Any teeth experts? Been referred to paediatric specialist.

[Nightfall1983]

19 month old DS has been referred to a paediatric specialist dentist today by our regular dentist. I know these things take a while so wondered if anyone on here knows much about teeth so give me an idea of a) what the specialist is likely to do to diagnose b) what might be wrong and c) what the treatment/outlook might be.

Am having no luck with Dr. Google. Don't worry, I know that it's just ideas and possibilities over the internet and I won't "do" anything or panic too much until we've actually seen the specialist.

Here is what's wrong:

He is 19 months old and has only got two teeth so far. One came at 14 months and one came at 16 months. No signs of any others coming through, no bumps etc. in his gums.

The two teeth that he has got are the front top teeth, the big flat ones. Except his aren't flat, they are sharp and pointy, fang like. They are not just crooked or coming down at a funny angle, they are too sharp to be 'normal'.

That's it really, at 19 months it's hard to say how else it I s effecting (affecting?) him, his general development seems normal. He has few words but does say a few and isn't off the normal scale for speech I would say. His eating is poor, but that is fairly new , until a couple of months ago he ate a good range though he has always had a small appetite, less so now and eating is a battle but similar things are happening across my antenatal group and it may well be toddler food regression. He often seems to be teething, or at least suffering with his teeth. His hands spend a lot of time in his mouth and he is currently drooling so much he has a rash on his neck from it.

Erm any ideas???

I'm a dentist, I've done peads as a speciality but not for a while.
Essentially, he'll have a really thorough examination & I would expect some X-rays. Until you know where his teeth are you really can't start guessing at potential treatment & an X-Ray is the only way to know.
He may just be at the extreme end of normal & everything's progressing normally but slowly. In which case you watch & wait.
It may be he has some teeth missing. Treatment for that varies hugely depending how many & where. It could be (in his adult teeth) he has braces to shuffle things up, it could be he needs implants (or about a million other things Inbetween). There is currently some NHS funding for children born with missing teeth (the correct term is hypodontia) for implants but that may not be present when he's older. If the specialist mentions it as even a vague possibility I'd suggest starting to put £10 per month (or whatever you can afford) away in a 'just in case fund'.
Don't go too mad on dr google. You really do need to wait & see what's going on under his gums first, as frustrating as that may be.

Wow isisis that is really helpful thank you so much!

I have a couple of questions if you have the time to answer some or all of them (if not then don't worry, thank you for what you've already said):

1. for the examination and x-rays how will they get him to hold still/open his mouth? Brute force? Is sedation likely?

2. in the extremely unlikely event that there are no teeth at all hiding under his gums are implants etc still possible?

3. any ideas what could be up with the two teeth he has got? They don't look like peg teeth from what I've seen, they are very very sharp and curved.

I had never even considered the possibility that whatever is wrong might not be covered by the NHS, gosh what a worry! Will listen to the specialist and see about starting a "teeth" fund. Thanks again!

Right, let's see what I can do. Obviously I'm making educated guesses as I haven't seen him & haven't done community (peads) for about 9 years & am on mat leave & have baby brain

1. I'd expect to want an OPT X-ray. That's one of the ones that you stand up for & it goes all the way around his head. I'd forgotten about his age when I was writing. Depending on his cooperation I might still try it. I wouldn't say that the benefit of knowing outweighs the (tiny) risk of sedation so if it couldn't be done easily I'd probably delay until he was old enough to cooperate. At his age you wouldn't be jumping into treatment anyway so even if it's a year or two before he could manage it wouldn't make any differance overall. I'll be back later, need to do baby's dinner/bath/bed. In case I forget later, expect more extensive questioning eg questions about if you and the father are related in anyway (always hated asking that, could never find a polite way to ask), any medical conditions in the wider family, if anyone else has missing teeth etc. Would be worth finding out before you go if you don't already know.

Sorry, I imagine you might well know if you & the father are related already, that came out wrong.

:) will work on my best shocked and offended face when asked "is your husband also your cousin?"

We're definitely not - at least not in the 5-6 generations we can trace.

I've had a couple of yes before! We also had to ask if you were married to your partner at the time the baby was conceived, if not were they on the birth certificate etc. it's about ascertaining who can give consent, some surprising answers to that too.

Right, where was I? Definitely no to anything being done by brute force. They will want to build a good relationship with your DS, that takes time but that's what they're there for.

2. it would be incredably unlikely to have no teeth at all. It's actually very common to have the odd one missing. Implants are all about the bone to put them in. If he had no teeth at all (very very rare & usually related to other syndromes) he probably would have reduced bone as well. It could be possible to graft (from the hip usually) but another option such as dentures may be more appropriate. If he has no teeth he would prob be referred further to one of the dental teaching hospitals to be treated by a super specialist as these cases are so so rare. If he had a few but not all missing & implants were being considered they're not usually done until 18years+ so other things could be done to keep him going until then.

