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Pulling Eye Teeth


Question

Regarding an individual with CdLS whose permanent eye teeth are growing in crooked, the orthodontist is recommending oral surgery to remove the permanent eye teeth for the following reasons: he will not have room for all of his teeth, he would be able to wear braces due to his behaviors (may try to pull them off), and the eye teeth may be pushing the root of another tooth and causing problems

Can you state whether you think that pulling his teeth is warranted? Would you be willing to consult with the orthodontist directly?

Answer of our experts

It is not common or preferred, in a routine situation, to extract the permanent cuspids (eye teeth). They are the longest teeth in the mouth and serve as pillars of strength at the corners of the dental arches. Having stated that, I must say that in some situations we do recommend extraction of the permanent cuspids when braces will not be able to be worn or when the teeth are causing resorption of the roots of adjacent teeth. This sounds like it is exactly what is happening to this individual. A lot of children with CdLS just can't wear braces due to a lack of adequate cooperation. We also do not want them to harm themselves, should they try to pull the braces off. Therefore, specific extractions are necessary from time to time in order to keep things stable and infection free. The orthodontist has the radiographs and has seen this person and therefore should be able to have a good understanding of the availability of the space for the permanent cuspids. I would feel comfortable with his or her decision

RM/TK 7-13-10

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Recommendation(s)

Feeding and Dental Difficulties

R12
In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
R13
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
R14
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
R15
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.

Recommendation(s)

Mouth, nose and throat

R42
The anaesthesiologist should be aware of the potential difficulty with intubation in individuals with CdLS.

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