Discoloured teeth, crooked teeth and more - An expert's opinion on kids' dental problems

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Dr. Terry Teo of The Dental Studio is back answering all your questions related to kids' dental problems. In this article, he focuses on queries related to cosmetic issues...

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Cultivating good dental hygiene habits from a young age is crucial to your child’s overall health.

When it comes kids’ dental health problems, it’s always good to get the advice of a qualified dental health professional such as Dr. Terry Teo of The Dental Studio.

You might have already been introduced to Dr. Teo in a previous article published on theAsianparent.com. But if you’ve missed reading it, he is a specialist paediatric dentist with years of experience handling a wide range of kids’ dental issues. His interest lies specifically in the field of paediatric behaviour management.

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Dr. Teo provides his expert opinion on your kids’ dental problems.

In an earlier article, Dr. Teo answered your questions on Early Childhood Caries (ECC) and your children’s dental hygiene routines. In this article, he answers the questions you, our readers, sent in related primarily to kids’ cosmetic dental issues.

Please note that the following information has been edited for brevity and clarity.

Q: My five-year-old child has a front tooth that is slightly off-white. From certain angles, it looks slightly green. I have brought him twice to a dentist for polishing but it’s not going off. Could it therefore be internal discolouration? How do I go about clearing it up?

A: If it is only one tooth that is slightly discoloured, then you are probably right in that the discolouration is internal. The likely cause is trauma to the tooth as a result of a knock or fall that may have occurred when your child was much younger, resulting in damage or death of the nerve inside it.

Sometimes, this happens even without the knowledge of the parents, especially in kids who are very active and “accident-prone.” Only a dental evaluation will confirm this diagnosis, and the treatment options depend on what signs and symptoms your child has experienced. It is possible that no treatment is required at all  if there is no sign of infection and you can live with the discolouration until the tooth drops out when older.

What do you do when your child’s tooth has a stain that brushing won’t remove? Find out on the next page. 

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Kids’ dental problems: What can you do when brushing won’t remove stains on your child’s teeth?

Q: My son has a yellowish-brown stain on his front tooth and choppy white enamel. It can’t be removed even with brushing. Can the stain be removed?

A: I assume that this stain is on your son’s permanent tooth, and that he is around eight to 10 years of age. What you are describing sounds like a condition called Enamel Hypoplasia, and there are a variety of factors that could have caused it such as childhood illness or past dental trauma.

Because this occurred during the development of the tooth while still in the gums, it cannot be removed by your own means. Usually, treatment at this age is conservative and temporary to mask the stain until your son is an adult, whereby more permanent options such as a porcelain veneer can be performed.

By then, your son will be able to decide for himself if the appearance of his tooth bothers him, and whether the benefits of such treatment outweigh the cost.

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Still no adult tooth after two years… should you be worried? Dr. Teo has the answer.

Q: My son lost one of his front teeth while in primary 1. Now he is in primary 3 but the tooth still hasn’t grown out.  The school dentist told us to wait until the end of the year. Should we show him to another dentist before this? 

At primary 3, your son is around nine years old. If one of his front teeth is not yet erupted, it is already two years overdue, and requires urgent x-ray investigation. In about three percent of the population, a buried extra tooth called a supernumerary is present which impedes the eruption of the permanent tooth.

If such an extra tooth is detected in his gum, this obstruction may need to be removed before his proper front tooth can erupt at all, and such treatment is beyond the scope of the school dental nurse.

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Should you let your child’s wobbly tooth fall out on its own?

Q: If a baby tooth is loose and shaking slightly, should I visit a dentist to pull it out or just wait for it to fall naturally? Will it affect the growth of the adult tooth if we delay pulling it out? My child prefers to let it fall by itself. 

A: I agree fully with your child, and would prefer for the tooth to drop out itself too. Why subject your child to an extraction when nature can take its course? Most of the time this happens eventually (even if the wait is long), especially if the tooth is already shaking.

Only rarely do I extract baby teeth that refuse to loosen, because the adult teeth are already growing right up behind them in the gums. This is most common in the lower front incisors. In these cases, once the baby teeth are removed, the adult ones naturally shift forward to take their place with no lasting harm.

How do you manage your child’s crooked teeth? Find out on the next page. 

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Kids’ dental problems: Can crooked teeth be fixed?

Q: My seven-year-old son had two falls while he was about two years old. His lips were badly hurt so we presume his two front teeth were damaged too. One of the front teeth pushed its way out and the baby tooth dropped.

But, the new upper adult tooth seems to be protruding out instead of growing straight down. If we leave the tooth as it is, will it eventually straighten out as my son grows, or will he need braces to help straighten the tooth? 

A: It is very likely that the crooked tooth was a result of the fall when he was young. The damage to the baby tooth was probably transferred to the underlying adult one as it was still developing in his gums, causing it to grow out at a different angle.

If crooked front teeth are detected between the ages of seven and nine, early treatment is sometimes possible to correct them and prevent the problem from becoming worse down the road.

Depending on the angle and number of teeth affected, such early correction can possibly be achieved in as little as six months by your son wearing a removable plastic plate in his mouth to shift the position of the teeth. This is called interceptive orthodontics, and often does not involve the wearing of braces.

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Getting your child’s teeth straightened while he is still young can improve his self-esteem as he grows older.

Q: My son is eleven years old and has crooked teeth. The orthodontist recommended  removing four good teeth to make space for braces at 13 years old.

As he is still growing, is there any chance that his jaws will widen and his teeth will grow better, so that he can avoid putting on braces? My son is small built and skinny. He has also had Alopecia since four years old but seems to be recovering. 

A: It sounds like you are very concerned for your son, and do not want him to undergo procedures which may cause him unnecessary distress. This is especially so if the teeth to be extracted are in good condition. However if his orthodontist recommends extraction of four teeth, that means that his crowding is quite severe and it is unlikely that his jaws can grow to compensate for this.

I empathize that due to his condition he may be affected by low self-esteem. The question to ask yourself is this: do you think that by having crooked teeth, he will be even more affected by the way he smiles when he grows up? There are ways for extractions to be performed painlessly, and the benefits of a nice straight smile last for life.

Q: What is the difference between a paediatric dentist and a general family dentist? Lots of dentists treat children and some say they have a special interest in treating children.

A: Lots of general dentists treat children as part of family dental care, and are wonderful at handling kids.
However, a Paediatric Dentist is one who devotes their entire practice to treating children from birth to adolescence, much like medical paediatricians do. Thus, they generally do not treat adults.

Paediatric dentists are recognised as specialists in their field. They go through up to three years of additional training after their basic dental degree to attain the knowledge, skills and expertise needed to master all the complexities of children’s dentistry.

This results in an additional qualification, usually a Master’s degree, which is reflected after the dentist’s basic dental qualification (usually a Bachelor of Dental Surgery).

theAsianparent would like to thank Dr. Teo for his informative answers to our readers’ questions.

What are you mostly concerned about when it comes to your child’s teeth? Let us know by leaving a comment below.  

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