Missing Permanent Tooth
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Missing Permanent Tooth
My 5 yo recently got his first oral x-ray. As a result, the x-
ray showed that he does not have bone for one permanent tooth
on the right lower jar. I was shocked that he will be missing
one permanent tooth for his life. Now he has a ''twin'' baby
teeth at the same spot. When we first noticed that he was
having a ''twin'' teeth, I took him to see the dentist. (he was
only 2) At that time, the dentist was not sure if he was
having one or two baby teeth and if he would have one or two
permanent teeth later on. Now he is not getting any permanent
tooth at all. I am wondering if someone or any parent have
similar experience and how do you handle this situation?
By the way, my 5 yo hates dairy-no milk, no cheese. The only
thing he will eat is yogurt. I am afraid this is why he does
not have bone for this permanent tooth-he is not getting enough
The dentist did say that it is his gene to cause this missing
tooth. But how can I help him?
My son's two front teeth on the bottom never materialized either, and my
parents eventually remembered someone way back there in the family that also
had the same thing. It's definitely a genetic thing and doesn't have anything
to do with your son's diet. Now mine is fifteen and just got his braces removed.
He's still got the little baby teeth in front but they will be replaced with
one false tooth eventually, most people don't realize the difference in his mouth
when they first meet him. For now you can't really help him but he will
probably need orthodontic work when he reaches adolescence.
This is not uncommon. My daughter has the same thing. And my
understanding is that it is genetic (and may be linked to Native
American heritage). First, this x-ray may not be definitive.
We've had different counts over the years as to how many
permanent teeth are not there. It seems that some may ''hide'' or
actually develop later. Second, the ''baby'' tooth is perfectly
capable of being a lifetime tooth if the child has good dental
habits and it doesn't get knocked out, since there is no
permanent tooth trying to cut off the blood supply and get it
out of the way. My wife still has one of her baby teeth, she
thinks. Third, there are all sorts of things to do in the
future if in fact the tooth comes out. Many people (myself in
fact) actually have to have a tooth pulled as part of having
braces to make room for teeth in a crowded mouth. Your kid may
just be lucky. If that doesn't work out (something you may not
know for years, since we've been monitoring our daughter's teeth
for some 5 years now), there are implants and things like that.
So, for now, I'd recommend just sitting tight and letting your
dentist advise you.
I had the same situation as your son -- Missing an adult tooth
in the lower jaw.
My experience has been -- the baby tooth has simply stayed next
to the adult teeth. I completely forgot about this, until at
around the age of 25 I ate something that was actually quite
soft and the top of a tooth kind of shattered. I was shocked
that a tooth could shatter. And then after going to the dentist
realized that this poor baby tooth had been working about 20
years overtime. I had a crown put on the baby tooth - and all
has been absolutely fine since then. I am now 45 years old.
So it has not posed a problem at all.
My reading of your post is that your child is missing a single tooth, yes?
It is true that this condition is genetic. It runs in my family. I was born
without permanent lateral incisors (the ones next to the two front teeth).
My sister has a mini-tooth, and my dad is missing one. In this day and
age, it's not a big deal at all. When I was growing up, they typically
corrected this with braces, and some orthos may still do so. The problem
with this is that you end up with teeth in the improper positions, which
can look sub-optimal and affect yoru bite. Nowadays, I think they usually
get better results by doing an implant. Implants are as sturdy as regular
teeth, and the operation is not that involved. Mouths heal fast. With
implants, you retain the other teeth's original positions, which makes
sense to me. They use porcelain and it looks fantastic. Because they
moved all my teeth over one, I had to get my incisors (fangs) filed down
and my molars were a little too far forward for comfort. So I later got
porcelain veneers on my front teeth and everything looks and functions
great now. But replacing a single tooth with an implant in the first place
will preclude all those orthodontics. Ask your dentist, or a cosmetic
specialist (and an oral surgeon) about your options. This stuff has come
a long way...
It sounds like your child may ultimately need a dental implant
if he wants a permanent tooth replacement. He is too young now
but when he is older dental implants are a great option. My
husband specializes in dental implants so I know that he treats
many patients with missing teeth. Feel free to send me a email
if you have any questions.
I am 41 years old and have two lower baby molars. Both
developed cavities and were filled many years ago. More
recently, the original amalgam fillings were replaced with
porcelain. Since I was a child, dentists have been remarking on
the teeth, urging me to have them replaced (and more recently,
to install implants). I've resisted, and they remain rock solid
healthy teeth. To an uninformed eye, they appear no different
than the other teeth. Dentists were convinced they'd fall out
years ago, but I'm convinced I've got 'em for life.
