[Closed] Missing adult teeth in child:- Bridge, implants or leave?

has she been x-rayed ?

my youngest had an incisor stuck up in the gum, a bit like one of the top stones at stonehenge. They were too late to act in referring her for removal and surgeon couldn't do "planA" so she needed 3 years of braces to straighten out the "mess" afterwards

She hasn’t had an X-ray. Dentist is confident they are missing and said the orthodontist would do one anyway so didn’t want to expose her to the radiation. The only issue is that with covid it’s a years wait to see one on the nhs.

I have a bridge that is stuck in - only had it a year, but the dentist reckoned it should last 20+ years if looked after (mainly flossing around the edges and gums). Wasn't a pleasant experience to be honest, but was way cheaper than implants. It was to replace an older bridge that had fallen apart after about 30 years.

I knocked one of my adult front teeth out as a kid. Had retainers with a tooth on, had bridges and everyone was a stopgap. I don’t think I had anything for more than 6 months without knocking a bridge out, snapping a retainer at rugby, biking, scrap with brothers or just being a kid and being clumsy.
It was all part of a journey towards getting an implant. Best thing I did, wouldn’t know to look at me. Did need braces to make the gap a bit wider before the implant after 10-12 years of other things. I also needed a bone graft from the bottom jaw to build up the jaw on the top as it has shrunk in the 10-12 years since I knocked it out.

I’d recommend that you push for an implant as soon as things stop growing, and unfortunately you’ll just have to ‘put up’ with other options. (I assume glues are better now for bridges, but it’s still not perfect)

I had my child and then adult cuspids (eye teeth or premolars) removed to make space for my third molars. I had those removed as well (impacted). Small mouth, giant teeth. My gaps all closed up without issue. My sister had the same and hers did not close. Your orthodontist will advise. A brace to close the gaps rather than an implant would seem more likely to me. I've never had any issues with my 24 subsequently well-aligned and well-spaced teeth (one filling in 53 years).

I had braces when i was about 10-12, top and bottom. It was miserable, endless mouth ulcers and discomfort. 35 years later my lateral incisors have twisted back again quite significantly.... annoying but nowadays I just shrug!

I had a similar experience to TiRed with teeth out to make space as a kid. As I have got older I have still suffered twice from impacted wisdom teeth and lack of space. Ironically i had a tooth out that broke and was beyond reasonable repair - on that side the space issue has gone away and the gap where the broken tooth was has closed up a fair amount.

Not really an answer I know...but your teeth do seem to move about a lot.

Also avoid the fizzy pop my dentist says.

Wisdom teeth are to replace missing ones anyway aren't they? They come in, your other teeth move forward, and in many cases these days with good dental hygiene, there isn't enough space and you get problems.

The problem with either doing nothing or closing the gaps is that aesthetics will be compromised. Canines will always look a bit pointy and large. Whether that will be a problem for your daughter when she’s older is going to be difficult to know now, but the space will be easier to gain whilst she’s young. Adhesive bridges can be, and usually are, very reliable and are minimally/non invasive to do. An adhesive bridge will normally only need to be anchored on one side, counter intuitively they often last longer that way.

You need to see the orthodontist first before making any decision.

Wisdom teeth are to replace missing ones anyway aren’t they

Yeah I think that is the case - in the good old days* your teeth were ground down by your gritty diet of berries mud and pebbles, the wisdom teeth came up to replace them and then you were dead by 25 anyway in the jaws of a sabre tooth tiger.

*not the 1950's

So this happened to my daughter and I’m also a dentist....

You need to get an orthodontist opinion.

A lot depends on the alignment of other teeth. If the other teeth are crowded enough to have needed teeth out (if the laterals were present) to get straight teeth, closing the spaces with braces can be a good option ( option 1 above ) It leaves no need for advanced dentistry long term and is less invasive. Whilst you can end up with a less aesthetic result as mentioned above, any decent dentist should be capable of removing the pointy tip from the canines and adding composite as necessary to make them look like incisors. This will only not work if the canines are very bulky compared to the incisors.

This is what we did and no one except us knows my daughter is missing laterals as we got a great result.

If your daughter is generally well aligned already and has too much space because the teeth are missing option 2 can work well. Adhesive bridges are generally easy to make, not that traumatic a process for the patient and if they are stuck to unfilled teeth, they tend to stay on really well - well enough to kind of forget about. As mentioned above, they work better stuck to one tooth rather than two - counter intuitive but that’s how it works. They generally look good enough to not be noticeable as false. They don’t last forever and you do get what you pay for to a certain extent so you need to factor in that you have left her with an ongoing need for dentistry through her life. Ultimately implants are a great longer term option to replace the bridges but she would need to be at least 18 and they will cost around 5 grand.

Option 3 she won’t thank you for later.

