Most of the time with children when a baby tooth is lost around 11 or 12, its loss is followed by the eruption of its permanent replacement. However, in about 5-10% of the population, the adult/permanent tooth never forms. The best way to confirm that an adult tooth is missing is via a panoramic x-ray.
The type of treatment and when to start it depends on the age of your child and other variables that may come into play like which adult tooth is missing, the crowding of the teeth and your child’s overall bite. These options can be to keep the baby tooth as long as possible, replace it in the future with an implant/crown or bridge or close the resulting space with orthodontic treatment. Just because a tooth is a baby tooth does not necessarily mean it cannot last a long time, and in the right situations, research out of the University of Iowa has shown that patients who retain their baby teeth (with no permanent replacement), 80% were able to keep the baby tooth well into their adulthood.
In other patients where and when the missing adult tooth will need to be replaced, orthodontic treatment is usually delayed until your child is a mid to late teenager if the replacement option is an implant and crown. If the replacement option is a bridge to replace the missing adult tooth, then orthodontic treatment could begin sooner and then followed with the bridge placed by your general dentist.
And finally in some cases, simply removing the retained baby tooth and orthodontically closing the resulting space may be the best option depending on the typical associated variables like which tooth is missing, overall crowding and your child’s bite. There can be many options for a missing tooth/teeth, so that’s why an orthodontist needs to be consulted so that your child can be accurately examined. With a thorough exam by an orthodontic specialist, you can be given a treatment plan that is customized to your child’s individual problems and your family’s needs.
Note: Dr. Edward Altherr is a board-certified orthodontist in private practice serving Apex, NC, and the surrounding towns/cities of Cary, Holly Springs, Morrisville and Fuquay-Varina. Dr. Altherr’s training in orthodontics was at the prestigious University of North Carolina at Chapel Hill’s program where we studied under many great orthodontic icons like Dr. William Proffitt and Dr. Camilla Tulloch. During his orthodontic training, Dr. Altherr’s research and further focus was on the orthodontic treatment of the mixed-dentition (mix of baby and adult teeth in kids between 6 and 14 yo). With his research and over 16 years of clinical orthodontic experience as of 2018, Dr. Altherr is considered an expert in mixed-dentition orthodontics and other areas of orthodontics like temporary skeletal anchors. This web blog is for educational purposes only. Dr. Altherr is licensed only in the state of North Carolina, and cannot diagnose and recommend orthodontic treatment over the phone or internet.