KMS, Apparently Lagging Behind on the Evolutionary Chain
i am missing one of my 4 lower middle teeth, but no one really
notices. the teeth all fit together nicely.
If I understood you correctly, all of your son's teeth are normal
(and he will have permanent teeth) except for just one tooth. I
am 42 years old and one of my molars is a baby tooth. It never
occurred to me that this was anything other than a novelty. In
other words, I wouldn't worry about it at all. Every time I meet
a new hygenist/dentist, I get an enthusiastic ''oh, you have a
baby tooth!'' comment.
One minor cautionary note: the new hygenist/dentist is always
quick to add that I might one day need a crown. Baby teeth tend
not to last as long as permanent teeth. They say I've had good
luck that mine is doing very well. But the baby tooth has had
absolutely no impact at all on me health-wise or otherwise.
I've got the same thing, but for me I have 5 spaces missing
permanent adult teeth. For two of the spaces I still have my
baby teeth (I am 35 years old!). On my bottom right, I have a
gap where the baby tooth fell out in my mid 20's (it doesn't
show) and then I have a bridge where 2 baby teeth fell out on
the upper right (early 20's) and there were no adult teeth to
My dentist also told me it's genetic (and I do have a first
cousin with similar dental anomalies). While inconvenient, it's
not the end of the world. Your son may have to get expensive
dental work done, but he may not even have to worry about it
until he's a young adult. And dental insurance covers a large
portion of it (although in my mid-20's I didn't have dental
insurance and so paid out-of-pocket-- my dentist was very
understanding; he put me on a long-term payment plan, charged no
interest, and only charged for supplies and not his time. Sorry
to go on for long, but I obviously am very grateful to him).
Anyway...it's not a huge problem, and I strongly doubt that
calcium has anything to do with it. My mother was always very
strict about us drinking our milk and here I am with gaps in my
I was missing a permanent tooth on my upper right jaw. I was
also told that it was genetic (in fact, my grandfather had
similar problems) and after the baby tooth fell out, the
orthodontist recomended waiting until I had gotten all of my
other permanent teeth in before taking action. I had a small
gap, and one of the teeth next to the gap grew in slightly
twisted. When I was in high school I got braces on my upper
teeth only to move my teeth into place and then I had a bridge
put in (a fake tooth attached to the two teeth next to it.) I
did have to wear a retainer with a tooth attached for a few
months after the braces. I was told the bridge would hold for 7-
10 years before needing to be replaced. I've now had it for 13
years. I rarely notice the bridge, you can't tell just by
looking at it, and it requires very little maintenance. If you
want more details you can email me.
I was born without permanent teeth in two spots. My two brothers
have the same two teeth missing. It seems reasonable that it's
genetic, not that your kid doesn't like dairy!
Get some good advice on how to handle this. Dentists screwed up
my two brothers' mouths. One had the baby teeth pulled, and the
other had his left in. In both cases, their other teeth had too
much room and came in crooked.
The trick with my teeth was that they preserved the space where
my missing teeth were until I was old enough to get bridgework.
They first capped my baby teeth with some substance that made
them not fall out. So my permanent teeth grew up around the baby
teeth, and the baby teeth held the space. Of course they were
much smaller than the permanent ones, and there was a gap there.
Later I had braces (to correct an overbite and malocclusion) and
the braces had a spacer to keep the permanent teeth away from the
baby teeth. Finally, when I was 18, they put a crown atop the
baby teeth, so they were the same size as my other teeth and
At 26, my dentist decided I finally needed to get bridgework,
because the baby teeth roots were causing bone loss in my jaw.
The crowned baby teeth were pulled--quite an operation because
they were fused to the jawbone. Then I had a bridge made between
the two adjacent permanent teeth.
It sounds like a lot of work (and money), but I'm glad it worked
out as it did, because my teeth look great and fit my mouth.
Also, I was always quite the conversation piece whenever I went
to a new dentist or got X-rays...
P.S. I still have the weird, misshapen, capped-crowned-baby teeth
that were removed at age 26. After that long, I couldn't just
toss them out.
Two Down on the Tooth Fairy
I know you received many responses to your post but I wanted to
add my two cents--I'm 34 and I have four molars that were never
replaced by permanent teeth. They've all required lots of
painful work and I often experience sensitivity in them. I was
recently told by a hygenist that people who have this condition
are ''genetically advanced'' (perhaps she was trying to make me
feel better!). Her explanation was that, as compared to cave
times, we don't need as many molars to chew tough foods.
Apparently orthodontists now deal with this ''problem'' by
pulling the baby teeth and moving the other molars forward.
