Missing and Extra Teeth

It is not uncommon for wisdom teeth to be missing.  No one seems to care, but when any other teeth fail to develop, it’s time to make a plan.

Other than the wisdom tooth or third molar, the next most common tooth to be missing is the lower second premolar.  About 3% of children are missing this tooth, and 2% are missing the upper lateral incisor.  That’s the one next to the large upper front teeth.  Upper premolars and lower incisors (those little front teeth) can also fail to develop, but at a lower incidence.

In an adult, the dentist might suggest a replacement for the missing tooth, either with an implant or bridge, but implants and bridges can’t be used in children until their jaws have stopped growing.  However, there is often an orthodontic solution.  With proper planning and treatment, other teeth can be moved forward to close the space, at the same time the bite is corrected and the teeth straightened.  Sometimes it’s necessary to camouflage this substitution by reshaping the replacement tooth, or having the dentist add bonding to the tooth to alter its shape or size a little. With these techniques, it’s usually difficult to detect the missing tooth.  In the rare situation that the space can’t be closed, the orthodontist can fashion a fake tooth or pontic to hide the space until orthodontic treatment is finished, and a more permanent replacement can be made.

If a baby tooth overlying a missing permanent tooth is firm and has a good root, it can act as a temporary space holder.  Baby teeth that have no permanent tooth replacement can sometimes last for years, but they eventually lose their roots and fall out, or they become ankylosed (fused to the bone) and start to submerge as the child grows.

Supernumerary or extra teeth can also cause orthodontic problems.  Most of the time, these extra teeth fail to erupt, but sometimes they block the eruption of the other permanent teeth.  Frequently, they’re not discovered until an orthodontist is consulted because of an alignment problem, or a delayed eruption.  Waiting for all of a child’s baby teeth to fall out before seeking the advice or care of an orthodontist can limit treatment options, and lead to an unhappy teenager (what other kind is there?).

It would be convenient if missing teeth and extra teeth occurred in the same child, but nature is rarely so accommodating.  Extra teeth are frequently misshapen and therefore not that useful.  Usually supernumerary teeth have to be removed. They can be left alone if they don’t interfere with the roots of the other teeth, or are in a location that is difficult to access.  If they are left behind, they should be periodically x-rayed to be sure that they’re not causing problems.

We’re here to help make sense of nature’s folly.  Call for a complimentary examination and we’ll be happy to tell you that your child has the correct number of teeth, or suggest ways to make everything better.

Dr. Arthur Fertman

Dr. Daniela Toro