Why Aren’t My Child’s Permanent Teeth Coming In?

Here at Sycamore Orthodontics, we understand how concerning oral issues can be for parents and caregivers. We see many older children and teens who miss one or more permanent teeth and parents who worry about their child’s smile. Thankfully there are several ways that orthodontic treatment can help your child—and you!—through what can be a stressful and worrying situation. 

We know you want the best for your child’s oral health and smile, and we are committed to helping you look and feel your best! One of our experienced doctors will work to create a customized treatment plan for your child’s unique case, and our team will walk you through the process every step of the way. To understand what can keep a child’s permanent tooth from coming in and how we can help, keep reading below! 

Congenitally missing teeth

Most of us will have a full set of thirty-two permanent teeth. If any of these teeth fail to develop fully, it will generally be chalked up to a case of hypodontia or congenitally missing teeth. Hypodontia is one of the most common dental developmental abnormalities, with up to 20% of all adults missing at least one tooth. Hypodontia most often affects: 

Wisdom teeth are normally found in the back of the mouth. Congenitally missing wisdom teeth are so common that if you take them out of the equation, the percentage of adults with missing teeth would drop from that previously mentioned 20% figure down to around 5%! 

The second premolars are the teeth that reside right in front of your molars. One of these may be removed if your child, at any point, receives braces treatment from an orthodontist, but if your child is missing this permanent tooth, it will almost always be due to hypodontia.

Upper lateral incisors are the two teeth that sit on either side of your two front teeth.

Lower central incisors are the two front teeth in the lower jaw.

Congenitally missing teeth are much more common and noticeable in permanent teeth. Less than 1% of children will have a congenitally missing baby tooth, and of those who do, there is likely not going to be a permanent tooth developing in the gums underneath it. In most cases of hypodontia, there will only be one or two teeth missing rather than multiple teeth.

What causes congenitally missing teeth?

Generally speaking, most cases of hypodontia will result from problems with the dental lamina. This band of tissue underneath the gums is where the tooth begins to form. Several genetic factors can result in the dental lamina failing to develop. 

Most current research points to this being due to a mutation with any one of three specific genes that have a significant role in the development of the teeth. If a mutation causes the dental lamina to be missing, the corresponding tooth usually does not form.  

Congenitally missing teeth can also be associated with various medical conditions and genetic disorders, such as Down’s Syndrome.

Identifying congenitally missing teeth

Children typically lose their last baby tooth by age twelve. In most cases, the loss of a primary tooth is quickly followed by the eruption of the new permanent one. If your child loses a primary tooth and a replacement hasn’t appeared within a reasonable amount of time, you may wonder if there are any steps you should take to find out why.

An examination with a qualified dentist can determine the most appropriate treatment for any child missing permanent teeth. A dentist can examine the alignment of your child’s teeth, any apparent crowding, and their bite. Because there are so many reasons for a missing permanent tooth, a complete set of dental X-rays is often the best way to see what’s happening. 

What can be done about congenitally missing teeth?

There will usually be three options when a permanent tooth is missing:

  • preserve the baby tooth
  • replace the missing tooth
  • orthodontically close the space

One of our doctors will work to determine the best choice for your child based on their examination at your child’s first visit.

Fortunately, there are quite a few treatment options available that can help improve the functionality of your child’s bite and the overall appearance of their smile, including: 


Orthodontic treatment can create a space where a tooth should have arrived, but didn’t, especially if another tooth has filled that gap. This can make room for an implant. Another option would be closing a space left by a missing tooth by guiding other teeth into position to close that gap. To accomplish this, we sometimes employ tooth shaping to properly fit and mimic the look of the tooth that would typically be in that spot.


Implants are the ideal solution for missing teeth. They are strong, durable, and aesthetically pleasing. However, we only use implants for children once they’ve finished the growth phase of adolescence. You may believe that once teens have reached a certain age, we can safely assume they’ve stopped growing and can be fitted with an implant, but every child is different. The only way to be sure of the right time for an implant is to work with one of our experienced doctors to determine the right time for placement. 

Removable bridge

A removable bridge is a common approach to treating hypodontia. Despite the name, it is a combination of a denture (because it is removable) and a bridge (because it bridges the gap between any number of missing teeth.) These bridges provide stability for the bite and a reasonable amount of cosmetic appeal. They are similar to the removable retainers we use after braces treatment, and while they may be a bit uncomfortable at first, they take no time to get used to!

Traditional bridge

A traditional bridge functions similarly to a removable bridge but is fixed and not removable. Fixed bridges are adhered directly to the surface of the teeth opposing the gap. There are some cases in which a traditional bridge will be preferred over a removable one, but they can be a bit more challenging to keep clean and may require the reduction of certain healthy portions of the adjacent teeth.

Why Aren't My Child's Permanent Teeth Coming In?

Composite bridgework

A composite bridge is a compromise between a fixed and partial bridge. A member of our skilled team will shape a “replacement” tooth with bonding material, then adhere it to the surfaces of the adjacent teeth without having to remove any healthy tooth material from them. If an implant or other solution becomes the preferred treatment choice at a later date, this bridge can easily be removed. It has some of the same cleaning challenges as a fixed bridge, so a proper oral care routine is a crucial part of keeping it functioning as well as it should.

Understand your child’s smile with Sycamore Orthodontics

For children or teens dealing with a suspected case of hypodontia, Sycamore Orthodontics offers the best in personalized, compassionate care for families in Sycamore and the surrounding communities. 

Our state-of-the-art offices are fully equipped to diagnose, treat, and create a fully functional smile that works well and looks attractive. With a pediatric dentist and orthodontic specialist on our team, you’ll find everything you need for your child’s smile under one roof. 

Contact our team to schedule a children’s dentistry appointment or free orthodontic consultation at our Sycamore office today. We can’t wait to see you smile!