Good luck to your son!
Your concern for your child's missing tooth is understandable.
Congenitally missing teeth are not altogether uncommon. About
3% of the population have one or more missing permanent teeth
as a result of this minor genetic ''mix-up''. Essentially, the
cells that create a ''tooth bud'' that should form a permanent
tooth never get turned on in certain areas of the growing jaw.
This hereditary trait is frequently passed on to one's
children . Often times, it is a person's wisdom teeth that
never form, which is a good thing because it saves one the
time, trouble, and money to have them removed later on by an
oral surgeon. Other commonly missing teeth are the upper
front ''lateral'' incisors (the ones on either side of the 2
front teeth) and the lower premolars. In the past, the common
school of thought was to orthodontically move the adjacent
teeth into the space of the missing teeth and then reshape them
to resemble the appearance of the missing tooth contour.
Another approach would be a bridge that is supported by the
teeth adjacent to the missing tooth space. Today, neither of
these options is considered ideal as they require the bite to
be compromised due to uneccessary tooth movement that results
in a less than functional long term result, or grinding down
healthy teeth to support the bridge. The best option is to
replace the missing tooth root with a titanium dental implant
which then is used to support a porcelain crown ( or ''cap'').
This results in the most conservative and longest lasting
approach because the teeth are kept in their natural position
in the arch and are not altered or compromised by crowns or
bonding. Also, the final result can appear as esthetic and
natural as the adjacent natural teeth with proper planning. As
for timing, it should be noted that implants cannot be placed
in a patient until they have completed growing. For girls,
this means about 16-17 years of age is usually the time to
begin implant therapy. For boys, it may require waiting until
about 21 years of age before they have completed skeletal
growth and are ready for the implant can be placed. So what
should you do in the meantime? Work with your dentist and
orthodontist so that they understand your concern and your
desire for the best long term results. Check with a
prosthodontist ( a dentist with advanced training in complex
dental procedures and dental implants) or dentist with
extensive knowledge on dental implants prior to the
orthodontics reaching completion and the braces being removed.
It is not uncommon to have a patient referred after the braces
have come off and they've been told to go ahead with the
implant. Sometimes the adjacent roots have not been properly
positioned to allow room for the implant placement which is
easily confirmed with an x-ray. It is not fun to tell a 16-
year old patient after undergoing several years of braces that
they have to go back into orthdontics for another 6-8 months.
So what are your options once the baby tooth falls out and you
wait for the patient to finish growing? Your dentist or
orthodontist can attach a prosthetic ''fake'' tooth to the wire
during orthodontic treatment and then add a tooth to the
retainer when the braces come off. Sometimes, a ''long-term''
temporary bonded bridge can be made by the dentist if the
patient has a few years to go and doesn't want a
removable ''partial'' or retainer. Dental implants are very
predictable (about 97% success rates) and often provide the
best results for patients missing teeth not only from a genetic
trait, but for replacing teeth lost as a result of gum disease,
deep cavities, root fractures, or trauma. Please feel free to
contact me if you have any futher questions at
skeithdds at hotmail.com Scott E. Keith, DDS, MS
My mother and I are both missing the left lower first incisor.
Nobody ever notices mine unless I point it out. My orthodontist
told me to be grateful it wasn't there: there wasn't enough
room in my jaw for the teeth that were there. I suppose missing
a bottom tooth is less aesthetically unsettling than if the
same tooth were missing on top (What's up, Doc?), but it really
has never seemed like a big deal to me. I was even a little
annoyed when the same orthodontist convinced me as an
impressionable 15-year-old to have my lower cuspids filed flat
on the tips to lessen the obviousness of the missing tooth.
one of the three percent with missing teeth
I have two baby teeth still where adult teeth just never came.
In my case (and probably in the vast majority of cases) it's
genetic. The only people that ever notice are dental
profesionals, and they've never been a problem. I guess it's an
extra insentive to keep brushing well to keep those teeth healthy
despite their being older. Unless it's making the rest of the
adult teeth come in crooked or something, I wouldn't worry about it.
Your daughter's missing tooth is a result of a genetic
blueprint--nothing else. I was missing a upper permanent tooth,
which has handily been replaced by a bridge. No big deal, and my
daughter, too, was missing a lower permanent tooth which
resulted, luckily enough, in one less tooth, for braces, needing
to be extracted. We like to think of ourselves as more evolved
because we are missing some, likely, unnecessary dentition.
Nothing to lose sleep over or blame yourself for.
We both have great smiles
Ya wouldn't know the difference
this page was last updated: Apr 17, 2005
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