Wednesday, January 24, 2007

Congenitally Missing Permanent Teeth














Take a look at this Panoramic Radiograph. If you know what to look for, you will see several missing permanent teeth. They never formed. This is more common that you may realize. It tends to run in families too, but not always. If there is no permanent tooth there, then the baby tooth will likely remain. Premolars and lateral incisors seem to be the most common (and third molars too). Usually it's just one or two teeth that are missing. This x-ray shows Seven missing premolars! (bicuspids). I've seen more than that on some kids.

Treatment can vary and can be anything from doing nothing to orthodontic treatment to close spaces, to a bridge or implant placement at an older age. The main thing is to know it is managable. In fact here is a patient who had two lateral incisors missing (that's the two teeth on either side of the two middle ones). Orthodontic treatment closed the spaces. Can you tell there are two missing teeth?

50 comments:

Anonymous said...

My son is missing a lateral incisor. He's 6 years old and his baby tooth just never came in. Does that mean he likely won't have an adult tooth there either? He's only missing the one, his other is normal looking. I can't recall what it's called, but both of my lateral incisors were stunted looking, like little fangs kind of. I had them capped when I was 13 (am 30 now) and my dentist says they are still fine. (He expected to have to fix them again when I was around 18/20 approximately) Are there any other worries that would come from him never having a baby tooth erupt there? Thanks, your site is very interesting!

Dr. Dean Brandon said...

Small lateral incisors are called "peg" laterals. Missing baby teeth do not necessarily mean missing permanent teeth. Have your dentist get an x-ray. They usually can tell with that. Missing teeth tend to run in families.

Anonymous said...

My 1 year old has all her teeth, but the two that are by the 2 front teeth. Sorry, not sure what they are called. The pediatric dentist my other daughter goes to said he can't feel any buds. When do I start to worry ? What age do I need to take her to an orthodontist? thanks !

Dr. Dean Brandon said...

I would suggest you go see a pediatric dentist to evaluate if there are any special considerations. One year olds tend to get teeth in odd sequences sometimes.

Anonymous said...

My grandson is 10 months old. His maxillary right central has erupted. In the space where the left should be is what I think is called a bifurcated central. The crown has a sharp point on the distal, then a rounded side on the mesial. If I am right how should we follow up? Wait or go to a pedodontist soon? What can be done. Grandma is a hygienist.

Dr. Dean Brandon said...

The AAPD recommends going to the pediatric dentist by one year of age. It's ok to go sooner if you have a concern! Most of the time if there is a partially geminated or fused tooth, you don't "do" anything right away. You might want to look at the post titled gemination and fusion of teeth. Could be something else too.

Anonymous said...

How is missing teeth passed on in a family? My husband misses 2 lateral incisors. But no one else in his family has this condition. My son is 2 years old now. Yet the 2 lateral incisors are not formed. What are the chances of him never having the 2 teeth? Thanks.

GP said...

My daughter (nearly 7) had her first xrays today and we found out she is missing 9 permenant teeth. How reliable are these first xrays? I have seen postings online where people mention that teeth were 'hidden' or not yet developed and later xrays show fewer teeth missing. Curious what the chances of that are.

Dr. Dean Brandon said...

Well, at 7 you can see a lot of teeth especially the front ones. You can usually make out the bicuspids, but sometimes I have seen them form late. You can be hopeful, but don't get your hopes up. By the time it is really important to know (braces etc.), the radiographs will show whether they have formed or not.

Anonymous said...

I had a aunt who was missing all perment teeth. My mother missing some. I have two upper laterals missing. I am 38. my perment cuspids moved forward and my baby cuspids where bonded to look bigger. My 5 year old is missing a baby lateral. Her pan-xray shows her missing her laterals also. I had a pan-xray on my 10 year old who is also missing a secound bi on the lower. I have one more child left to see if he will have the lucky gene to. He's 3. I have been a dental asst. for 20 years now. I have heard meny people refuse a pan xray.That xray tells more stories then you think.

Anonymous said...

My 13 year old daughter is missing all bicuspids (8 teeth). In addition, her lateral incisors are extremely small. We have seen several orthodontists who have given us somewhat different advice. My question is does she need braces to close the gaps and eventually implants? I want to have the small teeth bonded, but I'm not sure if I should do this yet. What do you suggest?

Dr. Dean Brandon said...

every orthodontic case is different and dependent on measurements,growth, etc. It is not unusual to bond small laterals or to close spaces or do implants if there is simply no way to close spaces. I cannot tell you which is the best way.

Anonymous said...

I am missing my top right lateral incisor, and I am soon getting orthodontic braces to close the gap by moving the upper canine tooth into the space normally occupied by the lateral incisor. Do you have any information and/or photos of people who have had only one missing lateral incisor and had the gap orthodonically closed? Any would be greatly appreciated.

Dr. Dean Brandon said...

