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Congenitally Missing Teeth: What Does it Mean, and What Can You Do About it?

The human mouth is designed to hold 32 permanent "adult" teeth, including four wisdom teeth. Sometimes, however, the mouth has other plans. Believe it or not, it is possible to be born with less than a full set of adult teeth. The number missing can range anywhere from one missing tooth to all 32. Dr. Michele Simpson of Wilmington, NC explains why some people are born without a full set of teeth – and what can be done to correct this.

The medical term for congenitally missing teeth is hypodontia. Hypodontia is classified as missing up to five adult teeth, while missing more than five adult teeth is referred to as oligodontia, and missing all your permanent adult teeth is clinically known as andontia. But while these conditions may seem bizarre to some, they are actually much more common than you may think!

What Causes Hypodontia?

There are several causes of hypodontia that doctors are aware of. The most common cause appears to be genetics, i.e., hypodontia may simply run in your family. Other causes include cleft palate or cleft lip, or genetic conditions like ectodermal dysplasia or Down syndrome. Hypodontia is also linked to some environmental factors like exposure to PCB’s, radiation, chemotherapy, allergies, and toxic epidermal necrolysis. It is also possible to experience hypodontia following illnesses like rubella and candida. Children with low birth weight (especially twins) have an increased risk of hypodontia, too.

Treatment Options

While there is no way to force the mouth to grow new teeth to make up for missing adult teeth, there are several procedures that can correct the appearance of missing teeth. We asked Dr. Michele Simpson how she treats hypodontia in her own patients. Says Simpson, "How you treat hypodontia depends mostly on how many teeth are missing, and where those teeth are located." According to Simpson, mouths missing one or two permanent teeth are the easiest to correct. "Patients missing only one or two adult teeth can often benefit from orthodontic treatment that shifts the remaining teeth to fill in the gap from the hypodontia. In fact, it used to be common practice in orthodontics to remove some permanent adult teeth to reduce crowding- so orthodontics is often the perfect solution to hypodontia." Simpson says once the orthodontic treatment is complete, the teeth may need minor filing for a more uniform look, but most people will never realize the patient is missing adult teeth following treatment.

For patients missing more teeth than can be treated by orthodontics alone, your best course of action is a dental implant. "A dental implant is placed by installing a ‘root’ to the jaw bone via a metal rod. A crown is then attached to the exposed portion of this root, mimicking the appearance of a natural tooth. Patients receiving this treatment would have a root installed in each area where hypodontia is present."

Another more permanent method of treatment for hypodontia is a bridge. Says Simpson, "a bridge occurs when the two teeth on either side of the missing tooth are filed down for crowns, and a custom crown is placed onto the two filed down teeth. The crown contains three teeth- two for the filed down teeth, and one fake tooth that fills the hypodontic gap in the center." If a bridge or implant doesn’t work, some patients opt for a partial denture that sits in place over the gap. However this is the most temporary option, and most patients prefer something a bit more permanent.

As for when to begin treatment, Simpson says timing is everything. "Once you realize your child is missing permanent adult teeth, it’s never too early to start discussing options with your dentist." Depending on how many teeth are missing, you may be referred to a hypodontia specialist who can come up with a treatment plan, or to an orthodontist. Says Simpson "If your child is only missing one or two adult teeth, it can usually be monitored by just your family dentist. When adult teeth begin to come in, your dentist will determine the best time to begin orthodontic treatment, or when to install a crown or dental implant." For more complex cases, working with a separate specialist is highly recommended, especially if there is insufficient bone present to support dental implants. In these cases, new bone must be surgically generated. A specialist versed in dental implants will best be able to determine the timeline for this type of procedure. If you or someone in your care is affected by hypodontia, don’t despair- speak to your family dentist to see what treatment options are best for your specific situation. Says Simpson "The thing we want patients to understand about hypodontia is that it can be treated. There are lots of options- there is hope."

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