Missing teeth at ten - what do?

May 23, 2013 2:05 PM

YANMson's dentist. His bones are all fine, but his on-the-small-side mouth is equipped with two less than the regulation 32 teeth: one pre-molar missing upper right, and one pre-molar lower left. (His last two milk teeth are still there, in their stead.) My question is: what are the typical options - or else what's a good resource for reading up on them?

As we've been had it explained to us, it pretty much boils down to: either pull out the two milk teeth, and get fixed braces that hold the spaces for the missing teeth free until the jaw grows/sets, and then put in two tooth replacements in their place; or else, since his ain't a spacious jaw to begin with, also pull out the corresponding upper left and lower right adult teeth in order to regain 28-toothed symmetry, and use fixed braces for a couple of years to realign everything properly.

Or are there other thoughts/options?

posted by progosk to Health & Fitness (17 answers total)

Have you actually asked them why the milk teeth can't stay? I have two milk teeth and they were perfectly fine until I was about 25 when one broke off when I bit into a nut...they are not really supposed to be used so long and withstand an adult diet...but several years down the line I still only have that one filling due to the nut incident and still have both of those teeth. A former dentist did try to push implants on me. At the time I couldn't afford implants. Whilst I can afford them now I would not want to go there unless the filling comes out. At that point the tooth really could not be saved any more because there's not enough left for a new filling.
posted by koahiatamadl at 2:11 PM on May 23, 2013 [1 favorite]

Both of those options sound right to me based on my experience with dental work in my family (IANADentist). I'd go with the latter - one thing to consider is that putting in implants in their place leads to him having to deal with implants for the rest of his life (sometimes there are complications years later). I'd rather have less real teeth than two fake teeth, if it were appropriate for my jaw size.

But I'd definitely not pursue that route (pulling the opposing adult teeth) until he is 15 or 16 and you have a better idea of what size he'll end up (do you or your husband have small/overcrowded mouths?).

I know several people who have had 2 or 4 teeth pulled (matching pairs on either side) because their mouths were small/overcrowded, not because they were missing an adult tooth. It's not that uncommon.
posted by amaire at 2:16 PM on May 23, 2013 [2 favorites]

My daughter (19) is missing two permanent teeth - I think the same spots as your son's. It's genetic, apparently, because my husband and his mother both had the same thing. She had braces with the "baby" teeth in place and they just pulled one (lower pre-molar) this past spring when she had her wisdom teeth removed. That one will be replaced with an implant. They are leaving the other one in place, but keeping an eye on it in case it needs to be removed later.
posted by Sweetie Darling at 2:18 PM on May 23, 2013

I have a small mouth and just 24 teeth now. I had braces when I was really young (5th grade, so 11 years old) and they actually took out my just-growing-in permanent teeth behind my canines and I had braces and the holes just closed up. Wisdom teeth got taken out when they were growing in, sometime in early high school. Personally I am happy and not having to deal with implants as an adult and the teeth I have fill up my whole mouth so I don't really miss not having more teeth.
posted by jessamyn at 2:22 PM on May 23, 2013 [1 favorite]

I didn't finish losing teeth until I was 12, at which point I got braces. I only had three wisdom teeth.

Everyone's mouth is different, and I'm obviously no dental expert, but ten just seems really early to me to start going down this path. If I were in your position, I would wait another year or two until he's a bit more fully cooked before thinking about making permanent changes.
posted by phunniemee at 2:27 PM on May 23, 2013

Response by poster: on keeping the two milk teeth: the roots of one seem to have pretty much disappeared, and the other one has a small cavity...

just generally, for cultural context: seems like here in Italy kids are all getting braces around this age - is this down to concerted dentists' initiative/jumping-the-gun? Is there a different established appropriate average age for starting this sort of tooth work elsewhere?

So far we're leaning towards avoiding implants...
posted by progosk at 2:33 PM on May 23, 2013

Pulling them plus pulling the symmetric ones so he's down to 28 is pretty normal around where I grew up (east coast USA). If his mouth is already small, having fewer teeth may even mean he'll be lucky enough not to have to get his wisdom teeth pulled.
posted by juniperesque at 3:00 PM on May 23, 2013 [1 favorite]

This is indeed a genetic condition, which my sister and I inherited from my mother. In my case, nobody noticed until I was seventeen, at which point I needed both surgery (to release the adult teeth from my jawbone) and braces (complete with cute little rubber chains) to correct it; whichever option you choose, doing it right now should lessen the aggravation later.
posted by thomas j wise at 3:04 PM on May 23, 2013

I have two congenitally missing teeth (though in different places than your son). The options (probably circa 1996 when I was 10) were pull the baby teeth and the corresponding adult teeth on the top and close the gaps with braces or see how long the baby teeth last. In principle, they can last your entire life. Mine didn't. They were starting to go and were pulled and replaced with implants when I had my wisdom teeth out at 17.