A common treatment is to close the space. The photo above shows two missing laterals, so look at that and one side would be like that.

Anonymous said...

Sorry I'm an adult please help if you can...I'll make this quick I hope. I was born missing my upper and lower lateral incisors. In 2001 I got braces to have the space created for the teeth. Well it's 2008 and i'm still wearing my retainers b/c I am not able to afford ANY of the post treatment. Question: Am I able to have my orthodontic treatment reversed? Meaning am I able to get braces again to just close all the space and be done with this. Please, any answers...Thanks in advance for you help.

Dr. Dean Brandon said...

Basically, yes. Braces can be done more than once.

Anonymous said...

In a case where a child is missing the adult K9 teeth bilaterally, is pulling the other teeth forward, as in the picture above, a better choice than implants?

Dr. Dean Brandon said...

No way to say as each case is different. Analysis and consultation with your pediatric dentist or orthodontist will yield a reasoned answer for an individual case.

Anonymous said...

I just would like to know the cause of non-development of baby and permanent teeth. For example, A chid who never develops his or her baby teeth on the lower jaw and only develops a total of 6 baby teeth on the top jaw (4 molars and 2 front teeth). Now at the age of 28 he only has 4 molars and lost the two front teeth by rough play at the age of 14. Is is due to an illness or deficiency?

Dr. Dean Brandon said...

Usually, not caused by an illness as I understand it. It is a developmental anomoly. It can be genetic or related to certain conditions such as Down's Syndrome or especially Ectodermal Dysplasia, but I see lots of kids that are perfectly healthy with this too.

Praveen said...

My baby daughter is 13 months old. She has no teeth yet. What should we do for this. The pediatrician said not to worry, it may come later… Please suggest what to do??? Thanks Prawin

Dr. Dean Brandon said...

It's not too early to see your pediatric dentist, still I tend to agree with the Pediatrician.

Anonymous said...

Hi I came across this website by accident and am in desperate need of advice as I have 2 baby teeth on the bottom teeth of my mouth. I am 26 years old and have no decay in them I think? Well no pain atm... If I removed them I would have a large gap and this would cause other teeth to tilt? What do I need to do? Should I see an orthodontist? And how much would this cost?

Any advice would be much appreciated!

Anonymous said...

I am embarassed to admit this but, I am 24 yrs. and I only have 12 teeth in my mouth. I like many people in my family have missing permanent teeth. The difference is that I only developed 12 permanent teeth and I have a very thin jawbone. I have been told by an orthodontist and a dentist that my jawbone is too thin to even get dentures without graphic bone surgery. I haven't been back to a dentist or orthodontist since I was 17 (this was 7 years ago). I've sort of gaven up because no professional could help me. Do you think there has been enough med. advancements for me to find someone to help me? I can't get my insurance to cover graphic bone surgery because it is considered to be cosmetic.

Anonymous said...

My 12 year old son had 3 rows/levels of teeth. His dentist removed his baby teeth and the next set of teeth which sat above his baby teeth. To date his permanent Central incisors have not come in. What options do we have to give him a normal smile without the teasing and jokes that come along with being his age with no front teeth.

Anonymous said...

My almost 7 year old (August 6th b-day) daughter lost both of her top incisors(?? teeth on either side of teeth in very middle) about six months ago. There are no signs at all of either side erupting. Should I be worried and take her in to be x-rayed?

Dr. Dean Brandon said...

At 12 I would expect front central incisors to be in. An x-ray by your dentist might be helpful in answering your question. When there are missing permanent teeth, we usually look at the orthodontic situation to see if anything can be done there while they are young and the dentition is still developing.

Dr. Dean Brandon said...

Upper lateral incisors are notoriously slow to come in. Might be ok to ask your dentist to see if an x-ray would help answer your question.

Anonymous said...

I am so relieved to read on your site that there is another child out there missing 9 adult teeth. My daughter who is 9 found this out yesterday. It is scattered, throughout her mouth, no pattern. I truly am worried, but see there is nothing that can be done at this point. Even though the proof is on the panoramic xray, should I still seek another opinion? Thank you.

Dr. Dean Brandon said...

There is only so much that can be done in young children. Get good advice from a pediatric dentist who will guide you on what and when to seek treatment/orthodontics, etc.

Me said...

I have a daughter who will be turning 3 in 2 months. She is missing her upper lateral incisors. I have never heard of such a thing, everyone I have ever known has had all their teeth! I can see by reading some of these comments that it's more common than I thought. Anyway, when should I get her mouth xray'd? Is there a chance that her permanent lateral incisors might be there? And is it common for the baby ones to be missing, but the permanent one come in no problem?....or do both sets usually run together, if the baby ones are missing, the permanent ones will most likely be missing too?

Dr. Dean Brandon said...

