Expert: Dr. Randolph Myerson - 5/18/2009

Question
QUESTION: Hello,  
My 7 year old son lost his upper front baby teeth naturally 5 months ago. His permanent teeth have not erupted, but the dentist says they are right under the gums (his lowers erupted naturally 1 year ago).  He had a panorex at the othodontist, and follow-up x-rays at the dentist which revealed that the roots are not fully developed, but nothing to worry about.  The dentist and orthodontist say we should just wait for them to come in.  I am concerned because I have two older children with missing teeth.  Do you also recommend waiting, or should I be doing something more proactive?  Thank you.

ANSWER: You've done all the right things.  A dental exam and an orthodontic evaluation have provided all the answers you need.  From the xrays taken you've been told that the permanent teeth are not missing so that is not a concern.  Since the roots are slow in developing you certainly do not want those teeth erupting with short roots so allowing them to continue developing right where they are is the best course of action.  Let's let nature do what it does best, even if it takes a bit longer.

---------- FOLLOW-UP ----------

QUESTION: Hello,
Thank you for your great answer.  I am still very concerned.  It has now been another four months, so he has been without his front teeth for 9 months.  Is there a point when I should become concerned?  I worry that maybe his adult teeth are just so small/undeveloped that they will never erupt.  You can easily see that they are right under the gums.  The gums are large and hard.

If his front teeth don't erupt by one year, is there a treatment that should be done?  (Is there even anything that can ever be done, if they don't erupt?  Are implants an option when there are teeth under the gums?)  What type of dentist specializes in these issues?  At what point would I persue treatment?

Thank you.

Answer
Perhaps a follow up with the orthodontist would be helpful after one year to determine if there has been some progress in the development of the permanent incisors.  Generally the permanent teeth don't emerge until the roots are about 1/2 developed.
Implants are not an option until around age 17-18 and only in a case where there is no permanent tooth present.