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Losing baby teeth and getting permanent teeth is a rite of passage. That first toothless grin, the first tooth fairy visit. For many parents, it goes without saying that permanent teeth are a sign that their child’s oral development is on track, so it can be concerning when permanent teeth are not coming in when or where you’d expect. 

When are permanent teeth supposed to come in? Most children start losing their primary (baby) teeth around six years old, though earlier or later is normal. These 20 primary teeth are slowly replaced by permanent teeth throughout childhood — and even into adolescence. By 21 years old, you should have all your 32 permanent teeth fully grown in.

Many parents wonder, “How long does it take for a tooth to come in?” Sometimes it feels like the gap in your child’s smile has been there forever. But it’s safe to say that each tooth has its own timing: some come in within a week, others can take up to six months. On the other hand, if it seems like your child’s permanent teeth are not coming in, here are the six most common reasons why.

1. Losing Primary Teeth Prematurely

Has your child lost a primary tooth from an injury or tooth decay? If so, this could affect the eruption of a permanent tooth. One of the main roles of primary teeth is to save space for the permanent teeth so when you lose a primary tooth prematurely, the permanent tooth might not be ready to come in, which leaves a gap. The teeth around the space naturally move to fill the space, so once the permanent tooth is ready to erupt, it has no place to go and gets stuck inside the jawbone. Other times, you might see only a bit of the permanent tooth and it may seem like the permanent tooth has stopped growing. These impacted teeth can sometimes cause jaw pain, infected gums or headaches. Impacted teeth sometimes means oral surgery or a tooth extraction.

Seeing Impacted Teeth With i-CAT Imaging

Impacted teeth are obviously hard to see if they’re hiding inside your child’s gums. At Okuda Orthodontics, we use state-of-the-art i-CAT x-ray 3D imaging so we can get an accurate model of your child’s entire dental and facial anatomy. Using i-CAT imaging, we can examine your child’s facial bone structure, bone density and nerves, and see where impacted teeth are sitting.

2. Not Enough Jaw Space

We like to think that our children’s faces are perfect in every way. But when it comes to their teeth, sometimes there isn’t quite enough jaw space to accommodate all their permanent teeth. Permanent teeth are larger than their primary counterparts, so it’s safe to say that they might need a bit more room. Are your child’s baby teeth close together without any gaps between them? This is a sign that their permanent teeth might have crowding issues. 

When there’s too little jaw space, you might wonder if a permanent tooth has stopped growing, but, in fact, the tooth just doesn’t have a spot to move into. With i-CAT imaging, we can see your child’s hidden teeth in 3D and suggest what should be done.

At Okuda Orthodontics, we’re experts in treating crowded teeth and misalignment with interceptive orthodontic treatment. Most children don’t need orthodontic treatment until all of their permanent teeth have come in, and, rest assured, your Henderson orthodontist doesn’t begin orthodontic treatment unless absolutely necessary. In the case of crowded teeth, though, interceptive orthodontic treatment can have a significant, positive impact on your child’s oral development. 

3. Teeth Growing in the Wrong Direction

It’s fair to say that sometimes permanent teeth grow in a less-than-ideal direction. It’s a pretty common issue for upper canine teeth and lower bicuspids. What does it look like? A directional problem can look like a tooth that isn’t vertical, or a tooth that erupts in a spot other than where the baby tooth sat. A tooth growing the wrong way can affect surrounding teeth so it’s not uncommon that corrective treatment is suggested. If the misalignment is severe, removing a baby tooth is sometimes an option, or if that doesn’t correct the issue, orthodontic treatment might be the next step.

4. Congenitally Missing Teeth

Sometimes genetics play a role in permanent teeth not coming in. Chances are if you or someone in your family has adult teeth that never came in, your child could be experiencing that too. The most common missing teeth are the wisdom teeth (third molars), with about 20% of people missing at least one or both. Some people are missing their permanent upper lateral incisors — the teeth on either side of your upper front teeth. The result? Your child’s baby incisors will stay put, that is, unless they are lost to tooth decay or trauma. If the latter happens, your child might need dental implants to fill the gaps or braces to correct teeth that have moved into the empty space.

5. Teeth That Just Don’t Want to Come Down

Though rare, another genetic issue is when your child’s permanent teeth exist but they’re just not erupting or they only partially come in, even if nothing is blocking their path. Called Primary Failure of Eruption, or PFE, typical treatment includes oral surgery and braces, which tends to happen over a few years. In the case of PFE, the team at Okuda Orthodontics will set up a treatment plan to coax teeth out, ensuring the surrounding teeth remain healthy.

6. Too Many Baby Teeth

Baby teeth sure are cute, but sometimes you can have too much of a good thing. When a child has too many baby teeth, they can block permanent teeth from coming in. Supernumerary primary teeth, as it’s called, is pretty rare and is oftentimes associated with issues like a cleft palate, Gardner’s syndrome, or cleidocranial dysostosis. The extra primary teeth are usually extracted with oral surgery, and if permanent teeth were misaligned as a result of the excess baby teeth, your child might need orthodontic treatment.

Preventative Orthodontic Care

The American Association of Orthodontists suggests you take your child to an initial orthodontist visit around age seven. We at Okuda Orthodontics agree — it’s that perfect time when primary teeth have started falling out, permanent teeth are coming in, and we can see any potential problems. An initial in-person visit at our Henderson office always starts with high tech i-CAT imaging, giving us a computerized 3D model of your child’s teeth and skull. After Dr. Okuda examines your child’s teeth, he uses the i-CAT model and his expert findings to develop a diagnosis. In most cases, orthodontic treatment is put off until children have all their permanent teeth and Dr. Okuda will just see your child for quick check-ups. However, if a treatment plan is suggested, we take the least invasive approach to ensure you and your child are comfortable.

Your child’s oral development matters to us and Dr. Brady Okuda looks forward to providing you with exceptional orthodontic care in our family-friendly environment. Just like you, we want your child to benefit from a healthy, straight, and beautiful smile. Book a free consultation at Okuda Orthodontics today. 

Dr. Okuda

Author Dr. Okuda

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