What to Do if Your Child Is Missing a Permanent Tooth

Houston Pediatric Dentistry Blog

What to Do if Your Child Is Missing a Permanent Tooth

Most children lose the very last of their baby teeth around the age of 12. More often than not, missing baby teeth are quickly replaced as permanent, adult teeth emerge. However, if a baby tooth is not replaced by an adult tooth after some time, it could be that the adult tooth is impacted (moving in the wrong direction), overcrowded, or missing altogether. Dental x-rays can help identify the cause of the problem. Once a diagnosis is made, you’ll have several ways of dealing with this issue.

Common Solutions for Dealing With Missing Permanent Teeth

There are three common solutions for missing adult teeth in children. To start, you may be able to preserve the primary or baby tooth if it has not already fallen out. You can also replace the missing tooth structure using an implant or dental bridge. Finally, the open space can be closed orthodontically. Each child is typically given an individual and needs-specific treatment. Thus, the option that will work best for your youngster will depend upon various factors such as the current condition of his or her existing teeth, the alignment of your child’s bite, and the amount and severity of tooth crowding.

Preserving or Retaining the Baby Tooth

In some cases, holding onto the existing baby tooth as long as possible is the best choice. If the bite is balanced and aligned and tooth crowding isn’t an issue, letting the baby tooth remain and then replacing this structure after it has fallen out is the least invasive and most effective choice. When the baby tooth does not have cavities or any other structural or cosmetic problems, it can stay right where it is over the long-term. Conversely, if this tooth is in poor health or if it no longer has its root, a dental bridge or dental implant can be used to replace it. Attempting to orthodontically close a space when crowding isn’t an issue and when the bite is already balanced and aligned is a challenging and time-consuming process that can actually create worse oral health problems. Asymmetrical mechanics and prolonged treatment times can lead to gum and bone issues, and uneven arches.

Closing the Gap When Bite Problems or Overcrowding Exist

If a child has a bite issue or a problem with overcrowding that would necessitate tooth removal on its own, extracting the baby tooth and then orthodontically closing the space is a wise choice. It may be that the child has an underbite or crowding at the lower arch. If all other teeth have developed as expected, removing the lower bicuspids might be a treatment option. If one bicuspid is currently missing, it would only be necessary to remove the other (given that the second bicuspid never erupted). At the upper arch, if protrusion or crowding is a problem, it might be best to remove the upper bicuspid. When children are congenitally missing their bicuspids or laterals, the open space can be closed so that no implants or bridge is needed. Keep in mind, however, that it’s rarely a good idea to close a gap if there aren’t problems with the bite or issues with overcrowding.

What’s the most important step to take when a child is missing a permanent tooth? Having your child examined by an orthodontic specialist is the first step in identifying the cause of the problem and the best and most needs-specific solution. During this exam, the alignment of your child’s teeth will be inspected as will his or her bite and the amount of tooth crowding that exists. If using orthodontic treatments to close the space is an option, it will be presented. However, if this method isn’t appropriate, the orthodontist and pediatric dentist can work together to prepare the mouth for eventual tooth replacement.

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