Three year old hypodontia (missing teeth)

[Waitwait]

My three year old is missing her milk incisors and the adult ones under that. Her front teeth protrude hugely. Her speech is very delayed, and she find it difficult to pronounce words, and with no signs of autism or any other delay, I wonder whether it's related to the teeth problem.

Our dentist says there is nothing to be done. Does anyone have any experience of this, and can anyone recommend a paediatric orthodontist who could help - somewhere in the south east/London ideally.

Thank you!

I’m afraid your dentist is right , fitting anything to replace those teeth would be very problematic, especially as their jaws are growing so much at this age .

It would require a denture at this age and dentures are a nightmare to wear and would, very likely , make speech worse, even if you could make one on a three year old and persuade them to wear it.

You cannot perform orthodontics in baby teeth as the roots are too short and movement will encourage early loss . Any orthodontics in future will be with the aim to open up spaces to replace the missing teeth.

The gold standard will be implants but that will not be until they are in their twenties and not on the NHS (unless they are missing more than 6 adult teeth and even then not guaranteed ). so start saving now . When they are older , depending on the spaces they may have a denture or a bonded bridge, depending on which teeth are missing.

Has your child had a referral for speech therapy yet?

Thank you, this is helpful. She’s having private speech and language therapy and her speech is developing (I have no idea if it’s as a result o the SLT or if it would naturally do this anyway).

I just feel so sad that there is nothing more that can be done for my little girl!

My friends child has severe hypodontia and is missing about 15 adult teeth. Bridge work/ crowns will need to wait until the child reaches 18 and stops growing. Whereas the mum was able to get dental work on the NHS, her child will need private treatment due to the cost and lack of NHS availability.

My daughter had one incisor milk and adult tooth missing. The teeth closed together so the gap no longer looks like a full tooth. At 16 she is now about to have braces via orthodontics at an NHS hospital to make the gap big enough to fit an implant.

Oh I’m not holding out for NHS dentistry - I wouldn’t ever trust the NHS with my family’s teeth I’m afraid. But I’m surprised there isn’t a private option and I do wonder what would be done in America in this situation.

They would make a flipper (denture) by strapping the child down to a papoose board and sedating them. It would need replacing on a very regular basis and in all likelyhood would not be worn by a three year old.

The flipper would not help speech , it is just for looks and in all likelyhood would make speech worse.

Papoose boards are barbaric and not allowed in the U.K. and EU. The child is , literally, strapped to a board so they cannot move.

I'm not a dentist, but I had a pupil with dental problems. He had a brace at secondary school and was given implants on the NHS when he was a senior pupil. (I recall that some of his adult teeth were growing high up in his gums and had to be removed. He looked like he had a touble row of teeth in places, if that makes sense.)

I do agree that mostly people are told to wait until they're in their 20s. At one point, I was possibly going to have surgery on my jaw and was told that it had to wait until I was in my 20s and had finished growing.

I guess that my pupil was an exception.

You may find they are the same people. I think many orthodontists work across both NHS and private practice.

The criteria is , for most places, to have at least 6 adult teeth naturally missing. However it is still not guaranteed implants will be funded.

To put this into context in my area the restorative budget which covers cases like this, trauma, oral cancer etc has the budget to restore two oral cancer patients a year . These are people who have had substantial parts of their face and jaws removed .

You might be better in a big city where there are bigger budgets but as the NHS is increasingly financially stretched difficult funding decisions have to be made . I have not had a patient have NHS implants since around the 1990s.

DD18 is missing 8 adult teeth. At 16 she has a fixed brace on the NHS after Abby lost baby teeth had either come out or were removed.

She is fine now, the brace has closed the gaps so you can’t really tell but if you look you can see she has no canines just incisors in their place (or vice versa).

She still has some baby teeth that were more firmly rooted but if /when they come out she may consider a denture or implant.

i have EDS so also have dodgy teeth, and her younger brother had 4 extra teeth !

She also had to have 5 baby teeth removed due to decay despite good diet etc

We must be unusual in our area as my DD 16 is having braces fitted this summer to create correct spacing to implant 1 missing incisor. Referred by our dentist to NHS orthodontics dept in hospital.

Thanks - yes, you’re right. Until recently we only had dentistry in my partner’s home country as experience here in both NHS and private was just vastly inferior (I’m British, grown up here so have nothing against the NHS - it’s just that dentistry here seems to have suffered across the board from different standards to elsewhere in the world - and that only becomes evident when you see what’s on offer jn other countries). But now the children are all at school, it’s harder to take them out to travel. We have a perfectly acceptable private dentist who does some NHS work too I think and is fine for all the standard stuff. I just wondered whether the “nothing to be done” was resignation or reality. It sounds like the latter! Thank you!

This is all really helpful everyone - both the positive and less positive experiences/insight. It is a whole new world for us so I’m grateful to know I shouldn’t be pushing our dentist to do more!

I can't remember precisely when my pupil had his done. Would have been some time after 2010, I think.

This is only a small region but - though I hesitate to say this - the budget was possibly available because so many parents here still opt for false teeth for their children, rather than proper care and/or restoration.

I've seen a 12 yr old who had every single tooth pulled and false teeth fitted. His own teeth were visibly ridden with decay - he had holes in his front teeth. His parents had never taken him to a dentist.

To this day, I don't understand why the parents weren't charged with neglect.

Orthodontics would always be funded . Most places the implants will not , especially when it’s only one implant.

As implants are normally not placed until person is in their 20s , because of jaw growth, after orthodontics most are given bonded bridges as a temporary solution.

If I were you I would start saving for the implant because even though it might be part of the NHS treatment plan , in 5 years time or so funding may well be a very different thing.

Very difficult to charge with neglect when tooth decay is the number one reason for young children to have a hospital stay .

In my area over 50% of five year olds already have decay . Nationally it’s around one in three 5 year olds have decay .

It does get reported when parents repeatedly cancel and miss children’s appointments , particularly when they are in pain.

However as a country our children and adults eat and drink too much sugar , 2 to 3 times the recommended daily amount but we are unwilling to make those changes to diet that are necessary for good oral and general health.

My 17 year old daughter has 9 adult teeth missing. She has been under the orthodontist/ maxillofacial department at our city hospital since she was 13 and has had fixed braces since 14 which are making spaces for her to have implants once she is 18, all on the NHS thank goodness.

My 13yo daughter has 21 adult teeth missing (!!) and is under NHS care. She currently has a fixed brace to move stuff around to make room for some false teeth until she's old enough to make the decision about implants. One piece of advice the consultant did give us was to try and keep the intervention to a minimum in the early years of treatment because children do get "dentistry fatigue."

Thank you everyone so much - this is all so useful. I love mumsnet for bringing all this experience, both personal and professional, together so helpfully!

My son is missing about a dozen adult teeth, and the ones he has are very slow to move. He’s had…maybe 8 baby teeth taken out to make room for the adult teeth to move down into position, and wore a retainer from ages 8-10 to help with that.

Were waiting now for all his adult teeth to be present and then he’ll likely get a full brace (he’s 12 so in the next few years probably).

Surprised at so many saying there’s nothing to be done - certainly not aged 3 I don’t think but as she ages I would have thought it could be managed similarly.