Children typically lose their last baby tooth around age 12. In most, the loss of a baby tooth is followed almost immediately by the eruption of the corresponding permanent one. If a baby tooth has been lost and a replacement does not appear in a reasonable amount of time, it could be because it is crowded, impacted (headed in wrong direction), or missing. The best way to determine what is going on is a dental x-ray. What can be done if your child is missing a tooth?

There are three options when permanent teeth are missing
There are three options when a permanent tooth is missing: 1) preserve the baby tooth, 2) replace the missing tooth, or 3) orthodontically close the space. These options are not necessarily interchangeable and the best choice is determined by other variables that include the condition of the teeth, the bite, and the amount of crowding.

Sometimes it is best to just keep the baby tooth as long as possible
If the bite is good and there is no crowding, the best option is to keep the baby tooth as long as possible and then replace the permanent one after the baby one is gone. If the baby tooth is in good condition, it may remain in place indefinitely. If it is in poor condition or if its root has been lost, the tooth can be replaced by an implant or a bridge. Trying to close a space orthodontically when there is no crowding and the bite is good is a long, difficult process that can introduce problems as bad or worse than the original. The extended treatment time and asymmetrical mechanics can lead to uneven arches as well as bone and gum problems.

Closing the space is an option if there is crowding or a bite problem
If there is crowding or a bite issue that would require the removal of teeth anyway, removing the baby tooth and closing the space is a good option. This is the case in the lower arch when there is crowding or an underbite. If all of the teeth had developed normally, one treatment option involves the removal of lower bicuspids. If a bicuspid is already missing, only one other permanent tooth would need to go (since the other was never there). If there is crowding or protrusion in the upper, it is not uncommon for upper bicuspids to be removed. If upper laterals or bicuspids are congenitally missing (from birth), the space can be closed leaving no need for a bridge or implants. Again, closing a space where there is no crowding or a bite problem is not usually prudent.

What is the most appropriate treatment for your child? An examination by an orthodontic specialist is the best way to find out. During the exam, he [she] will examine the alignment of the teeth, the amount of crowding, and the bite. If the space can be closed orthodontically, that option will be presented. If space closure is not appropriate, he will work with your dentist to prepare the mouth so that the tooth can eventually be replaced.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.