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Dental and Oral Health (Children)

Best Way to Handle an Unerupted Tooth

05/12/2011

Question:

My son had a baby tooth that never erupted. He was referred to an oral surgeon to have it removed. It was pulpy, not solid, and we were told that no permanent tooth was in evidence and that the bone was not fused in that area. The permanent tooth eventually showed up on an x-ray and we were referred to an orthodontist. My son wore braces on his upper teeth for 2 years and has worn a retainer since. We were told the purpose of the braces was to keep the teeth from drifting so that the tooth had a space to come into. He is now 11 and the tooth still has not erupted. Now our orthodontist wants us to start with a spacer on that side, followed by 2-3 years with braces again.

Based on the x-ray, this makes sense - it seems like the tooth can`t erupt because there isn`t a place for it. However, the orthodontist stated that the tooth appears to be straight/centered (no bump) and my son is not experiencing any pain or even discomfort. And based on his history, is it possible that what we are seeing is not even a formed tooth, but a mass similar to the baby tooth?

I am concerned that we have been dealing with this since my son was about 3. What if we go through 3 more years of braces only to find that it doesn`t make a difference?

My questions are what happens if we do nothing, or wait until it becomes problematic? And is there another solution, such as just going in and removing the unerupted tooth? And if we are to get a second opinion, should we start with our dentist, back with the oral surgeon, or with another orthodontist?

Answer:

Your son's situation is complicated, and the treatment that has been provided seems reasonable given the information that the care providers had when they treated him. You are correct that a second opinion is now indicated. As you note, the unerupted permanent tooth could be a mass (called an "odontoma") that is not really a tooth at all.

Given your son's age, I would recommend that he see a specialist in dentistry for children. That is a pediatric dentist, and s/he is well-trained in identifying unusual tooth eruption patterns. Be sure to take your son's x-rays to that appointment. While new images may be necessary, the past images will help the pediatric dentist make a diagnosis.

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Response by:

Dennis J McTigue, DDS Dennis J McTigue, DDS
Professor of Pediatric Dentistry
College of Dentistry
The Ohio State University