Missing Permanent Teeth: Best Age to Treat?

My 11 year-old son is missing his three upper and four lower permanent teeth. Full jaw x-rays were taken. Incisors and bicuspids seem to be involved. Needless to say, he is very disturbed by his small deciduous teeth. Our dentist says that we should not have any bonding or capping of the teeth until he is four years older. His deciduous roots are in good shape. What are our options for treatment? What is a good age to begin treatment?

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My first recommendation would be to consult with an orthodontist, if you have not done so already. This consultation will help you determine which deciduous (i.e. primary, baby) teeth are best to keep, which ones may need to be extracted, and what type of space maintenance is required. In the future, you and your dentist can decide which teeth need crowns or porcelain veneers. Bridges or implants may also be necessary. Orthodontics, either now or in the near future, may eliminate the need for some restorative or cosmetic dental procedures.

Because of your son's age, it is a good idea to postpone extensive dental procedures until the nerve tissues in his teeth have had time to fully develop. Perhaps 15 or 16 years-old is a good target date to begin dental work.

Some simple cosmetic bonding, which requires little or no tooth structure removal, can be completed at this time, however. This procedure will help maintain your son's confidence and self esteem. If your dentist feels uncomfortable doing bonding, ask him for a referral to a pediatric dentist that has experience performing cosmetic dental procedures.

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