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  • Writer's pictureDr. Mark Feinberg



In previous blog posts we have discussed various reasons for visiting an orthodontist as recommended by the American Association of Orthodontists (AAO) no later than the age of 7. Which brings us to today’s blog topic…all you wanted to know about missing teeth and more but didn’t know what to ask. Our discussion will be limited to teeth that are missing not as a result of them being removed or lost due to disease or from an accident but rather as a result of never having developed. This condition know as Hypodontia (missing one to six teeth) is characterized by a primary tooth having no replacement by a permanent tooth. There is a genetic tendency for this condition to occur and the technical description is congenital absence of permanent teeth.

A bit of background, excluding wisdom teeth (3rd molars), Hypodontia occurs in 3-8% of the population. The most common missing tooth is the wisdom tooth followed by congenital absence of the lower 2nd premolars. The upper lateral incisors, which are the teeth on either side of the two centered upper front teeth, are the third most commonly missing tooth and occurs in approximately 2% of the population. This may affect one or both upper lateral incisor teeth.

Based on clinical judgment and the patient’s clinical presentation oftentimes a screening film, also know as a panoramic radiograph, will be advised somewhere around the age of 8. This is an excellent tool that Dr. Feinberg will use for diagnosing all types of potential orthodontic clinical issues that may necessitate preventive or interceptive care. The panoramic radiograph is truly essential for assessing whether a patient has a full complement of permanent teeth or is missing any.There are occasions where a tooth may not actually be missing, but hidden underneath the gums and in poor position, preventing normal eruption. This will typically require orthodontic treatment to bring the tooth into its proper position or alignment.

So what are the possible strategies that might be employed when a permanent tooth is missing?

In the broadest terms it’s a matter of space management. The first option, the space where the missing tooth should be will be opened(if there is not adequate room). If the space has not been lost than it will merely be maintained. The second option would involve closure of the space where the tooth would have been. Depending on the clinical situation Dr. Feinberg will determine if the space caused by the missing teeth can be closed or should remain open. If the decision is to leave the space open than some type of tooth replacement would be necessary in the future to fill the space and maintain the bite. Without orthodontic treatment, the teeth on either side of the missing tooth will move randomly and tip into the open space, causing poor tooth alignment, bite problems and bone loss as we age.

Again it is so important to perform an examination no later than the age of 7 as early diagnosis is so valuable. When the problem is diagnosed at an early age, the solution can be much simpler. For instance, a basic appliance (space maintainer) may be placed to hold the space, which makes orthodontic treatment easier, when all the permanent teeth erupt. In some situations, if a space maintaining appliance is inserted and all the other teeth erupt normally into the mouth, orthodontic treatment can be avoided. Clinical situations, like missing teeth require an interdisciplinary approach and Dr. Feinberg will meticulously quarterback and treatment plan the case with his dental colleagues. A general dentist can then replace the permanent tooth with a permanent replacement. This might involve an implant typically no earlier than the age of 18, or perhaps a crown or bridge.

A permanent tooth is missing underneath the X. The device pictured is referred to as a band and loop device. Other similar devices belong to a class of devices called arch length maintainers or lingual arches. The band and loop device shown holds the molar in position while the rest of the permanent teeth erupt.

The appliance is cemented on the teeth so maintenance is easy and there are no problems associated with it as long as the patient is brushing their teeth regularly and staying away from sticky foods.

Please feel free to contact our Shelton, CT office with any questions or to schedule a complimentary initial evaluation.

Want To Know More About Personalized Orthodontic Care? Call Mark Feinberg Orthodontics Today!

When you are looking for an orthodontist, you want to search for an experienced professional who is board certified, attended the best specialty training program, and is active in their professional organizations and communities. When you meet Dr. Mark Feinberg, you’ll find he is exactly that. He brings that knowledge and experience to his patients, young and old, providing exceptional orthodontic care. Feel free to call us if you have any questions about the information we have shared or if you would benefit from orthodontic care at 203-892-6822. Dr Feinberg will examine your teeth and get you started on the best treatment plan for creating a lasting shining smile.

If you have any questions about early treatment, don’t hesitate to contact our office, Mark Feinberg Orthodontics. Also please feel free to request a copy of our resource guide on early orthodontic care.

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