Question
My two year old recently had his four top front teeth extracted because of tooth decay. I am concerned about how this will affect his development and speech. Will his facial development and adult teeth be affected? Are there any steps I should be takin
Answer
The dental situation with your two year old is unusual, but actually quite common at around age four. Primary upper front teeth are often lost from trauma or caries, or cavities. Although you didn't report the reason for the tooth decay, it is likely related to what is called "bottle caries" in dentistry; that is, erosion of enamel with caries development from a child having a bottle in the mouth for hours per day, using it like a pacifier. Milk, juice, or even water in the bottle can lead to the development of bottle caries, so children should be discouraged from carrying a bottle around with them. In some families, erosion of enamel and the development of cavities can have a genetic link. Whatever the likely cause, I'm sure your dentist has discussed with you how to prevent further caries development.
Your dentist provided accurate information about the possibility of delayed permanent incisor eruption. Bone remodeling at the extraction sites provides a slightly more difficult challenge for adult teeth to erupt. But not to worry, eruption will occur even though it may be a bit later than other children of similar age, as your dentist projected. The likelihood of the adult incisors erupting with normal anatomy and enamel content is good unless there is a history of enamel erosion in the family.
As a good parent, I can understand why you would have concerns about future facial and speech development. My guess is that your son's facial and speech development will continue to progress normally, so I would encourage you not worry about him. You can, of course, expect a lisp to develop, and that or any other speech errors that may develop can be corrected later on.
When your son is a bit older (as young as age 4 and more likely at age 5), your dentist can make a "flipper" - a removable appliance with false upper incisors attached. These appliances work very well, especially where the child is motivated to have front teeth like everyone else. In the meantime, I'm sure that you are getting used to a cute smile without upper front teeth. I encourage you to enjoy this cute period.
Until a dental appliance is appropriate, and if you see Mr. Tongue protruding forward excessively in speech or at rest, you can consult a speech-language pathologist who would encourage your son to touch his tongue tip against the back of the lower incisors for /s/, and also to rest the tongue tip against the lower incisors. For /s/ productions, which are normally produced by forcing air through a small space between upper and lower incisors, your child should be encouraged to bite on his back teeth for /s/ to narrow the anterior space and prevent excessive protrusion (fronting) of the tongue. But my goodness, your son is only 2 years old!! At this point in his life, he has other things on his mind than worry about speech or having lost a few teeth. I appreciate and applaud his attitude!
My guess is that your son will do very well in speech and facial development if we all leave him alone at this point. I would only advise you to seek guidance from a speech-language pathologist if and when the tongue fronting becomes unbearably bothersome to him or you. Good luck, and you will need it, as he soon will be three!!
Robert M. Mason, DMD, Ph.D. is a speech-language pathologist (CCC-ASHA Fellow), a dentist, and orthodontist. He is a Past President of the American Cleft Palate-Craniofacial Association, a professional, interdisciplinary organization specializing in problems associated with facial and oral deformities. Dr. Mason has studied and written extensively about orofacial examination, developmental problems related to the tongue, and the anatomy and physiology of the speech and hearing mechanisms. His reports have appeared in speech, dental, medical, and plastic surgical journals and texts. He is considered to be an expert in tongue thrusting, tongue tie, and other problems related to tongue functions and speech.