Q My child is eight years old and many teeth are coming out crooked. She had beautiful teeth till the permanent teeth came out now. Everything looks like a mess. Why is this happening?

It is not uncommon for children to experience issues with the alignment of their permanent teeth, especially around the age of eight, when they transition from their primary (baby) teeth to their permanent (adult) teeth. This transition period is critical as the new permanent teeth come in and begin to align themselves.

Permanent teeth often erupt in a sequence that does not always align perfectly with the spacing of the primary teeth. This can cause temporary crowding or misalignment as the permanent teeth find their position. It is normal for teeth to shift and adjust during this period, but if the misalignment persists, it may require intervention. If the jaw does not grow proportionately with the number of teeth or if there is insufficient space in the arch, it can lead to crowding and crooked teeth.

Genetic factors play a significant role in the development of the dental arch and overall alignment. If primary teeth are lost too early due to decay or trauma, the surrounding permanent teeth may shift into the vacant space. This can disrupt the normal eruption pattern and lead to misalignment. Habits such as thumb sucking, rolonged use
of pacifiers, or mouth breathing can affect the alignment of teeth.

It is important to monitor your child’s dental development closely and consult a pediatric dentist or orthodontist for guidance. Early intervention can address alignment issues before they become more pronounced. Depending on the severity of the misalignment, treatment options may include braces, space maintainers, early orthodontic appliances, maintaining good oral hygiene and regular dental visits.

Q I am only 45 years old but cannot bite and chew and enjoy my food properly because my teeth have flattened and become very short. Why is this happening and what is the remedy?

Experiencing difficulty with biting, chewing, and enjoying food due to flattened and shortened teeth at the age of 45 is a concern that can significantly impact your quality of life. This condition, where teeth become worn down or diminished in height, can stem from various underlying issues. Understanding the causes and exploring appropriate remedies can help restore your dental function and overall comfort.

Causes of Tooth Wear and Shortening:

One of the most common causes is bruxism, which involves the habitual grinding or clenching of teeth, often occurring during sleep. This constant pressure can erode the tooth enamel and gradually flatten the biting surfaces.

Acid erosion is another significant factor that can contribute to the shortening of teeth. Frequent consumption of acidic foods and beverages, such as citrus fruits, soda, and certain medications, can lead to the gradual dissolution of tooth enamel.

Natural wear and tear from regular chewing and biting can also contribute to dental attrition.

Gum disease (periodontitis) can result in the loss of bone support around the teeth, leading to tooth mobility and eventually contributing to the perception of shorter teeth.

Remedies and Treatments:

The first step in addressing this issue is to consult with a dentist for a thorough evaluation. Your dentist can assess the extent of the wear, identify the underlying causes, and develop a personalised treatment plan.

Depending on the severity of the wear, various restorative treatments may be recommended, like crowns can be placed over worn-down teeth to restore their shape, size, and functionality. For less extensive wear, dental veneers may be an option. Dental bonding involves applying a tooth-coloured resin to repair and reshape the damaged teeth. If bruxism is identified as a contributing factor, your dentist may recommend the use of a night guard. To mitigate acid erosion, it is essential to modify dietary habits and minimise the consumption of acidic foods and beverages.

Q I am told by my dentist to get a root canal done, but I am extremely anxious due to fear of dentists and needles. Is there any alternative solution?

Facing the need for a root canal can be daunting, especially if you experience anxiety about dental procedures and needles. It’s essential to address your concerns while exploring all available options to ensure you receive the appropriate care for your dental health.

A root canal is a dental procedure designed to treat infection or damage within the pulp of a tooth. When the pulp becomes infected or inflamed due to decay, trauma, or other issues, a root canal may be necessary to save the tooth and prevent further complications.

If anxiety about dental procedures and needles is a significant concern, there are strategies to help manage and alleviate your fears:

A. Sedation Dentistry: Sedation options can help you feel more relaxed during the procedure. Nitrous Oxide (Laughing Gas), Oral Sedation, IV Sedation.

B. Local Anaesthesia: Local anaesthesia is used to numb the specific area being treated.

C. Communication and Support: Open communication with your dentist is crucial. Let them know about your fears and anxiety so they can provide reassurance and take measures to make the procedure as comfortable as possible.

D. Distraction Technique: Using distraction techniques, such as listening to music, watching a movie, or engaging in guided imagery, can help shift your focus away from the procedure and reduce anxiety.

By exploring alternatives, discussing sedation options, and utilising anxiety management techniques, you can make an informed decision and approach your dental care with greater confidence. Prioritising open communication with your dentist will ensure that you receive the best possible care while addressing your concerns and maintaining your overall oral health.

Dr Kamlesh Kothari, MDS, DND, DICOI, is a dental implant specialist, cosmetic dentist and maxillofacial surgeon in Calcutta. He is the founder and clinical director of Aesthetica, 2/7 Sarat Bose Road, Vasundhara Building. He can be contacted at 9830183000, 40035900, www.aesthetica.co.in and Instagram profile @drkamleshkothari. ‘Tooth Troubles’ addresses queries about dental and maxillofacial surgery. You can send your questions to drkamleshkothari@gmail.com