我家宝宝换牙期，遇到了些问题，急于解决，今天一天的求助让我对这个问题有了越来越清晰的认识：

是我们国家的医疗水平不够？还是医德缺失？——关于孩子换牙时双排牙的问题

http://bbs.yaolan.com/thread_51332199.aspx（家长的困惑与自助）

http://www.gov.cn/fwxx/jk/2009-06/30/content_1353635.htm（国内网站铺天盖地的关于双排牙必须拔掉乳牙的说法）

http://www.xici.net/d94231122.htm

http://www.hebzc.com.cn/qinzi/xlq/200907/14125.html

看到这里，我几乎就决定第二天就带孩子去拔牙了，但是总觉得这么多孩子有双排牙问题，难道都需要通过这种方式？而且既然乳牙一拔，新牙就会自然归正，那为什么不顺其自然，等乳牙脱落后自行归位，为何一定要强行介入拔除？而且一般双排牙发生的话下恒牙长在乳牙里边，上恒牙长在乳牙外面，好像有一些道理，这样至少就防止了最严重的牙齿排列情况：“地包天”。而且往往那些拔了乳牙的孩子以后换牙时还会出现类似情况，难道还要一次次地“拔牙”？

想起孩子他爸以前说过一个意大利儿科医生来华从医后对中国儿科医生的看法后，我想关于这个问题，我不妨看看国外牙医的观点，做个参考。

结果，第一个搜索结果就让我顿悟。

http://en.allexperts.com/q/Dentistry-966/Multiple-rows-teeth-six.htm（同样的问题，国外网站医生的观点截然相反）

有很多家长可能并不会访问英文网站，对于英文也看不真切，我这里有必要翻译一下：

“牙医回答—六龄男孩的双排牙”

Question
My son, who is 6 years old, still has all of his baby teeth, none of which are loose.  In the bottom front he now has two teeth coming in right behind his baby teeth.  This leads me to believe the orthodontist will want to pull the baby teeth, but I really do not want my son to have to be under any sort of general anesthetic - especially at this young age.  Is pulling the baby teeth the norm in this case?  Will the new ones that are behind the baby teeth just "uproot" the baby teeth and could they possibly fall out on their own (although since the baby teeth are not loose at all it does not really look as if that will happen at this point).  As a family we take the alternative approach to medicine, choosing to use as few medications as possible in favor of herbs or natural remedies, so we are looking for any alternatives to anesthetic and the pulling of the baby teeth (as well as probably the antibiotics they will want to prescribe to my son afterwards) - but I fear there aren't really any out there.  My son has not complained about any of his teeth at all up to this point, so I don't believe it's causing him any sort of discomfort.  Thanks for any opinions you have on this subject.

“问题

我儿子六岁了，他的乳牙一颗都没掉，但是下门牙里面长出了两颗牙齿，正巧长在原来两颗的后面。这让我相信牙齿矫正医师说要把乳牙拔掉的话，但我真的不想让我儿子用任何麻醉物—尤其在他这么小的年纪。这样的病例中拔掉乳牙是通常的做法吗？长在乳牙后面的新牙会将乳牙挤掉吗或者乳牙会自己脱落吗（虽然乳牙没有丝毫松动的迹象，上述假设貌似不太可能）？如果有其他选择，我们家是尽可能少用药或药物治疗的，较赞成草本和自然配方，所以我们在寻找一些能替代麻醉和拔乳牙以外的其他可选择的办法（另外可能之后他们会开抗生素的处方给我儿子）——但我担心可能没有这样的好的方法。到目前为止，我儿子并没有抱怨过他的牙，所以我认为这并没有让他有任何不舒服。感谢您对于这个问题的任何观点。

Answer
Dear Maureen Cole,

The situation you describe-- with the adult lower incisors erupting behind the primary incisors, forming a double row of teeth-- is the normal pattern, and no action needs to be taken. In fact, this two-row pattern is the preferred eruption/exfoliation sequence, because the retained primary incisors will hold the lower permanent incisors in a more posterior position, which reduces the risk of those permanent lower teeth being pushed too far forward and causing a cross-bite with the upper incisors when they erupt later.

So, your son is exhibiting a perfectly normal eruption pattern, and no action needs to be taken except to let nature take its course.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

“回答

您描述的情况————在乳切牙后面长出矮小的恒切牙形成了双排牙————是种普遍的现象，不需要采取任何措施。实际上，双排牙现象是一种萌出/发芽的一个步骤，因为还未脱落的乳切牙会使矮小的恒切牙保持一个较靠后的位置，这样就减少了这些矮恒牙长得太靠前，而造成后长的上切牙长出后形成“地包天”的风险。

所以，你儿子展现的是非常好的自然萌出情况，除了顺其自然以外不用采取任何其他措施。

希望对能有所帮助

马克  伯恩费德 （牙医医学博士）

www.dentaltwins.com（个人网址）

纽约布鲁克林区

我还去了他们的网站看了马克博士的个人简介

Mark Bornfeld DDS...

...has lived most of his life in Brooklyn since moving there in 1958. He has attended P.S. 213 and J.H.S. 166 in East New York, and is a 1969 graduate of Brooklyn Technical High School. Mark earned his Bachelor of Science degree in 1973 from Brooklyn College, and his Doctor of Dental Surgery degree in 1976 from the New York University College of Dentistry, at which time he was inducted into the Omega Kappa Upsilon Dental Honor Society. He received his postdoctoral training at the Peninsula Hospital Center in Far Rockaway, NY, and with his twin brother Steven has maintained a private dental practice in Brooklyn since 1977. He holds the position of editor at the Queens County Academy of General Dentistry, as well as dental consultant at AllExperts.com. He lives in Mill Basin with his wife, Maria.

大概翻译：他从1958年搬到布鲁克林后基本上一直住在这里。1973年在布鲁克林大学取得理学学士学位，他的牙外科博士学位是在1976年纽约大学牙医学院取得的，在此期间他就职于某牙医荣誉协会。他在纽约某区的中心医院进行博士后的工作培训。从1977年开始，他和他的双胞胎弟弟在布鲁克林坚持牙科实践。

事后我看了一下，这个网站是美国纽约的一个类似百度的问询网，唯一不同的上面回答问题的都是各个领域的专家。

同样是专业人士的回答，结论确相差那么大，真相只有一个：美国的牙科落后了或是我们的牙科“落后”了。。。

如果大家有答案，请一定告诉我，并告诉你身边可能有同样问题的孩子的家长。