What to Do if Your Child Is Missing a Permanent Tooth

Everyone looks forward to a visit from the tooth fairy when our children are young and lose a baby tooth. But if you have an older child or teenager that loses a permanent tooth, or never develops one or more of their adult teeth, it can be a far cry from being a celebration. It is a stressful and often upsetting situation. Our jaws continue to develop until closer to adulthood which makes treatment not as simple as immediately replacing a permanent tooth after it is lost. Here at Dillehay Orthodontics, we understand how worrying oral issues can be to parents and will do all we can to set your mind at ease. Let us take a look at what the causes are and what we can do about it.

Most people end up with a completed set of thirty-two permanent teeth. If any of these teeth fail to fully develop, it is considered to be a case of congenitally missing teeth, or hypodontia. Hypodontia is one of the most common developmental abnormalities in dentistry. It ranks right up there with double teeth or having an extra tooth. 20% of all adults are missing at least one tooth, that is how common it is!  The most common congenitally missing teeth are:

The wisdom teeth – these often pesky teeth are the ones all the way in the back of the mouth. The percentage of adults with missing teeth would drop from 20% down to 5% if people missing wisdom teeth were taken out of the equation. That is how many people have congenitally missing wisdom teeth!

The second premolars – these are the teeth right in front of your molars. If your child is missing this permanent tooth, chances are it is due to hypodontia, although one may sometimes be removed during braces treatment.

Upper lateral incisors – The two teeth that sit on either side of your two front teeth.

Lower central incisors – The two front teeth in the lower jaw.

Congenitally missing teeth are much more common and noticeable in permanent teeth.  Less than 1% of children have a congenitally missing baby tooth. If they are missing a baby tooth, it is likely that there is not a permanent tooth developing in the gums underneath it, either. There are usually only one or two teeth missing rather than multiple teeth in most cases of hypodontia.

Child missing front tooth pointing at it with her finger

Causes of a Congenitally Missing Tooth

It is a complex process the way teeth are formed in our mouths. There are many genetic signals that need to be read correctly to complete it. Most cases of hypodontia result from problems with the dental lamina. The tooth begins to form underneath this band of tissue. The dental lamina failing to form can be caused by a number of genetic factors. Most research points to a mutation of any one of three specific genes that have a big role in the development of the teeth. If a mutation occurs and the dental lamina is missing, it is likely that the corresponding tooth will not form, either. Congenitally missing teeth are also often associated with various syndromes, such as Down’s Syndrome, as well as genetics.

Because there are so many reasons for a missing permanent tooth, the best way for professionals like Dr. Dillehay to determine what is happening is through a set of dental x-rays. There are typically three options when a permanent tooth is missing:

  • preserve the baby tooth
  • replace the missing tooth
  • orthodontically close the space

The best choice for any particular patient is based on the condition of the teeth, the bite, the amount of crowding, and a number of other variables.


There are a number of ways in which orthodontics can be used in conjunction with dentistry to help correct hypodontia. Orthodontics can create a space in the area where a tooth should have arrived, but did not, and another tooth has filled that gap. This can make room for an implant. A space left by a missing tooth can also be closed by guiding other teeth into position to close that gap. To accomplish this, tooth shaping is sometimes employed to properly fit and mimic the look of the type of tooth that would normally be in that spot naturally.


An implant is the absolute best solution for missing teeth because of its strength, durability, and cosmetic appeal, but implants are only viable after your child has concluded the growth phase of adolescence. The only way to be certain if your child has finished their growth is with a visit to the orthodontist. At Dillehay Orthodontics we can determine if growth has stopped by performing a series of 360-degree cranial x-rays that are known as cephalometric scans.

girl missing a tooth

Accident and Injury

The associated problems and treatment options will mostly be the same if you have an older child who has lost an adult tooth not through hypodontia, but due to an accident or injury. The potential for damage and long-lasting difficulties can be different, though. Baby teeth that have been forced into the gum can damage the permanent teeth beneath them. Losing a tooth before it is ready to come out can lead to other teeth crowding into the vacant spot, which may not leave enough room for the adult tooth to emerge, causing crooked teeth. This can be alleviated by inserting a space maintainer where the tooth is lost to keep that area of your child’s mouth open until the permanent tooth naturally begins to emerge.

A knocked out permanent tooth can sometimes reattach if held in place for several weeks by splinting the lost tooth to the teeth next to it using a thin plastic or metal wire. Over time, the ligaments that join the tooth to the bone will regrow, and we will check regularly to see whether the tooth has reattached and if it is safe to remove the splint.

Dillehay Orthodontics has a team of highly trained and skilled dentists and staff to provide the best in personalized service! Whether your older child is dealing with obvious hypodontia, a suspected case of congenitally missing teeth, or a tooth that has been knocked out due to injury or trauma, we are here to help. If you are in the Wichita area and want compassionate and customized care for your child’s smile, get in touch with us today!