How We Treat Missing Teeth

What happens when your child is missing a tooth? Sometimes you know when a child has lost a tooth because it got knocked out or had to be removed by the dentist, but what if a tooth just never grows in? What causes that and is there any way to prevent missing teeth? Luckily, there are many different treatment options available if this situation occurs.



What are congenitally missing teeth?

A tooth that never grows in is called a congenitally missing tooth (CMT). Congenitally missing teeth, also known as hypodontia, are considered a developmental abnormality that occurs when people are born without certain teeth. Although it is one of the most common dental issues, and approximately 20% of people are born without at least one tooth, CMT can negatively impact a patient’s quality of life in several ways if left untreated.

What are some of the causes?

Genetic factors are the most common cause of congenitally missing teeth, and this condition can often be observed in different generations of the same family. Environmental factors like maternal smoking or rubella during pregnancy might play a role, too. Finally, trauma to the area before a tooth forms may disrupt the tooth germ development, so a tooth never forms. (1)

Which teeth are most often affected by CMT?

Most commonly, the teeth affected are the wisdom teeth, premolars (located between the canines and molars), upper lateral incisors (located on each side of the central incisors or front teeth), and lower central incisors (bottom front teeth). In most common cases, less than six permanent teeth fail to develop. Interestingly, CMT is found more often in women than men, and it’s been noted to exist at a much higher than average rate in identical twins.

Why prompt treatment is important:

As we know, there are many reasons why it’s important for children to see a dentist and orthodontist at an early age in order to establish a positive relationship and ensure their teeth and jaws are developing properly. (This means scheduling a dental appointment for them every six months from the time their first tooth erupts, and an orthodontic screening when a child is seven years old.) This way, if there is a missing tooth or other issues, options can be explored in order to determine the best course of treatment before the situation becomes more difficult to correct. Early treatment will also minimize the extent of complications such as reduced chewing ability, difficulty with pronunciation, an irregular bite, nutritional deficiencies, low self-esteem due to an unfavorable appearance, and other issues (2, 3).

Gum disease, injury, and tooth decay can cause the loss of permanent teeth and, unlike congenitally missing teeth, these factors are preventable. Luckily, regular dental appointments will allow us to catch and treat gum disease and tooth decay before it results in tooth loss.

Complications of missing teeth:

If missing teeth are not promptly treated, a variety of complications could arise for the patient. “Besides an unfavorable appearance, patients with missing teeth may suffer from malocclusion, periodontal damage, insufficient alveolar bone growth, reduced chewing ability, inarticulate pronunciation, and other problems,” most of which need rather costly and challenging treatments (2).

One common complication in this situation is that teeth without an opposing tooth to bite into can experience an ‘overeruption’. This is where root surfaces end up exposed, gums can recede, the supporting bone can be affected, and the tooth itself, as well as the adjacent teeth, can be at risk of tooth decay or cavities.

When even one tooth is missing, it can create a “domino effect” where the other teeth will move out of alignment. Poor alignment can cause other dental and health problems, including cavities, gum disease, headaches, and TMJ disorder, just to name a few.

Prevention:

Since genetics are the cause of congenitally missing teeth, there is no way to prevent this. However, losing permanent teeth due to decay or gum disease can be prevented through good oral hygiene, a healthy diet, and regular dental appointments.

One of the most common causes of teeth being knocked out is from sports. Although not all injuries that result in knocked-out teeth can be prevented, if you are diligent about wearing a well-fitted mouthguard while playing sports (and make sure your child wears one) you greatly reduced the risk.

Treatment options:

Your treatment options will be tailored specifically to your unique situation and will include consideration of the specifics of your condition, how your bite functions, aesthetics, your needs and financial situation, and any other important factors. The ideal treatment should always be the least invasive possible, meaning the option that satisfies your needs and also results in the smallest impact on nearby healthy teeth. When a tooth is missing, there are a variety of good options for the long-term health of the mouth and we can help you determine the best course of treatment for replacement of the missing tooth.

Our goal is to ensure that any patient who is missing teeth will be treated holistically so we gain the best case scenario for the entire oral cavity, which allows it to be maintained and kept healthy for a lifetime. If your child is missing teeth, Dr. Culp, our pediatric dental team, and our orthodontic team will work together to coordinate the best possible treatment for your child. If our orthodontic team is treating an adult with missing teeth, we will coordinate care with your general dentist to be sure that your treatment is seamlessly executed to create excellent, long-lasting results.

Treatment options include:

  • Closing spaces or gaps

  • Placing an implant (If we are treating your child this can be done once they reach skeletal maturity.)

  • Placing a bridge (This option is less desirable because it affects healthy teeth.)

  • Using removable prosthetics

Examples of treatment options:

Since every person’s situation is unique, treatment can be very different for this condition. In these x-ray images, you can see two instances of children with congenitally missing teeth (one congenitally missing permanent second premolar, and two congenitally missing right and left permanent lateral incisors). To help you understand the variety of treatments available, you can read on to discover the treatment options that we suggested.


To treat the missing permanent second premolar:

  • We first removed the existing primary second molar because the erupting permanent first premolar was eating away at the primary molar’s roots. We could not allow the primary tooth to remain until it naturally fell out for that reason.


  • Now, we will monitor the growth and development of the patient until they are mature enough for orthodontic treatment.


  • At that time, we will provide the choice to maintain the space for a possible future implant or to close the space. At this phase, we will be cautious and ensure that either choice leaves the little one with optimal alignment and the best overall cosmetic and functional results.

To treat the missing lateral incisors:

For these missing teeth, a different approach is used. We gave the child’s mother two options for treatment. Both options will allow the child’s mouth to function well and remain healthy throughout their lifetime.

Option 1. Correct and align the teeth and preserve space using two prosthetic teeth until permanent implants can be placed when the child reaches skeletal maturity, or

Option 2. Contour the permanent canine teeth to look like the missing lateral teeth, align them, and close all spaces.

If your child’s tooth gets knocked out, this is a dental emergency, so please call us right away. If you notice that your child’s tooth is not growing in right, or a tooth is missing for any other reason, we are here to help you make the best decision for the long-term health of your child’s mouth. We also have many options in orthodontic care for adults who are missing teeth and would be happy to schedule your complimentary consultation.


At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.


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1. Al-Ani, Azza Husam et al. “Hypodontia: An Update on Its Etiology, Classification, and Clinical Management.” BioMed research international vol. 2017 (2017): 9378325. doi:10.1155/2017/9378325

2. Rakhshan, Vahid. “Congenitally Missing Teeth (Hypodontia): A Review of the Literature Concerning the Etiology, Prevalence, Risk Factors, Patterns, and Treatment.” Dental Research Journal, U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/pmid/25709668/.

3. Resnik, Randolph. “When Permanent Teeth Don't Grow.” When Permanent Teeth Don’t Grow, International Congress of Oral Implantologists, https://www.deardoctor.com/articles/when-permanent-teeth-do-not-grow/.

4. Abdulgani, Azzaldeen, et al. “Congenitally Missing Lateral Incisors; Orthodontic, Restorative, and Implant Approaches.” International Journal of Dentistry and Oral Health, vol. 2, no. 3, 2016, pp. 71–81., doi:10.25141/2471-657x-2016-3.0071. https://biocoreopen.org/ijdoh/Congenitally-Missing-Lateral-Incisors-Orthodontic-Restorative-and-Implant-Approaches.php.


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