When Your Child’s Teeth Are Not Coming In: How Oral and Maxillofacial Surgeons Can Help

As a parent, you may be concerned that your child’s teeth are not coming in as expected. Most children’s baby teeth begin emerging at six months of age, and almost all children will have a complete set of 20 baby teeth by age three. Children begin losing these teeth around 6 years old, after which their permanent teeth should start to erupt. For some time, your child should have a mixture of baby and adult teeth, until they lose all of their baby teeth.

An oral and maxillofacial surgeon (OMS) can provide valuable support and ensure your child’s development is on track. Here are the steps to consider if you have this concern.

Observe and Monitor

Every child is unique and teething (eruption of the baby teeth) can begin at different times. But if you notice significant delays or abnormalities in your child’s tooth development, it is important to speak with a professional.

Consultation with a Pediatric Dentist

The first step to consider taking when you notice your child’s teeth aren’t coming in is to arrange a visit to a pediatric dentist. Pediatric dentists specialize in children’s oral health and can assess your child’s dental development. After the assessment, the pediatric dentist can determine if further testing or treatment by an OMS is necessary.

Assessment by an OMS

If your pediatric dentist finds it necessary, you should schedule an appointment with an OMS. OMSs are highly trained in the diagnosis and treatment of complex oral and maxillofacial conditions. They can provide a more detailed evaluation to determine the best course of action for your child.

Tooth Development Assessment

Your OMS can provide a thorough assessment of your child’s dental development. X-rays and other imaging tests may be ordered to assess the position and condition of the teeth and help identify the cause of delayed or abnormal tooth eruption.

Reasons Why Teeth Might Be Delayed

A slight delay in teeth erupting is not cause for concern, as every child is different. However, there are several reasons why your child’s teeth may not be coming in, which include:

• Lack of space – Because baby (primary) teeth are smaller than adult teeth, there might not be enough room in your child’s mouth for the adult teeth to erupt.
• Teeth coming in the wrong direction – Your child’s teeth may not be following the typical eruption course, and instead are developing in an abnormal direction or location.
• Teeth are impacted – Just like wisdom teeth (third molars), regular adult teeth can become impacted, meaning they are trapped below the gum line after the time they should have erupted. Impaction can be a result of a narrow jaw, lack of space, other underlying medical conditions, pathology or prematurely lost primary teeth.

Treatment Plan for Teeth Not Coming In

Based on their evaluation, your OMS can create an individualized treatment plan tailored to your child’s needs. This plan may include different interventions, such as orthodontic treatment, surgery or a combination of both, depending on various factors.

Orthodontic Treatment

In some cases, orthodontic treatment may be recommended to encourage proper tooth eruption, especially in cases where there is not enough room for permanent teeth to erupt. Orthodontic appliances, such as braces and aligners, can help reposition teeth into their correct positions and make more room for other teeth. An OMS and orthodontist can work closely together to ensure the best possible results.

Surgical Intervention

Surgical intervention may be required if a tooth is impacted or the eruption is blocked by another tooth. Your OMS can perform procedures to expose or reposition teeth so that they come in properly. These surgical procedures may require sedation or general anesthesia depending on the location and orientation of the tooth. If the tooth is easily accessible, the procedure might be completed with only local anesthesia. Anesthesia options can be discussed with the child and parents to create a comfortable experience. 

Your Child’s Care Team

Throughout the treatment process, your OMS should collaborate with other dental professionals, such as pediatric dentists and orthodontists, to provide comprehensive care and optimal outcomes for your child.

If you are concerned about delayed or abnormal tooth eruption, consult a pediatric dentist or OMS. Through collaborative care and timely interventions, your OMS can help ensure your child’s dental development progresses smoothly.