Child new adult teeth knocked out

[user1473960648]

Hi
On the last day of the summer holiday my son fell off his scooter and knocked out his two front ADULT teeth! After feeling very upset about the accident he and I have recovered from the shock and need to think about the future.

The dentist has given us a few options.

Dental bridge and when his jaw is fully developed (17-21) implants
or - one which I have never hear of...
Wait for his next teeth (ones either side of the front two) to come through and put a brace on to move them to the front. This is the treatment the dentist seems keen on but sounds very strange.

Was wondering if anyone has had the same experience and how you resolved the problem.

Thank you

Sorry to hear about your son's accident. I'm afraid I don't have any advice, but would be interested to hear the replies you get. My daughter broke both her front teeth in half a few years ago. They have been built up and look fine, but we might be looking at other options later on. I had wondered about implants and also hadn't heard of bringing other teeth in to front teeth place. Interesting.

I would imagine that moving the next two teeth in will cause all sorts of issues with his bite? The rest of the teeth won't sit together properly top and bottom? It's not an expert opinion just based on anecdotal information from friends who had teeth removed due to overcrowding prior to braces.

You'd be amazed about how far teeth can move when using a brace. I would seriously consider what the dentist suggests because the teeth will have proper strong roots.

I think, in your position, I'd opt for the real teeth being moved.

How old is he ? I'm guessing about 6 or 7.
Are the next teeth along showing in the mouth at all yet ?
If not they are likely to drift towards the midline anyway as they erupt.
Is there family history of teeth being crowded?

I'm a dentist with a specialist interest in traumatic injuries.

Was there any attempt to reimposition the teeth ?

Reimposition??

REIMPLANT

Thank you for all your responses. My son is 6 so quite early to have had his adult teeth. No attempt to put the teeth back in for a few reasons - mainly I couldn't find them, in the middle of nowhere with one injured child and a distressed toddler ....

The next teeth along are due to appear soon as seen on x-ray. The gap for the 2 front and 2 side teeth is massive. Bridge and implants seems to make sense to me in that he will have perfect shape, bite, size teeth as opposed to brace moving teeth to the centre and then more work being done to improve their appearance.

Intend on meeting orthodontist and someone who specializes in implants as I have lots of questions to be answered before we make a decision.

Any idea how many years the brace takes to move all the teeth and follow up work? Ever heard of this being done before? Don't want my child to be a guinea pig.

Don't want him to go through the brace treatment to end up just looking ok when they could be bridged and implants when he is grown up and ends up with a great smile.

Such a big decision. After lots of upset and mothers guilt I am realising things will be fine and thankfully he is still my bright, happy, beautiful boy.

I have a bit of overcrowding at the bottom but nothing was done about it as a child.

From a purely aesthetic point of view, I would think that to move the two lateral incisors (I had to Google the names btw, I'm not a dentist) in place of the two central incisors might look odd. They'll be smaller in size, obviously, but then followed by the canines on either side... I can't help but the missing teeth would be quite noticeable.

If you opted for implants in adulthood, though, what could be done in the meantime?

Bridge which would be changed as he grows (NHS). When his growth slows we will go private as the quality is much better and he will keep it for longer. He will then be old enough and more understanding about having implants or can continue with a bridge.

If you went for the orthodontic option the lateral incisors would have porcelain added to make them look like central incisors.

Something to consider is the pain. I had braces when I was about 11, including work to pull an impacted incisor down and some very minor straightening work - every time I had my braces adjusted I was in a lot of pain and couldn't eat anything solid for a few days, and that went on for a year. I imagine that bringing those two teeth into the centre would be excruciating.

I'd go for moving the front teeth via a brace. They will reshape and veneer or crown all the front teeth to make them look cosmetically correct but most importantly he'll have live teeth with roots at the front. My son did something similar (not quite the same) that has left us with only the bridge and implant route. We've been told bridges cause problems with the surrounding teeth - they are likely to loosen and may then come out as it would have to be in from such a young age. Implants are notoriously fickle and may not work.
I've got the full quota of mother guilt too but honestly it's just bad luck! 1000 kids could have done the same thing and 999 would have got away with a split lip :(

Not quite the same situation but my DD has a missing lateral incisor on one side and a peg one one the other. She also had to have a canine hauled into place as it was originally up beside her nose.

