they can start to move together and that can actually block the space of the adult teeth underneath. So the baby tooth is actually holding the space for the adult tooth to come through. But because it’s removed now, the neighboring teeth inch into the open space. So when that happens, and it can happen very quickly and very fast as well, is that the adult teeth have no longer space to come through and it might come through crooked or it might come through the in a wrong position.

Diane Tay: (07:48)
Sometimes we may need to actually extract or remove the adult tooth because it has absolutely no space to come through. Or we then end up needing to do exposure surgeries With braces to help bring the adult tooth into the space. And often Times it is together with working with an orthodontist to do so. So we really try, if possible, you know, to keep the space or try to avoid this happening so that your child does not require such complicated treatment down the track. And that comes in a varieties of ways. So sometimes when we remove a baby tooth, particularly the back ones to prevent the neighboring teeth from moving, there are special little appliances, things we call space maintainers. among parents, as I understand, they call them spacers.

Diane Tay: (08:46)
So there are different kinds of designs and varieties that you know, you need to chat to your dentists and orthodontists about, but they help to try and keep or prevent the neighboring teeth from moving into the space. And so, yes, it is a case by case basis, but this is where, again, oftentimes for myself because it’s so important for us to achieve the best outcome for your child and ensure that down the track their bites or their teeth come through in a nice position. Often times I would work together with an orthodontist in cases like that. So referring them on to the orthodontist once I have taken care of the pain, the cavity and remove the source of infection.

Andrew Chang: (09:41)
coming back to your comment, As orthodontists, we see the late effects where Ab adult tooth has got no room to come through. And for parents out there, it is more painful and traumatic if this requires removal. If the adult tooth is embedded in the gum, there are more costs, either in the cost of having that tooth removed or in terms of more complex orthodontic treatment to reopen that space. and not to mention the additional treatment time, to visit orthodontists for the adjustments or to see a surgeon to expose the adult tooth. The idea behind a space maintainer, which is quite a comfortable appliance or spacer is very sensible.

Andrew Chang: (10:52)
A space maintainer is custom made to fit their mouth. the idea behind this is it is really a relatively simple procedure that parents can invest for their child to minimize these sort of issues later on or avoid these issues. so the questions that parents ask me is, one, does it hurt? A short answer is no, and even more better still because with the development of what we call scanners, and 3D printing, what We used to do for younger kids is where they have a mould taken of their teeth, where the doctor mixes up some Gooey material and places a tray in their mouth for a minute. Kids with a strong gag reflex can find this uncomfortable. This is now a much more comfortable procedure for kids where a scanner is used, which is like a pen shape that shines light onto the teeth and produces a three dimensional model of the teeth from which the space maintainer appliance is made.

Andrew Chang: (12:02)
So the next question parents ask is does it affect speech or eating or cleaning? I recommend a minimum coverage appliance Design for ease of cleaning and there’s all different types of designs. so I mean, in its simplest variations, it doesn’t affect the speech. of course with eating, whenever you have anything inside your mouth it is still advisable to avoid biting on ice or playing with spoons on the appliance cause that can cause it to break. It Is relatively easy to maintain. So my experience of kids who’ve got spacers, they all pretty much say it’s a very comfortable appliance and Diane, is there anything else you want to comment about that?

Diane Tay: (13:02)
No, I mean I think you’ve covered it really well, to parents, & anyone out there who may be listening and their child may be in the process or about to proceed with having a space maintainer. So that’s really good information. And you’re right, it is a relatively straightforward procedure. And I would say from experience and looking at the children with them, that kids tolerate them very well. In fact, lots of kids love to show them off to their friends, so Acceptability in kids is really quite good and they seem to maintain it very well.

Andrew Chang: (13:48)
last question, parents often asked how long should a spacer or space maintainer stay in for?

Diane Tay: (13:58)
So in my experience, I would say to parents that it does vary case by case, but of course generally once the adult teeth start to come through, we remove the space maintainer and most parents ask me, is it really simple to remove? And the answer is yes, it is a straightforward thing to remove in your child. And children tolerate that really well in the chair.

Andrew Chang: (14:46)
Yes. It doesn’t hurt to have that removed and its quite straight forward. So once again, Diane, thank you again for taking the time and I think, I’m sure our audience today, parents of many kids out there, have found this valuable. So once again, thank you.

Diane Tay: (15:06)
Really always good to chat to you Andrew and we’ll come up with more topics as well down the track.

Andrew Chang: (15:12)
Thank you and have a good night. Once again, if you have any questions or there’s any topic you’d like to hear more of, jump onto our website at or email us at [email protected] or visit our Facebook page, smiles and faces. If you like this podcast, please share this with your friends on Facebook or social media or give us a review on iTunes. We really grateful for your tuning in. My name is Andrew and Look forward to next time.