3. not sure. You've looked at peg shaped teeth? They may (again I'm guessing) be supernumerys. These are 'extra teeth' they can take any kind of weird shape. In fact, that's another possibility. He could have extra 'bits' which are blocking his proper teeth from erupting. Again, would only be confirmed by xray. If that was the case you'd remove them & hope the teeth would errupt.
   I think (again, just my opinion) that there will be further cuts to dentistry budgets in the not so distant future. If you've got the money in the bank then you've got options in the future or a bloody good holiday if it's not needed for teeth
   Hope that's some help. Peads specialists tend to be really really good. It's hard work getting kids to do what you want them to do when they don't want to. You don't go into it unless you really want to. Hope I haven't made you worry more. I suspect you may not get definitive answers straight away & there may be a lot of trips back & forth to come.

That is all really helpful, thank you. It's not all exactly what I WANT to hear but still incredible useful. You've definitely not made me worry more, I'm interested to hear the possibilities and will reserve my worrying till after I've seen the specialist. I do hate the wait and see approach though...

Definitely start a teeth fund.

My DCs were both referred to a (private) paediatric specialist dentist and last year I spent the price of a holiday on their dental care.

They are older than your DC though.

I have now signed them up to a pay-monthly dental scheme!

P.S. Our specialist dentist is bloody fantastic. My DCs love going to see her.

I can't comment on your ds's teeth as I'm not a dentist, however, ds1 sees the paediatric/community dentist and she is fab. When ds first went to her at 3yo he wouldn't even sit in the chair, let alone open his mouth. She spent lots of time building his confidence and now he'll happily sit in the chair and let her 'do' his teeth. He even had a filling (with no anaesthetic!) so drilling, the sucky tube thing, different tastes etc and he didn't bat a bloody eyelid. Sooo proud of him and I wish I had a dentist like her when I was a child and having big dental problems.

Iirc community dentists are salaried, as opposed to nhs/private dentists who get paid per patient (isisis is this right? Or was I misinformed?) so they have more time to spend with the patient.

Good luck to your ds and I hope it's nothing serious

Yes, they are salaried. I see perhaps 25-30 patients a day, they might see 6. They also have special training/experience & the patience of a saint. It's as far opposite to the old 'school dentist' as you can imagine. Glad your DS is doing well with them. Lots of 'intro' appts is the norm to get kids used to them/dentistry. Some parents feel like you're not making progress but it's laying the ground work so you can then make progress. I know one who just does magic tricks for the first treatment appointment.

Ooh thanks for your experiences. Tooth fund plus be prepared for not a lot to happen at first. Check. I will find that frustrating as I'd like to see things being done but I understand that his cooperation is required and so taking it slow and getting to know him is important.

On a side-note I just googled "super-numery teeth". Don't do that.

Got to love google images!

I'm a dentist and have seen this before, the child ( in question) all of a sudden at the age of 26-28 months got all their remaining teeth.
I doubt very much they will xray a 19 month old as it will have little clinical value at present and would impossible to get a credible image without a GA.
Also it would not change the treatment plan at this stage.
IMHO they will have a look reassure you and review you in 6-12 months by which time I'm sure there will be more teeth. hth

Odd question but how is his hair and skin?

On mobile so just quickly:

Louismummy did this child also have the unusually shaped front teeth?

Re hair and skin: he was born a baldy but has slowly slowly grown hair since. Now still has little hair but it's defiantly there, quite thin and quite blond - not white blond, slightly darker. About an inch long ATM.

His skin is fairly pale, probe to eczema but it's under control. He marks easily if he scratches or bumps himself but heals quickly too...

no they didn't

Adding this as a point of interest more than anything: I spoke to the dentist today because she wanted to let me know that as well as referring him to a paediatric specialist she has written to our GP and asked him to assess DS because tooth issues can have a medical (or genetic or chromosomal) cause sometimes. It's unlikely in this case as DS is meeting his developmental milestones with no other significant health issues but worth checking out. All fine with me and I'm just adding this incase it ever helps anyone else :)

Back with an update again in case of anyone searching with similar symptoms in the future:

DS has been diagnosed with a medical condition which affects the growth of teeth, hair, nails and skin. The condition is Ectodermal Displasia and is very rare. So far DS is only really affected by the teeth but that may change in the future. We've seen a specialist dentist locally and have now been referred to Guys Hospital in London for treatment.

I have experience of this, happy to talk if you want to PM?

PM'd :D

I have just read this thread through and was thinking it could be that condition. I have a friend whose sons were diagnosed with this I think - am I right it only occurs in boys? How is your Ds doing?

Donut its is far more common in boys. I'm not an expert (yet) but as I understand it there are different variants with different 'causes' for instance some are spontaneous genetic mutations and some are inherited, I believe that the inherited variant is common and affects boys only.

DS is doing fine thanks, he's not really affected at all at the moment but we are aware that he will require multiple dental operations as he gets older and will potentially have skin-issues.

Ah I see. I think her boys have the inherited version. I seem to remember that she is the carrier, but it would only be passed on to boys and girls would be carriers too.