Thursday, May 6, 2004
Dear Dr. Mady: My fourteen year old son has not lost any of his baby molars yet. Is this normal? I thought a fourteen year old would not have any baby teeth left at all.-Cathy V. in Windsor
Dear Cathy: When we talk about children losing baby or primary teeth we generally speak in relation to averages. The average age for losing primary molars is eleven to twelve years of age. Many children and adolescents will shed their primary molars earlier or later than this and there can be other contributing factors involved.
You may think that fourteen is an abnormal age to be in this position, but being in dental practice myself, I can assure you that this is not as uncommon as you may believe. I have seen many cases over the years with individuals where some of the permanent teeth do not develop at all. If this is the case, then the baby tooth that precedes it will not exfoliate when it is supposed to or maybe not ever. The four teeth that replace the primary molars are known as premolars (meaning before the molars) or bicuspids. It may be possible that your son has not developed some or all four of these permanent premolars under the primary molars. A dental x-ray (radiograph) will confirm whether or not this is the diagnosis. However, it is rare that all the premolars remain undeveloped, and if that is the case then maybe one or two is not present, but it is unlikely that the other two will be absent also, although not impossible.
If in fact these premolars are present, an x-ray will confirm that and also display the stage of development of these teeth. Permanent teeth will generally erupt when their roots are approximately two-thirds formed. If the permanent root development is slower, this will delay eruption.
On occasion primary teeth will not come out due to a condition known as ankylosis. Ankylosis is a dental situation in which the roots of primary teeth lose their
normal attachment to the bone (small ligaments) and become fused directly
to the bone. The cause of this is not known, but it is seen fairly often,
particularly in lower primary molars. It is rumored that children who grind their teeth experience ankylosis most often. If this condition is present, the baby teeth practically become bonded into the jaw bone and it is very difficult or impossible for them to exfoliate on their own or even to be extracted by a dentist or oral surgeon. In this case the permanent teeth will never erupt until the preceding baby tooth is absent and they may, in the meantime, try a different path of eruption and end up in the wrong place.
If the x-ray exhibits a lack of permanent premolars, then I advise to maintain the primary molars for as long as possible. The reason for this is so that occlusion (bite) can remain stabilized until all other adult teeth have erupted and until all craniofacial growth is completed. If these baby molars can not be maintained for a long period of time due to root resorption, decay, trauma or anything else, your dentist can explain to your son, all treatment options available for tooth replacement.
I have patients in my own practice that have retained primary molars and other teeth and some are into their fifties and sixties without a problem. So if this is the diagnosis, it is not “the end of the world”. There are many treatment modalities and options.
I would not jump to conclusions until an x-ray is completed. Most likely he is a bit behind schedule with his dental development. One trip to your dentist will undoubtedly answer your question and set your mind at ease.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5