How will I know if a permanent tooth is missing?

An x-ray will be necessary to confirm that a permanent tooth is missing.  Sometimes the issue of a missing permanent tooth is noticed because a baby tooth is retained too long or a baby tooth was lost but the replacement tooth never erupted.  Sometimes it’s noticed through routine x-rays.  However it’s noticed, it must be confirmed with an x-ray to determine the permanent tooth is actually missing and not just impacted (blocked or unable to erupt).


Why does this happen?

Hypodontia (missing 1-5 permanent teeth excluding the wisdom teeth) is usually genetic. Oligodontia is the absence of six or more teeth (excluding wisdom teeth) which is rare. Sometimes a permanent tooth may be lost due to accident or injury.


Are there specific teeth that are more commonly missing?

Usually, it’s the upper lateral incisors (the teeth next to the front centrals), the second premolars (the teeth before the molars), the lower incisors or the wisdom teeth that are more commonly missing.


What are my options?

Once it’s determined that a permanent tooth is missing then there are basically three different options to deal with this issue.

One option is to leave the deciduous tooth in place for as long as it will last.  If there is not significant crowding and the tooth itself and roots are healthy then sometimes the deciduous tooth can be preserved and actually last for years.

Another option is to close the space orthodontically.  This can be a good option when there is a bite issue or an issue of crowding.

The other option is to replace the missing tooth with a bridge or implant. Often orthodontic treatment is necessary with this option as well in order to idealize space for the replacement tooth.   Final replacement with a bridge or implant can only be done once the patient’s jaws are done growing so temporary replacements will be utilized until then.


How do I know which option is best?

An orthodontic consult is the way to determine which option is best.  There are many factors to consider when making this decision.  An orthodontist will consider factors in the teeth, bite and face while also considering the long term effects of each option such as maintenance of the replacement tooth, timing of treatment and cost.


There is not a simple answer to the issue of missing permanent teeth.  Two patients with the same missing tooth may be treated differently.  It’s important to consult an orthodontist when you realize or suspect there is a missing permanent tooth.