My three year-old never got upper eye teeth

Dear Kim,

My son, who is almost 3.5 years old, never got his upper eye teeth. My dentist advises against x-rays, as he feels that it's not wise to expose him to the radiation. He wants to x-ray when he's about 5, to see if the adult teeth are there. At this point, there is ample space for those teeth.

What are my options if he never gets those teeth?

Question:

Dear Kathi,

You have a couple of options if your son never develops these teeth. First, I want to address the issue of the x-ray just for your information. According the textbook "Oral Radiology Principles and Interpretation," Edition II, by Paul W. Goaz, D.D.S., S.M. and Stuart C. White, D.D.S., Ph.D., published by the C.V. Mosby Company in 1987, a person in an average location in the United States would have to have a complete full mouth intraoral periapical (shows the whole root of a tooth) and panoramic examination every 4 months to equal the exposure of a person living in Denver exposed only to the natural radiation (sun) present there. While it is fine to have caution in the amount of radiation to which we expose our patients, they are necessary to help us diagnose decay and potential problems. I also do not normally take x-rays (radiographs) on children under 5 or 6 years of age, unless I suspect decay or a potential problem. In your son's case, it might be prudent to take one radiograph of the upper anterior (front) teeth to determine the situation.

If your son never develops these teeth, one option is to do nothing. One function of primary teeth is to hold the place for the permanent teeth. This function is most important in the posterior (molar) region. If a primary molar does not develop or is lost prematurely, we always recommend placing a space maintainer to help hold the place for and guide proper eruption of the permanent teeth. This is not as important in anterior region. The anterior teeth, however, are important for esthetics and phonetics. Again, since it sounds like your son has his incisors (the four front teeth), this is not as big a concern. If you would like to fill in the space, though, it is possible to create an appliance which contains these eye teeth for your son to wear. As he grows and his jaw changes, new ones will need to be made. If you are interested, I recommend discussing this possibility with your dentist.

As your son loses his primary teeth and develops his permanent teeth, you and your dentist should monitor this development. While not developing all the baby teeth does not guarantee your son will be missing permanent teeth, a close watch should be kept. If not all permanent teeth develop, you have more options for replacement. Please see answers to previous questions regarding missing permanent teeth for more information.

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