I saw two different orthodontists, one who believed in each plan. Ultimately, the 'leave them and see what happens' guy had a more compelling argument. I am not aware of a downside to having had implants what is now nine and a half years later.

My guess is that you're probably not going to harm your kid no matter what you pick. If you can get a second opinion, doing what my parents did and picking the more reasonable-sounding guy is probably the best you can do.
posted by hoyland at 3:12 PM on May 23, 2013

My nearly 15yo son has one missing permanent tooth. He has spaces between his teeth already, so we opted to leave his milk tooth in for now and hope for the best. It does have roots and no cavities though. We're in the UK, and he'll get braces next month.

We hadn't heard of this before the dentist showed us his X-rays.

Best of luck whatever you decide.
posted by mgrrl at 3:13 PM on May 23, 2013

My daughter was missing an upper incisor on one side and the one on the other side was a little half tooth. They pulled it and moved everything forward with braces. After the braces the two canines were shaped and filled to match her other two front teeth.
posted by tamitang at 3:23 PM on May 23, 2013

I have 28 teeth, including two "baby teeth" and I'm in my 30s. The baby teeth were fitted with crowns about 10 years ago and they are holding up quite nicely. Mine have great (but short) roots. The shape of these teeth do cause a little trouble next to adult molars, but every dentist I've seen is impressed with these little teeth of mine!
posted by coolsara at 4:02 PM on May 23, 2013

I had this, right down to the same teeth. But I had four missing (top and bottom). The milk teeth were removed when I was eight (the dentist said they might otherwise keep sinking down into the gum and cause problems) and it was fairly painless and easy recovery, even though they did all four on the same day. It's not like wisdom tooth removal where they are large and sometimes fused to the jaw.

Then they just left the gaps. They aren't visible with a normal smile, and they don't cause me issues except occasional trapping of popcorn or something. My teeth have gradually shifted over the years so that the gaps are much smaller, too. And I never had problems with crowding even when my wisdom teeth came in, thanks to the gaps, so I didn't have to get my wisdom teeth removed, and never needed braces.
posted by lollusc at 4:16 PM on May 23, 2013

In the x-rays, are there teeth that will come in to fill the milk teeth spaces? If so I would recommend pulling the milk teeth and have spacers until he is say 12 or 13. That's when most kids finally have all their permanent teeth, except for wisdom teeth. Then you can do braces accordingly. If there are permanent teeth in the jaw but they don't seem like they want to erupt, I have seen devices that can be put in through the gum above the tooth, and slowly help it come on in. If nothing ever comes in, then braces are fine to scoot teeth around to make a nice arch. It will also make things easier when the wisdom teeth come in. It is early but if you're worried I'd take the x-rays and get a consult with an orthodontist. (btw, these are things I picked up as an orthodontist assistant, but things have changed in the last few years)
posted by PJMoore at 5:59 PM on May 23, 2013

I have 28 teeth as I had a milk tooth canine in my upper jaw and spacing issues in my jaw until my late teens. There was an adult canine in my jaw but it was decided that it would probably be damaged if they tried to pull it down, so the milk tooth was taken out along with some teeth from the top and bottom jaw (molars, I think. Quite hard to tell now) and the adult canine was removed from the jaw (this was all done in one operation under GA in the UK). I got braces for just under 2 years to shuffle everything around, so I have no gaps. (which, incidentally has really helped with my bite now as my family has history of overstuffed jaws/crooked bites which has led to a lot of false teeth in later life)

Personally, I think that waiting till I was out of my early teens was the best thing we did as it gave the majority of my teeth the time to come in and I didn't have braces at the time of maximum teenage self-conciousness but I'd probably get x-rays and talk to an orthodontist for their opinion for your son.

I don't yet have wisdom teeth (well, they're there but they apparently show no signs of exiting) and my 28 teeth fit my jaw/mouth much more comfortably than the pre-dental work amount did.

(Of course, should I ever become a vampire, I will take ages to feed, on account of only having one fang but I'll cross that bridge if I ever come to it. Hehe.)
posted by halcyonday at 1:35 AM on May 24, 2013

I'm nearly 44 and still have one baby tooth with no roots. It was covered by bonding during my teens. (Only had top braces so this tooth was not a factor in that.) Still there after all these years, shows no signs of instability. Hoping to keep it forever. Some anecdata for you.
posted by ImproviseOrDie at 4:59 AM on May 24, 2013

Can you just pull the milk teeth and let the surrounding teeth fill the space? IANAD, so I'm not sure how well this works.

I was born without one of my front bottom adult teeth and never had a problem, never needed braces.
posted by Joe Chip at 8:26 AM on May 24, 2013