Pieter Schoeman

Dear madam,

Thank you for your question.

Enamel loss is unfortunately inevitable, especially as one gets older. This process increases from middle age onwards. Due to cyclic fatigue of teeth (the chewing process throughout your life), abrasion (due to excessive tooth brushing), attrition (due to bruxing), erosion (due to acid reflux, acidic foods, or bulimia) enamel is lost. Defective enamel due to congenital or hereditary reasons, can also accelerate enamel loss. The best a dentist can currently do is placing porcelain/ceramic veneers or crowns or a cheaper alternative resin restorations. It depends on the severity, extent and what you are willing to spend on your teeth. Unfortunately, dental insurance is not always willing to pay for it, depending on your plan, since they sometimes see it as cosmetic and not as essential. It is best to get a quote from your local dentist and discuss payment options with him/her.
I sincerely hope this helps.

Dear parent,

Thank you for your question!

I do not want to alarm you, but in my professional opinion I think you should consult with your local dentist asap. Please see the following website to guide you:

*www.colgate.com/en-us/oral-health/life-stages/childrens-oral-care/kids-with-no-teeth-what-causes-delays-in-tooth-eruption-1015
<http://www.colgate.com/en-us/oral-health/life-stages/childrens-oral-care/kids-with-no-teeth-what-causes-delays-in-tooth-eruption-1015>*

I hope this answers your question.

Regards,

*When Do Teeth Usually Appear?*

Babies are born with most of their teeth already formed within their gums, and they usually begin to appear by the age of six months <https://www.colgate.com/en-us/oral-health/life-stages/childrens-oral-care/your-childs-mouth>. The two lower front teeth emerge first, followed by the four upper front teeth, then the remaining two lower front teeth. The rest generally arrive two at a time – one on each side of the mouth – and by the age of three, nearly all children have a complete set of 20 primary teeth.

*When Is a Delay Considered Abnormal?*

Kids with no teeth by the age of 18 months should be taken to see a dentist, according to the American Academy of Pediatrics (AAP <https://www2.aap.org/oralhealth/docs/OralHealthFCpagesF2_2_1.pdf>. Four to 15 months of age is the normal range for the appearance of the first tooth, and the other teeth usually follow in a regular schedule. Most children have four teeth by the time they are 11 months old, eight teeth at 15 months, 12 teeth at 19 months, 16 teeth at 23 months and 20 teeth at 27 months. Permanent teeth begin to appear around six years of age. Teeth that do not follow this normal eruption pattern aren't necessarily a concern, but no teeth at all can indicate more advanced problems in a few cases.

*What Causes It?*

A number of things may be to blame when a child's tooth eruption falls outside the normal schedule. Sometimes, late tooth eruption is simply a family trait. Preemie and low-birthweight babies may also experience delayed tooth eruption, and the teeth can have enamel defects that come with it. Research cited in the American Journal of Orthodontics and
Dentofacial Orthopedics <http://courses.washington.edu/gradorth/Ortho%20565%20Spring%20Theory/Suir%20AJODO_2004.pdf> suggests some rare genetic abnormalities that cause poorly formed teeth and late tooth appearance as well, such as amelogenesis imperfecta and regional odontodysplasia. Nutritional deficiency and vitamin D-resistant rickets can also cause a delay, though it may be a symptom of Down's Syndrome, hypopituitarism or a similar developmental defect.

*Is Delayed Tooth Eruption Harmful?*

Delayed tooth eruption that is not part of a broader problem isn't a serious concern, but it may create a higher risk of dental problems <https://www.colgate.com/en-us/oral-health/life-stages/childrens-oral-care/ada-03-late-baby-teeth-may-mean-more-visits-to-the-dentist> later in life. In fact, a study of children who were genetically predisposed to late tooth eruption found their chances of needing orthodontic treatment by 30 years old was 35 percent higher. In addition, keep in mind primary teeth play an important role in helping kids eat well, and are a guide for permanent teeth to serve the same purpose. When these teeth finally appear, they require regular cleaning with a toothpaste for infants and a soft-bristled brush such as Colgate® My First® Toothbrush <http://www.colgate.com/en/us/kids/products/detail/colgate-my-first-toothbrushes> to prevent early decay.

For most children with no teeth, a delay is simply an opportunity for parents to enjoy their gummy smile a little longer. Nonetheless, the parents should arrange a dental visit for children whose teeth appear later than the regular schedule – especially if they're worried the delay may indicate a more serious issue. Caring for your child's teeth, however late they erupt, gives them the best start for long-lasting oral health.

Hi Thank you for your patience!
To be to the point - some wisdom teeth are easy & and some are quite difficult to remove:
Most wisdom teeth, when correctly erupted, if they need to be removed, due to caries or gum disease, it is like any other tooth extraction. The problems is when the wisdom tooth has erupted in an awkward position usually at an angle to the 'normal' 2nd molar. Then the dentist often have to make a small insision in the gum & remove some bone with a dental drill - usually a grove besides the wisdom tooth, or splitting the tooth in easy removable parts. Sutures are place after the removal in the mouth.
Sometimes it is best to refer to a oral maxillo-facial surgeon, who is a specialist dentist with extra training & experience, for the most difficult cases. Best to discuss this with your dentist. Each dentist scope is different - some have additional training & experience. Referral to a specialist is also more expensive. There are, like any medical / surgical procedure, complications that can arise: some are minor & probably temporary, others more serious & potencially permanent. Therefore you have to give consent after your dentist discussed the pros & cons with you, even when you just get a simple extraction. The more difficult your extraction, the more likely the complication & time for healing. Hope this gives you a satisfactory answer.

Hi, Thank you for your patience!

It depends - if the clicking is associated with pain, discomfort or locking of your jaw. Even if no current symptoms are experienced, besides the clicking, these can develop later. Also, does it bother you? Is is very loud or barely audible? There is no harm to get a consultation, but it could create additional costs. Get a second opinion, if you are unsure. Surgery is not necessary in all cases. Ask about all the treatment options, if any treatment is advised. The clicking is caused by a cushion disk between your scull & lower jaw joint. This cushion disk is attached with a ligament. Sometimes, this ligament is warm & the disk slides forward & then suddenly 'jumps' back in position.

Hope this gives you a satisfactory answer.

Hi,

Thank you for your patience! This is nothing serious, although it can be painful & very uncomfortable. A dry socket occurs when a recently extracted tooth socket gets a setback in the healing phase. There is usually an underlying cause. This can be due to a medical condition, medication, smoking & drinking shortly after the extraction was performed. Difficult extractions and teeth with severe infections before the tooth was removed, are also more prone. It is usually self limiting within 3 weeks after the tooth has been extracted. Treatment is simple - debriding of the socket, rinsing with saline and placement of a soothing dressing. Pain medication can be prescribed. Treatment might need to be repeated. Hope this satisfactorily answers your question.