Children are not immune to dental complications, they are actually more susceptible and will have more complications in the future due to dental conditions. The lack of development of permanent teeth effects 2.8 percent of the United States population, and may lead to other dental complications and malnutrition. The absence of permanent teeth is known as hypodontia or oligodontia, depending on the number of teeth missing and is commonly referred to as congenitally missing teeth. Hypodontia describes 6 or less teeth missing, and oligodontia describes more than 6 teeth missing. A condition in which all teeth are missing is rare but still occurs, this is called anodontia.
Permanent teeth erupt between the ages of 12 and 14, and all primary teeth and the crypts of permanent molars are visible using radiography at time of birth. A radiography diagnoses of hypodontia or oligodontia can be made at an early point in life due to the visibility of the crypts, the spaces in which teeth will grow, before the development and eruption of teeth. But definite diagnosis should not be made until the age of 6, because formation of teeth vary based on gender and race. Teeth can be missing on either the left or right side of the jaw with the opposite side having a complete set of teeth, but teeth missing teeth on both sides of the jaw occur as well.
Factors that have an effect on the development and eruption of permanent teeth are environmental and genetical. Environmental effects that may cause hypodontia or oligodontia are fractures in the jaw occurring before tooth development, surgery on the jaw, chemo and radiation therapies, treatment for malignant diseases, irradiation procedures, and Thalidomide use during pregnancy. Thalidomide is a medication used for multiple myeloma and as a sedative. The genetic factor that causes hypodontia and oligodontia is a mutation chromosomes MSX1 and PAX9. There are thought to be mutations in other chromosomes that affect tooth development, but they have not been discovered yet. Screening tools for mutations in the MSX1 and PAX9 genes are used in research, but are not yet available for routine testing.
A gap between the teeth, called an open bite, as well as a difference in dental occlusion, the way that upper and lower teeth fit together, may be present in cases of hypo- or oligodontia. Other cases may have teeth that are so tight in bone that they cannot erupt or only partially erupt. Children with hypodontia and oligodontia do not respond to braces treatments and may require partial, or full, dentures.
A delay in formation and eruption of teeth, reduction in tooth size, difference in the shape of teeth and displacement of teeth, short tooth roots, and rotated teeth may also be present in children and adults with hypo/oligodontia. The amount of enamel on teeth may also be affected, causing dents, discoloration, and/or discolored spots on the tooth/teeth, this is called hypocalcification.
In most cases of congenital missing teeth, only one or two permanent teeth fail to develop, with the most common teeth effected being the premolars and the incisors. Because this is a genetic condition, if one parent suffers from, or has a long family history of hypodontia/oligodontia, then it is extremely likely that any offspring will also develop the condition.
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