Lost Tooth Not Replaced

I have a seven-year-old daughter. During the process of growing up, her teeth would literally push each other out and be immediately replaced with new ones. Unfortunately, the last tooth that came out 3 months ago was never replaced. Could it have been a permanent tooth?

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The two teeth together in the front of the mouth are called central incisors. The teeth on either side of the central incisors are called lateral incisors. The permanent lateral incisors are the most likely teeth to either be missing or misshapen (usually referred to as a "peg" lateral). While this may not be the case with your daughter, it would be a good idea to have a radiograph (x-ray) taken to see if the lateral incisors are just developing slower than the central incisors or if there is, in fact, a problem. An occlusal x-ray should be taken.

If the x-ray reveals that the lateral incisors are present but misshapen, there are several treatment options after the laterals erupt. At first, options are limited because the nerve inside a new permanent tooth is usually large, and a dentist would not want to traumatize that nerve by doing extensive work, such as placing a crown (or cap) on the tooth. Perhaps, some tooth-colored filling material (called composite) can be bonded to the tooth to create a more aesthetic look as the child grows. Later, when the nerve is smaller and development is more complete, treatment options may include porcelain veneers or crowns.

If the lateral incisors are completely missing, again you have several treatment options. An orthodontic procedure to move the teeth to fill in the missing space is a possibility. While the child is young, a removable partial denture is an option to fill in the spaces until the permanent teeth on either side of the space are erupted and developed enough to have more extensive work. When the child reaches late teens, a conventional bridge or a procedure called a Maryland bridge can be completed to fill the space. A bridge fills in a space by preparing the teeth on either side for crowns. A fake tooth will be attached to these two crowns. A Maryland bridge is a much more conservative procedure requiring less tooth structure removal than a conventional bridge. Maryland bridges have a tendency to come off. They may need to be recemented. Another option in the later teens or early twenties might be dental implants.

I urge you to take your daughter to the dentist for a radiograph first. If a problem does appear, then you should discuss these options with your dentist.

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