When Permanent Teeth Never Come

By Donna Gentile

Welcoming the arrival of your child’s teeth is one of the pleasures of parenthood. But what happens when your child’s teeth don’t arrive? According to the National Foundation for Ectodermal Dysplasia, 20 percent of adults have one to two teeth that never develop. Congenitally missing teeth are a result of a genetic trait passed down through families. Besides cosmetic effects, these missing teeth can cause dental problems. Early recognition and intervention by the right team of dental specialists is the key to good oral health.

There are typically three options when a permanent tooth is missing: Preserve the baby tooth; replace the missing tooth or, close the space using orthodontics.

These methods are not always interchangeable and the best choice for any particular patient will be decided based on the condition of the teeth, the bite, the amount of crowding and a number of other variables. Oftentimes, it is the lateral incisor or the second premolar that is missing.

Missing lateral incisor

Lateral Incisors are the teeth that sit on either side of your two front teeth. One way to overcome the aesthetic and functional defect of a missing lateral incisor is to shift the canine tooth into the lateral position. Depending on the overall size and shape of the remaining dentition, this may be all that is needed. Some minor modifications to the canine tooth and voila! However, usually this is only a temporary solution. When age is appropriate, the orthodontist will move the canine teeth back into its original position. Space is created for a dental implant or a fixed partial denture to replace the missing tooth. The final outcome is an aesthetic, symmetrical, well-balanced smile. The later modality of treatment should be started in the late teens/early 20s. The face continues to grow in a downward forward motion well past puberty. Placement of a fixed restoration too soon can lead to a tooth that looks too short or out of position. Many patients in the transition stages of treatment wear removable retainers with replacement teeth in them. This gives the appearance of a full smile while allowing for late stage growth.

Missing second premolars

The second premolars are the teeth right in front of your molars. When these adult teeth are missing, we try to maintain the “baby tooth” as long as possible. It will preserve the space in the arch needed for the ideal tooth replacement. When the child is of the appropriate age, a dental implant or fixed bridge can be used. Careful inspection is important, eventually the “baby” tooth may become ankylosed, meaning it fuses with the bone. In this situation, the tooth will not erupt to the height of the surrounding adult teeth. This will create an imbalance in the alignment of the opposing and adjacent teeth leading to many dental complications such as wear, fracture and root problems.

In summary, congenitally missing teeth are more common than one may think. Routine dental visits will detect this condition early. The sooner intervention occurs, the better the outcome. Understandably, a great deal of stress is associated with spending childhood and youth missing teeth. Proper coordination between dental specialists such as orthodontists and prosthodontists will ensure a smooth the transition from one phase of treatment to the next.

Donna Gentile, DDS, is a Prosthodontic Attending at Interfaith Medical Center, and clinical assistant professor at Stony Brook School of Dental Medicine. Her practice is located in Massapequa, NY.

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