A very common question is “What is the best age to bring my child for their first dental visit?” The American Academy of Pediatric Dentistry recommends at the appearance of the first baby tooth. Although parents are welcome to bring their children in at that time, in the absence of any obvious decay, we usually start seeing children around their third birthday. Most children are able to sit in the dental chair and get their teeth cleaned and checked at that age. For those who are too fearful, we do a “knee to knee” exam. A parent holds the child in their lap facing them. The parent has the child’s legs straddling their lap, and holds on to their hands. The seated parent faces the seated dentist “knee to knee” and lowers the child so that their head in in the dentist’s lap. Since the child is facing the parent, they remain calmer and are safe from sharp objects since the parent is holding their hands. This way, the dentist can safely examine the child’s mouth, the child does not get out of what they thought would be an unpleasant situation by acting out, and still feels comfortable by being with the parent.
Another common situation where a permanent tooth is not in its normal path of eruption is when the first molars (six year molars) are attempting to come in too far forward thus resorbing the roots of the baby tooth that is ahead of it. If this situation is allowed to continue, then it will cause the baby tooth to be lost prematurely. The offending permanent molar will then erupt too far forward, thus leaving no room for the bicuspid to erupt later. I have found that by pushing the molar back before the baby tooth is lost, then the baby tooth can be retained until its normal time to come out. The procedure is call distalization. I connect orthodontic bands on a couple of molar teeth and connect them to a spring. I then bond a hook on the chewing surface of the offending tooth and engage the spring. This pushes the tooth back into its normal position. I remove the spring and allow the tooth to erupt normally. The process takes from two to four months.
Ectopic eruption is where a permanent tooth is in an eruptive path that is out of line with the norm. The most common example is that of wisdom teeth. Since there is not very much room for them to come in normally, it is extremely common for the wisdom teeth to be directed in all sorts of directions. The usual corrective procedure for that is removal of the wisdom teeth. A common occurrence of ectopic eruption is when the permanent lower incisors erupt too far on the tongue side. It kind of looks like shark teeth with them in two little rows. I have had many a frantic patient rush their child into my office to show me that problem. I have found that if the baby teeth are extremely mobile, they can be allowed to come out naturally. However, if not, I recommend extracting the offending baby tooth or teeth. By doing that at the proper time, the tongue will push the permanent teeth forward into their natural place without the need for expensive orthodontic treatment.