When our children are young and lose a baby tooth, we look forward to a visit from the tooth fairy. But what if you have an older child or a teenager that has lost a permanent tooth, or who has never developed one or more of their adult teeth? Far from being a cause for celebration, this can be a stressful and often upsetting situation. Because our jaws continue developing until closer to adulthood, treatment may not be as simple as immediately replacing a permanent tooth after it is lost. Here at Children’s Dental Center, we understand how worrying oral issues can be to parents, and we want to do all we can to set your mind at ease if you have an older child with a missing adult tooth. Let’s take a look at what can cause this to happen, and what we can do about it.

Congenitally missing teeth

Young girl with braces

Most people will end up with a completed set of thirty-two permanent teeth. If any of these teeth fail to fully develop, it will generally be considered a case of congenitally missing teeth, or hypodontia. Hypodontia is actually one of the most common developmental abnormalities in dentistry, ranking right up there with double teeth or having an extra tooth. It’s so common that up to 20% of all adults are missing at least one tooth! 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. So many people have congenitally missing wisdom teeth that were you to take them out of the equation, the percentage of adults with missing teeth would drop from that 20% figure right down to around 5%.

The second premolars – these are the teeth right in front of your molars. One may sometimes be removed during braces treatment, but if your child is missing this permanent tooth, chances are it’s 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 therefore more noticeable, in permanent teeth.  Less than 1% of children will have a congenitally missing baby tooth, and for those who do, it’s likely there isn’t 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.

What could cause a tooth to be congenitally missing?

The way that teeth are formed in our mouths is a complex process, and there are many genetic signals that need to be read correctly to complete it. In general, most cases of hypodontia result from problems with the dental lamina. This band of tissue underneath the gums is where the tooth begins to form. There are a number of genetic factors that can result in the dental lamina failing to form, with most research pointing 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’s 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.

What can be done about congenitally missing teeth?

Typically, children will 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 has lost a primary tooth and a replacement hasn’t appeared within a reasonable amount of time, what steps should you take?

Because there are so many reasons for a missing permanent tooth, the best way for dentists like Drs. Rowland, Selecman, and Daniel to determine what is happening is a thorough 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

These methods are not always interchangeable, and the best choice for any particular patient will be decided based on the condition of the teeth, the bite, the amount of crowding, and a number of other variables.

If your child is missing a permanent tooth, the most appropriate treatment for them can be ascertained by an examination with a qualified dentist. At Children’s Dental Center, our doctors will examine the alignment of your child’s teeth, the amount of crowding if there is any, and the bite. There are several treatment options that can be pursued in order to help improve the functionality of their bite and improve the overall cosmetic appearance of their smile. Some options may not be immediately available, however, until your child is in their late teens or entering adulthood. Some of these options are:


There are a number of ways in which orthodontics can be used in conjunction with dentistry to help correct hypodontia. One example is orthodontics creating a space in the area where a tooth should have arrived, but didn’t, and another tooth has filled that gap. This can make room for an implant. Another option would be the closing of a space left by a missing tooth 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. However, implants are only viable after your child has concluded the growth phase of adolescence. There are some who believe 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, and the only way to be certain of this is to work with an experienced dentist to determine the right time for placement. We can determine if growth has stopped by performing a series of 360-degree cranial x-rays that are known as cephalometric scans.

Removable bridge

A removable bridge is another common approach to congenitally missing teeth. This is actually a combination of a denture, because it is removable, and a bridge, since it bridges the gap between any number of missing teeth. These partials are able to provide stability for the bite as well as a reasonable amount of cosmetic appeal. Similar to removable retainers used after braces treatment, these may be uncomfortable at first, but they are easy to get used to.

Traditional bridge

A traditional bridge functions in the same way as a removable bridge, bridging gaps between teeth, but unlike partials, it is fixed and not removable. This is adhered directly to the surface of the teeth opposing the gap. Fixed bridges may be preferred over removable bridges in certain cases, but they can be a bit more challenging to clean, and will usually require reducing certain healthy portions of the adjacent teeth.

Composite bridgework

A composite bridge is a compromise between a fixed bridge and a partial one. We shape a “replacement” tooth with bonding material, and then adhere it to the surfaces of the adjacent teeth without having to remove any of the healthy tooth material from them. Should an implant or other solution be preferred 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 essential to keep it functioning as it should.

Losing a tooth through accident or injury

If you have an older child who has lost an adult tooth not through hypodontia, but due to an accident or injury, both the associated problems and treatment options will mostly be the same. Where this differs is in the potential for damage and long-lasting difficulties. Baby teeth that have been forced into the gum can damage the permanent teeth beneath them. Losing a tooth before it’s 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 particular issue can often be prevented by dentists 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. Experienced dentists are able to splint 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’s safe to remove the splint.

Keep calm & call Children’s Dental Center

CDC Staff Photo

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, Children’s Dental Center has a team of highly trained and skilled dentists and staff to provide the best in personalized service! If you’re in Memphis or the surrounding area and need intuitive, compassionate, customized care for your child’s smile, get in touch with us today to get started!