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Over-Retained Baby Teeth: A Guide to Treatment

Dr. Pamela L. Alberto

Baby teeth, which are called primary teeth by your dentist, should exfoliate so that the permanent tooth underneath can come into the mouth. When the eruption of the permanent tooth is delayed for more than a year from the expected date, it is considered over-retained. Early removal of primary teeth will cause delay of eruption of the replacement permanent teeth. It is important to keep track of the loss of children's primary teeth.

Dental Assessment of Over-Retained Primary Teeth

When a child presents with over-retained primary teeth, it is important that the child's oral health be carefully assessed with a comprehensive clinical exam and dental x-rays. The shape, color, position and condition of the primary tooth is also important to evaluate. There is a chance that the primary tooth could be fused to the bone. This is called ankylosis. This prevents eruption of the primary tooth, making it look submerged.

There are many reasons for primary teeth to become over-retained. The most common reason is the absence of the permanent tooth, which would normally push on the root of the primary tooth. This occurs about 2.5–6.9 percent of the time. It also happens more in females than in males. The other reasons for over-retained primary teeth are pathology, obstructions, misalignment of the permanent tooth underneath, trauma, infection and late eruption of the permanent tooth.

Why should we treat this condition? Why not leave the over-retained primary tooth alone? Over-retained primary teeth can cause problems if not properly treated. They can cause periodontal problems, dental caries and the tipping of the adjacent permanent teeth.

Treatment of Over-Retained Primary Teeth

What are the treatment options for over-retained primary teeth? It depends on the condition of the primary tooth and the surrounding structures. If the child has several over-retained primary teeth, there may be several missing permanent teeth. It is important that, in addition to your dentist, an orthodontist should evaluate the child so that a proper treatment plan can be developed.

If the primary tooth is structurally and aesthetically acceptable, the tooth can be retained. If the tooth is not aesthetically acceptable, the primary tooth can be retained and reshaped using a restoration.

When the primary tooth is crooked, it is better to extract it; the space can be closed using braces. Another treatment would be extraction of the primary tooth followed by the replacement of the tooth with a fixed bridge or dental implant. At this time, the dental implant is the treatment of choice after extraction due to its higher success rate.

Primary Teeth and Permanent Teeth

The most common types of over-retained primary teeth are the primary maxillary second molar followed by the maxillary primary canine. The most frequently missing permanent teeth are the mandibular second premolar followed by the maxillary lateral incisors. Due to the absence of permanent second premolars, the primary second molars will be over-retained. They will usually remain until adulthood before needing removal.

The etiology of missing teeth is not completely known. There is a genetic component, but there are also environmental factors, trauma, infection and endocrine disorders that can be the cause.

It is clearly very important to always have your children's baby teeth checked by a dental professional so that conditions such as over-retained primary teeth can be identified as soon as possible. Early treatment will improve the outcome.

Source: N/A

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