Missing Teeth: More Common Than You Think!
What? Missing teeth??
In fact, 0.2-16% of the population is missing a tooth, including the wisdom teeth. Aside from the wisdom teeth, the most commonly missing teeth are the upper lateral incisors (2nd from the front) and the lower 2nd premolars (right in front of the molars). Often, orthodontists are the first to inform patients that they have missing teeth. This is diagnosed with a routine x-ray that looks at all of the developing teeth and jaws, called a panoramic radiograph. Since missing teeth is genetic, the family may be aware that their child may be missing teeth, just like one of their parents.
What do you do if a tooth is missing?
If a tooth is missing there are 2 main options: either you replace the tooth or you close the space with orthodontics. If you are replacing the tooth, often an implant or bridge is the best option.
How do you decide if you replace the tooth or close the space?
This decision is a very important one and is made on a patient by patient basis with the treating orthodontist and the family. This decision is based on a number of factors:
- Is the tooth on the other side missing? Usually, keeping things symmetrical is ideal for esthetics.
- How much crowding is there? If there is a lot of crowding, maybe there is not enough room to create or keep space to replace a tooth.
- What does the bite look like? Whether the patient has an overbite, underbite or crossbite will come into consideration for optimal function.
- What does the patient want? Always an important consideration!! The patient has to be open to paying to replace a tooth, if that is the plan.
- What are the surrounding teeth like? Is there enough tooth or bone to properly replace the tooth with an implant or bridge?
How do I know if I am missing a tooth?
Your dentist or orthodontist will let you know if a tooth is missing. This is picked up on a routine x-ray taken by an orthodontist, called a panoramic radiograph. If a family member is congenitally missing a tooth, you will be at higher risk of missing one, too. As a general rule of thumb, if a tooth has come in but its partner on the other side has not come in within 6 months, there may be a problem with that tooth (or it may be missing!)
I thought I shouldn’t take my child to an orthodontist until all of the adult teeth are in?
This is a common misconception. The American Association of Orthodontists recommends the first visit to an orthodontist by age 7. At this visit, the orthodontist will take a panoramic radiograph and will check to see if all of the teeth are present. You don’t know what you can’t see– maybe you will find out that your child is missing some permanent teeth, or might have some extra teeth! If detected early, you can make a plan with the orthodontist for the long-term management of this situation, whether that means creating space to replace the tooth or closing it orthodontically. The sooner it is detected, the sooner you can make a proper plan
Panoramic radiograph of a patient with missing upper lateral incisors
Same patient before and after orthodontic treatment. In their case, the decision was made to close all of the space orthodontically and substitute the canine teeth for the missing laterals. The canines will be bonded by the general dentist so that they appear to look more like “regular” lateral incisors.
Panoramic radiograph of a patient who is missing all 4 adult second premolars.