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Why Aren’t My Child’s Permanent Teeth Coming In?

If your son or daughter has lost a baby tooth and there is no sign of a permanent tooth coming in after a few months, there can be a couple of common and a few uncommon reasons why this may occur.

One of the main reasons is that there may be a lack of space for the permanent tooth to erupt.  This is especially true in the front of the mouth, where the adult teeth are much wider than the baby teeth that they replace. So if there is not enough space, there is a chance that the adult tooth is having a hard time erupting and won’t appear in the mouth. 

Another reason that they may not be erupting in the proper space that the permanent tooth could be moving in a different direction.  There are some instances when a developing permanent tooth can move away from its usual spot.  In this instance, it does not follow and replace the baby tooth, but may interfere with the development of other teeth.  The term for this instance is often referred to “an impacted tooth” by orthodontists and dentists. The most common impacted teeth are upper canines (often called fang teeth by patients) and lower second premolars.  If a tooth has been spotted to have a deviated eruption path, it could help to remove a baby tooth to get the tooth back on track, as soon as it is noted.  If the path doesn’t change, orthodontic treatment is often necessary to help guide the displaced tooth into the proper position.

In addition to these main concerns, there may be additional factors that orthodontists need to consider when dealing with impacted teeth.   One of these rare conditions is that the permanent that usually replaces the corresponding baby tooth may have never developed.  This is often not known until we take xrays at an orthodontic office to see if a tooth is not present. 

Another rare condition is something called “primary failure of eruption”, which ultimately means that the tooth will not come in on its own and needs help to erupt.  A combination of oral surgery and orthodontics is needed to help these teeth erupt into the proper place.  There be more than 1 tooth that is affected by this condition and orthodontic treatment may take longer than the usual 2 years. 

Lastly, ankylosis is another less common reason for adult teeth to not erupt.  Essentially, this is when a baby tooth becomes fused to the bone and won’t move.  The most common solution to this situation is their removal or leaving them in place until a future restorative option can be determined.

If your son or daughter has lost a baby tooth and you do not see a replacement adult tooth after a few months, you should have him or her evaluated by an orthodontic specialist.  An orthodontist a dental specialist that is trained in the diagnosis and treating the problems related to development of teeth.  They can determine if treatment is warranted, the optimal timing for possible treatment, or just reassurance and peace of mind if treatment is not needed.