One option we were given was to remove the baby lateral incisor and the peg one and then haul the canines and the ones behind round to close the gap. Then a load of reshaping would have to be done to make the canines look like laterals and the ones behind look like canines. We were also told that work would then also need to be done on the lower set to get the bite correct.

We didn't go with that for various reasons. One being that DD is a woodwind player and we were advised to try and avoid a brace on the lower teeth. So, for now, the impacted canine has been brought into place and she wears a retainer at night. The laterals are compromised but we are nursing them along. Dentist and orthodontist advised keeping the canines in their rightful place to keep the shape of the face. If the laterals come out sooner rather than later she will have a bridge. Implants when she is an adult.

I hope the treatment goes well for your son.

I should add that, compared to your situation, DD is already 15 and hasn't grown much for the last year. So we are unlikely to need a bridge for as long as your situation.

One thing we did do was get a second and a third opinion. First was from an orthodontist in a private/NHS practice, where we used to live. He referred DD to the hospital NHS ortho who wanted to remove teeth and haul the others around. Then we moved and went to another private practice where the treatment was done although under NHS funding.

I'd be asking for a referral to a Dental Hospital - they will have consultants specialising in paediatric Dentisty, orthodontics, restorative and implantology - that would cover all your options.

Thanks again for all the advice. So good to get lots of opinions even though it is making my list of questions for the next appointment very long!

Good to hear from someone who has heard of the brace option. I know its only teeth but I feel like we are having to make such a big decision about our sons future dental health, appearance, pain he might have to go through (again!) and emotional aspect (brace. Already been called names at school even though most kids are loosing their front teeth).

I will look into getting a few more opinions - could do with having a dentist friend for an unbiased opinion!

Effic - Does the bridge look realistic? What age can your son have implants? Does he have to wear a mouth guard for sport?

Trufflethewuffle- Were you told how long the brace would be on for?

Katz - I will speak to the dentist to see if they can refer me to the hospital.

I'd go with the Orthodontist and brace suggestion as it will be least work in the future for him apart from wearing a night time retainer.

My son's adult bottom front tooth snapped and the Orthodontist pulled it up from the gum and then filed the tooth . You'd never know it had only been half a tooth. I've been amazed at what they can do wrt moving teeth so that would be my first option.

Bridges last about ten years and are very expensive if not on the nhs ,I would avoid that if at all possible as we might not have nhs dentists in the near future.

Hi
Sorry I didn't explain myself very well - not the same situation as your son as mine didn't knock his front teeth out - he snapped them off at the gum line and damaged the roots so they died. We were given the option that they were removed and he had a bridge or that we risked root canals and then crowns but knowing that they are unlikely to last till he's an adult. I was going to go for the bridge option but then we were told that there was a high risk that the bridge would eventually loosen the teeth it was anchored too and then the large gap & resultant jaw bone loss etc would threaten the success of the implants he could have as an adult. So he's had root canals and crowns and we have everything crossed that they will last till he's 20 which is when he can have implants apparently. However the jaw bone loss from having 'dead teeth' apparently means it's less likely to succeed. It's a nightmare! He does play contact sports - I pay for the pro level gumshields (£60+ sigh) although I have recently found out they are more to stop concussion than to protect teeth!! Grr.....
just my opinion but it seems to me that front teeth with roots are the most likely long term successful thing rather than risking bridges & implants etc that may not work? Just my opinion though - not an expert at all!!

Sorry, no I don't know how long the brace would be on for if you go for the moving teeth around option. As we were going for the option to "keep everything where it is and haul the canine into its designated slot". That option took 18 months of braces on the top set.

But situation not comparable as in my DD's case all her adult teeth were through and just one tooth was being positioned.

I should imagine that it would be more complex given that your DS is so young and there are going to be a lot more adult teeth coming through. You certainly are going to have a lot of questions to ask.

One thing that seemed to come across to us as we saw three different sets of people was that sometimes the answer seemed to be what would be quickest and most straightforward for the NHS rather than what would be the best long term for our child. We are extremely lucky that we could access this treatment for our child on the NHS but we also had to weigh up a specific need because of possible career choices for her as a musician.

So we chose not to move teeth around but, as I said in my previous post, we are unlikely to be looking at long term (if at all) use of a bridge if we can look after the compromised laterals long enough. We, as her parents, will be the ones coughing up for the implants when required though!

Orthodontics should not be particularly painful

Ds said after the first time they were fitted they were fine- achey but not agony and he took pain killers when they were tightened .