At Children’s Dental Center, we know that dental problems can be stressful for parents and caregivers. One problem we often see is when older kids or teens are missing one or more permanent teeth. This can make parents and patients worry about why it’s happening and how to fix it. But it’s important to know that a child’s jaw is still changing and growing until they’re almost an adult. Because of this, treatment isn’t always as simple as just replacing the missing tooth.

If you have an older child or teen with a missing permanent tooth there are several ways that orthodontic treatment can help your child – and you! – through what can be a stressful and worrying situation. We know you want the best for your child’s oral health and smile, and we are committed to helping our patients look and feel their best! One of our experienced doctors will work to create a customized treatment plan for their particular case, and our team will walk you through the process every step of the way. To understand more about what can keep a child’s permanent tooth from coming in and how we can help, keep reading below! 

Congenitally missing teeth

Most people end up with a full set of thirty-two permanent teeth. If any of these teeth fail to fully develop, it’s generally attributed to a case of hypodontia or congenitally missing teeth. Hypodontia is actually one of the most common dental developmental abnormalities, with up to 20% of all adults missing at least one tooth. Hypodontia most often affects: 

The wisdom teeth – these teeth are normally found all the way in the back of the mouth. Congenitally missing wisdom teeth are so common that were you to take them out of the equation, the percentage of adults with missing teeth would drop from that previously mentioned 20% figure all the way down to around 5%! 

The second premolars – these are the teeth that reside right in front of your molars. One of these may be removed if your child, at any point, receives braces treatment from an orthodontist, but if your child is missing this permanent tooth, it will almost always be due to hypodontia.

Upper lateral incisors – these are the two teeth that sit on either side of your two front teeth.

Lower central incisors – these are 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 will have a congenitally missing baby tooth, and of those who do, there is most likely not going to be a permanent tooth developing in the gums underneath it, either. In most cases of hypodontia, there will only be one or two teeth missing rather than multiple teeth.

Causes of congenitally missing teeth

The way teeth are formed in our mouths is a complex process, and there are a multitude of genetic signals that need to be read correctly in order to complete it successfully. Generally speaking, most cases of hypodontia result from problems arising with the dental lamina. This band of tissue underneath the gums is where the tooth begins to form. 

Several genetic factors can result in the dental lamina failing to develop. Most current research points to this being due to a mutation with any of three specific genes that have a big role in the development of the teeth. If a mutation causes the dental lamina to be missing, the corresponding tooth usually does not form, either.  

Congenitally missing teeth can also be associated with various medical conditions and genetic disorders, such as Down’s Syndrome.

What to do about congenitally missing teeth

Children will typically lose their last baby tooth by around the age of twelve. In most cases, the loss of a baby tooth is quickly followed by the eruption of the new permanent one. If your child loses a primary tooth and a replacement hasn’t appeared within a reasonable amount of time, you may wonder if there are any steps you should take to find out why.

The most appropriate treatment for any child missing permanent teeth can be ascertained by an examination with a qualified dentist. A dentist will be able to examine the alignment of your child’s teeth, the amount of crowding, if there is any and the bite. Because there are so many reasons for a missing permanent tooth, a thorough set of dental X-rays is often the best way to see what’s going on. There will usually be three options when a permanent tooth is missing:

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

These methods aren’t always interchangeable. One of our doctors will work to determine the best choice for your child based on the condition of their teeth, their bite, the amount of crowding (if any), along with several other variables.

Fortunately, there are quite a few treatment options available that can help improve the functionality of your child’s bite and the overall appearance of their smile, including: 


There are many ways that orthodontics can be used in conjunction with dentistry to help correct hypodontia. One example of this is orthodontic treatment creating a space in the area where a tooth should have erupted, but didn’t, particularly if another tooth has filled that gap. This can make room for an implant. Another option would be closing a space left by a missing tooth by guiding other teeth into position to close that gap. To accomplish this, we sometimes employ tooth shaping to properly fit and mimic the look of the tooth that would typically be in that spot.


Implants are the ideal solution for missing teeth. They are strong and durable and create aesthetically pleasing results. However, implants are only an option for your child once they’ve concluded the growth phase of adolescence. You may believe that once teens have reached a certain age, we can safely assume they’ve stopped growing and can be fitted with an implant, but every child is different. The only way to be certain of the right time for an implant is to work with one of our experienced dentists to determine the right time for placement. 

Removable bridge

A removable bridge is a common approach to treating hypodontia. In spite of the name, it is actually a combination of a denture (because it is removable) and a bridge (because it bridges the gap between any number of missing teeth.) These bridges provide stability for the bite as well as a reasonable amount of cosmetic appeal. They are a bit similar to the removable retainers we use after braces treatment, and while they may be a bit uncomfortable at first, they take no time to get used to!

Traditional bridge

A traditional bridge functions in the same way as a removable bridge, but unlike its partial counterpart, it is fixed and not removable. Fixed bridges are adhered directly to the surface of the teeth opposing the gap. There are some cases in which a traditional bridge will be preferred over a removable one, but they can be a bit more difficult to keep clean, and may also require the reduction of certain healthy portions of the adjacent teeth.

Composite bridgework

A composite bridge is essentially a compromise between a fixed bridge and a partial one. A member of our skilled team will shape a “replacement” tooth with bonding material, then adhere it to the surfaces of the adjacent teeth without having to remove any of the healthy tooth material from them. If an implant or other solution becomes the preferred treatment choice at a later date, this bridge can easily be removed. It has some of the same cleaning challenges as a fixed bridge, so a proper oral care routine is a crucial part of keeping it functioning as well as it should.

Reasons Your Child's Permanent Teeth Aren't Coming In

Set your mind at ease with Children’s Dental Center

For children or teens who are dealing with a suspected (or obvious!) case of hypodontia, Children’s Dental Center offers the best personalized, compassionate care for families in Collierville, Midtown, and Arlington! Our state-of-the-art offices are fully equipped to handle diagnosing, treating, and creating a fully functional smile that works well and looks great. One of our experienced doctors and the rest of our amazing team provide innovative treatment options that are customized for each patient we see, so contact us today to schedule your child’s first dental appointment. We have what it takes to give your child the smile they deserve!