Also, she will definitely qualify for nhs orthodontics cos she’s missing teeth. They won’t treat her until all baby teeth are gone so depending on her age, a year wait might not make much difference

Implants are almost never funded on the nhs ( they do them occasionally in cancer or trauma patients but never in things like this)

Thanks for info guys. Daughter is already 13 so didn’t want to leave it too long. The nhs ortho is just treating his private patients and hasn’t seen an nhs case since March due to COVID so has a big backlog so we are thinking about going private - assuming it’s not good to leave it too long. I did send some pics to a private ortho and he though closing the gap wouldn’t be an option due to the cross bite.

@ceepers, @crewlie - the adhesive bridge sounds like a good option, minimally invasive etc. However is there a risk of bone loss in the jaw due to the missing tooth that might affect her gum line or cause an issue if she wants implants in later life?

Maybe go for the bridge option and start putting a little money aside each year to pay for implants when she is old enough. I had an implant a few years ago and with the additional bits needed (removal, braces, bone graft) it wasn't cheap.

You won’t get bone loss as she hasn’t had a tooth extracted, it was just missing in the first place. I would have happily gone the adhesive bridge route for my daughter if it had been the right option. If you are being picky, the aesthetics are better with an implant as it comes up through the gum like a tooth whereas the bridge tooth just hovers over the top but as said above, the average person wouldn’t notice. Also the bridges can be all ceramic ( ceramic Wing and tooth, usually only available privately) or ceramic tooth with metal wing that glues on. The metal wings stick better but if her teeth are translucent it can make the tooth it’s stuck to look slightly grey. Again a dentist would notice, you probably wouldn’t.

If she’s 13 you do probably want to get started soon. The nhs orthodontist will have to get his finger out soon - the nhs have just imposed a target of 70% normal activity for the period of jan to April for ortho contracts.

Privately you will get seen ASAP. Costs depend on where you are. Our local private orthodontist (who is BUPa) do a fixed fee for kids of around £1600 but most private ortho treatment costs around 3 grand.

The bridges are available on the nhs for free as she’s under 18 although they won’t be the nicest quality. It might be worth paying privately for nicer replacements when she’s older. Again it depends on how closely you or she are looking - the nhs ones will fool most people but if she’s modelling or intending to be on tv they might not.

Probably not as the tooth was never there (assuming they are missing and not buried) but I should leave that one to @ceepers as he’s still working at the coal face 🙂

@crewlie the enamel face! 😂

Also they’re more likely to be missing than buried. Missing laterals is relatively common, buried is not ( but more common for canines )

Great, thanks for the advice, much appreciated. Had a ballpark price for braces and bridges of 5K. Might have to put that new bike on hold, though interesting about the 70% back to normal for NHS contracts.

I've got a bridge, had it since I was ~16 (I think?) after having a plate for ~7 years. Fitting was very simple (compared with the multiple extractions and injections I had!) but the glues must have been a bit crap when I was young as it came unstuck quite a few times, though that may have been more due to doing typical stupid teenager stuff and a lot of sports. However, it was simple to reinstall and it's remained in place for ~10 years now since the last time it came out.

Downsides are minimal, the colour no longer matches very well as I've had it for ~24 years and the other teeth are no longer quite as white as it is. Also, if you really look for it the teeth it's attached to look slightly grey-ish but it's not hugely noticeable. I've been thinking about changing it for an implant for a while, but it would basically be for a small aesthetic upgrade so the cost and hassle don't really seem worth it just now.

@ebennett - 24 years is pretty good! Were you cleaning with floss where it sits on the gum everyday, or just normal brushing? I suppose the colour change would happen with implants too over time. The other option could be to have some tooth whitening to match the colour back in to the bridge rather than replacing.

I had my upper and lower front premolars removed when I was about 12ish.  It was thought that they were baby teeth but apparently hey had roots.  Weird!

Good job they came out as all the gaps closed up on the bottom teeth which guess means I would have had overcrowding issues.

Top ones are a bit gappy, my other premolars have moved forward a bit so there is a small gap each side.  No dramas aside from the occasional bit of steak getting stuck.

EDIT: i didn't need any braces or anything they just sorted themselves out.

Just brushing, I don't recall the dentist recommending flossing around it but tbh the last time I went to one was ~10 years ago (sorry Ceepers!). It was one of the front teeth though, so I can't really see how I'd be able to floss around it. According to my wife my breath is fine, so it doesn't seem to be causing any issues anyway (or she just doesn't want to tell me). I have thought about whitening but currently laziness > vanity!

If she gets a bridge it will feel really weird to start with, because there's a lump of cement where your mouth isn't using to there being anything. However, you get used to it fairly quickly. If I were in your position I'd get her a bridge but plan to get an implant once she's old enough as it seems like a better long-term solution.