Just because the primary teeth are missing does not necessarily mean the permanent ones are affected too, but I have seen that too. I can usually get an x-ray of the upper front teeth at age three or four.

the rye family said...

2 of my daughters are missing teeth - the 14 year old is missing TEN (10) and the 11 year old is missing EIGHT (8). We are working with our dentist and our orthodontist - and are very happy with both of them, but have NO DENTAL INSURANCE. Are you aware of ANY programs that could help us?

Dr. Dean Brandon said...

Not much help from me I'm afraid. I do know Medicaid is for families with limited income. There are some State run programs for children a little above the Medicaid level. In Alabama it's called ALkids. Otherwise, most treatment like that is over a long period of time so things sometimes can be spread out. Of course discuss all this with your doctors.

Anonymous said...

Dr. Brandon, I am a physician. My 8 year old son lost his medial incisors 4 months ago. The right permanent medial incisor came out normally, but there is no sign of the left one. When do we start to worry?

Dr. Dean Brandon said...

Generally--the upper central incisors come in between 7 and 8 years of age. The exact time varies. The left and right can come in at the same time but can be separated by up to 6 months. A radiograph will help to determine if there is a problem or not--like a supernumerary tooth or something.

Mandi said...

My niece is 4 yrs old, after consulting with a specialist we found out she will only have 3 permenant teeth when she gets older! She is scheduled to have surgery Aug. 7th to " save her baby teeth"! My question is, Is there any way her permenant teeth might just come in late? Please get back to me if you can? We realy don't want our baby to have to go through this surgery if it is unnecessary!

Dr. Dean Brandon said...

Hmm. Kind of unusual to have that many permanent teeth missing. I do not know if you heard correctly, as many permanent teeth are not even formed on any x-ray at age 4 (although many are including the front ones). I have seen multiple missing permanent teeth with a syndrome called Ectodermal Dysplasia. If they have x-rays or can get them they can give an informed answer to your question. Can't give you advice, but encouragement that whatever the case, it is likely manageable. You should feel confident in your decision or else get more information. By the way, I take kids to the OR every week or so to restore badly decayed baby teeth.

Anonymous said...

my daughter had her central and lateral baby incisors (top) removed when she was three. She is eight years old now. Her permanent bottom central incisors came out more than a year ago but no signs of eruption for the top ones. Could this be because the were removed too early or is it possible that she does not have any adult teeth in the said area?

Dr. Dean Brandon said...

An current x-ray might help. Ask your dentist. Still, the "average" time for central incisors to erupt is 7-8 years of age. There is always variation.

Anonymous said...

my 10 and 12 year olds are missing permanent teeth.
both lateral incisors plus two lower teeth for my 10 year old.
We are looking into possible options to correct this. at the moment both children are with a private dentist but is this something that can be done on the national health ?

Dr. Dean Brandon said...

I am unfamiliar with national health programs affecting dentistry in other countries (other than the USA).

Anonymous said...

i have twin daughter, one of my daughter had two central incisor lower one. now she is 4 & half, and my dentist say it is not abnomal they will come as permnent teeth, are there are any worries that they will not be permanent teeth

sace said...

i am 18 years old and i still have 8 or so baby teeth still left in my mouth ! the baby teeth that i still have left in my mouth are rotting why do you think this is?

Dr. Dean Brandon said...

sace--retained baby teeth can get decay just as easily as permanent ones, in addition baby tooth are really not built to last past age 12 although sometimes they do quite well for a long time. Get it looked at by your dentist.

Anonymous said...

I have three children.
My oldest son was missing two permanent teeth and with ortho they made space between teeth and later we have to do implants.
My yonger daughter is missing 4 teeth two of the beside the big front teeth and the rest are mollers. But we are doing ortho with her with moving the eye teeth to beside the front teeth. And my little 4 year old already missing baby teeth never developed.
It seems like the more children I have the less teeth they develop.

anniki said...

I am an eleven year old girl and my parents don't care about my teeth.
I have an under bite and I also have a back tooth missing.My back tooth has been missing since i was four, when it got ripped out.It is full of black gunk.Is there anything i can do too help my tooth or help my under bite?
I really need an answer because picture day is coming up soon!!!

tresmagueyes said...

hi. my almost 8 year old daughter lost one of her bottom,not 2 middle, teeth, i think it is called an incisor. the tooth came out fine and she already lost the middle ones and the permanent teeth came in fine there, but she is not getting her permanent tooth in this spot yet. should i worry about her not having a permanent tooth there? she was 13 months old before she started getting any of her teeth so she is loosing her baby teeth later i believe. thanks for your time.

Dr. Dean Brandon said...

Sounds like you need a full dental exam--that way all your concerns will be addresses--it takes time.

Dr. Dean Brandon said...

tresmag--x rays will show if the teeth are just slow or are missing--I've seen missing lower incisors before, but it is usually manageable with orthodontic treatment.