Missing Permanent Tooth

Parent Q&A

  • Options to resolve missing adult tooth

    (11 replies)

        Our daughter, now 13.5, was born missing her wisdom teeth and one of her rear adult bicuspids.  For now, the baby tooth remains in that place holding the space open. In the long run, leaving the baby tooth there will cause other issues, as would simply pulling it out. Her orthodontist is looking at two options: either replacing the tooth with an implant when she has finished growing; or remove both the baby tooth and the corresponding adult bicuspids in the other three quadrants of her mouth, and adjust the position of the remaining teeth to eliminate the gaps. He noted that implants can present problems, and indeed my husband's jaw more-or-less rejected an implant installed by a reputable guy -- we're waiting to see if the replacement implant works out.
        We plan on getting second opinions before proceeding, and none of the steps I've described would happen immediately. We're also interested in what folks at the receiving end of such treatments have experienced.  Has anybody out there had this type of problem or similar treatments?  Thanks!

    As an adult, due to a gum issue, they had to extract one of my molars (the one at the very rear).  We just left it open, it took a little getting used to, but has been fine.  I don't know if my age (middle aged) had anything to do with that decision. I also had an implant for a tooth that was between two other teeth, and that implant went fine.

    I am missing one teeth too (as my dad did), I am 46 and still have my baby tooth! It's just recovered. I am not a dentist. But I would not remove it if it remains in place. You can protect the teeth by covering it and see what happens. 

    I never got my lateral incisors (second teeth from the front on top) on either side as baby teeth or adult teeth. My parents had the option of moving my teeth forward or creating space and getting implants. I also had wisdom teeth that were going to come in impacted unless all of my teeth were moved forward. They decided to do the spacing and get implants for me (I may have contributed to the decision - can’t remember, I was in 6th grade). I got the implants at 17 and have had them for 15+ years now. No issues with them and it was the right decision. I ended up having all 4 wisdom teeth removed and the titanium implants implanted at the same time. It was a rough few days then but it got everything taken care of at once. 

Archived Q&A and Reviews

5 yo won't have one permanent tooth

October 2003

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 calcium.

The dentist did say that it is his gene to cause this missing tooth. But how can I help him? Anon

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. julia

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. Been there

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. margo

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... kim

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. loria

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. nice smile!!

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. ali

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 replace them.

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 teeth! anon

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. Olivia

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 looked nice.

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 lori

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. Whatever!
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. Mike

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