Children hit many different milestones in their young lives with some children reaching developmental stages well before others. It’s not uncommon for parents to be concerned and seek our opinion when their child does not lose their baby teeth on time.
While there is a usual pattern and time frame for teeth to emerge into the mouth and others to be lost, as dentists, we begin to become concerned when a tooth/teeth goes well beyond these expected dates and there is a significant delay.
There are several common reasons for what we called “retained” baby teeth. A dental clinical and x-ray examination will determine why the baby tooth is failing to fall out (exfoliate). Afterwards, the dentist will decide whether to extract the baby tooth or keep it in the dentition.
It is not uncommon to find differences in treatment options amongst dentists as there are many factors to consider before deciding on a treatment plan, such as preserving bone, aesthetics, function and maintaining contact with surrounding and opposing teeth be preserved.
Incomplete root resorption
Have you ever wondered why only the crown portion of a baby tooth falls out? This is because the root portion of the tooth dissolves away. Sometimes, the roots do not get resorbed equally or completely. The course of action that the dentist will take often depends on the location and position of the adult tooth. Because the baby teeth are natural space holders, removing them too early can interfere with space that is needed for the eventually arrival of the adult tooth. A dentist may wait for the baby roots to eventually disappear or may help the process along by removing the final portions of the baby tooth to allow the underlying adult tooth to emerge.
Under normal conditions the teeth and bone do not touch, rather, they are connected by way of tiny hair-like fibers. Think of how a trampoline mat is connected to the supporting steel frame by way of tension springs. In this way, the tooth is free to move slightly so it can withstand the forces exerted upon it during chewing. Sometimes, however, teeth become directly attached to it’s surrounding bone. Treatment depends on whether or not there is an adult tooth present underneath the baby tooth.
a) Adult Tooth present – If the baby tooth is fused to the bone AND has an adult tooth to replace it then your dentist will likely extract the tooth. A space maintaining device will be placed on the adjacent teeth in order to keep this space available for the future incoming adult tooth. The area and adult tooth will then be monitored during it’s own eruption process for any signs of abnormality.
b) Adult Tooth Absent – If the baby tooth is fused to the bone and DOES NOT have an adult to replace it then the decision of extraction versus retention becomes a more complicated issue and bone preservation becomes a very important consideration.
i) Maintain – If the retained baby tooth is of sound structure and is in a good position to function (chew) with the other teeth then your dentist will likely opt to keep this tooth in the dentition and monitor it over the years. It is not uncommon to find many older adults that still have a retained baby tooth. Good oral hygiene is very important as there is no adult tooth to replace this tooth. If the tooth is lost eventually, then a dental implant can be considered.
ii) Maintain with Modifications – This is often the case when the tooth is submerged somewhat and is therefore lower in height and dimensionally smaller than the adjacent teeth. If the dentist decides that that the tooth is viable enough to be kept in the mouth, a few modification may have to be done to the tooth in order for it to function properly and have contact with all surrounding and opposing teeth. The tooth can be built up and reshaped in order to achieve function, but the tooth and surrounding bone will have to be closely monitored over the years.
iii) Extraction – If the baby tooth is removed now, the resulting space will have to be preserved with a space maintaining device until a future implant can be considered. The dentist may opt to perform a procedure called decoronation, whereby the crown portion is removed from the tooth and the site left to heal over. It is believed that important supporting fibers will then reconnect with the adjacent permanent teeth present. As these neighbouring teeth advance in their eruption process, the bone height and width can be maintained for many years until an implant can be considered.
Adult Tooth Misalignment
Unerupted – If the developing adult tooth is “stuck” in it’s position underneath, in the bone, the baby tooth may also be delayed in falling out. There are dental procedures that can help move the adult tooth along in it’s eruption process and eventually into position in the dentition. Your dentist may send you to an orthodontist for further evaluation. In consultation with the orthodontist, both short and long term solutions can be discussed that is unique to your child. Today, interceptive orthodontic treatment can go a long way in preventing the need for more extensive orthodontic treatment in the future.
Erupted – It is not uncommon to have adult teeth come into the mouth in front of or behind the baby tooth it’s suppose to replace. Removal of the baby tooth will depend on the position of the adult tooth, in which arch (upper or lower) this is occurring and at what stage of “falling out” the baby tooth is in. Although seeing permanent teeth erupt out of position when the baby teeth are still present is an unsettling thing for parents to see occur, it is a common situation. Once the baby teeth fall out or are removed, the adult tooth will eventually move into place naturally or with the assistance of orthodontia.
We cannot emphasize enough the importance of regular dental check-ups. Dental development and eruption problems are more common than one would think. Missing teeth can be caused by a number of things including genetics, injury, infection and endocrine disorders.
As challenging as some cases may be, with today’s advances in dentistry, there are now a variety of short and long term solutions available for consideration. Early diagnosis and intervention is often an important consideration in planning for a healthy tomorrow.
Yours in Better Health,
The Your Smile Dental Care team