Hypodontia (Missing Teeth)

People with hypodontia may experience:

• One to six missing teeth (either the baby or adult teeth) anywhere within the oral cavity
• Peg-shaped teeth or unusually small teeth
• Gaps and spaces between the existing teeth
• Difficulties in eating, chewing, and speaking
• Underdeveloped jawbone due to poor stimulation from teeth

In some cases linked to genetic disorders (such as ectodermal dysplasia), additional features may be seen:

• Nail abnormalities
• Hair thinning
• Poor vision and hearing
• Lack of sweat glands

Various causative factors lead to hypodontia:

• Genetics: Hypodontia is mostly a birth defect and passes down in the family. In patients with hypodontia, abnormalities in the dental lamina, i.e., the tissue underneath the gums where the teeth are formed, are observed.
• Associated syndromes: Hypodontia may occur in association with certain syndromes, e.g., Crouzon syndrome, Williams syndrome, achondroplasia, orofaciodigital syndrome, and Rieger syndrome.
• Medical conditions: Hypodontia has also been observed alongside other conditions, such as low birth weight, genetic disorders (Down’s syndrome or ectodermal dysplasia), or cleft palate/lip.
• Infections during pregnancy/childhood: Hypodontia can manifest due to infectious diseases such as candidiasis or rubella.
• Cancer treatments: Chemotherapy and radiation therapy may interfere with tooth development.

Hypodontia can be diagnosed by a dentist using the following:

• Oral examination: Dentists may look for other symptoms of hypodontia (apart from missing teeth), such as the presence of gaps between existing teeth or peg-shaped teeth.
• Dental X-rays: Dental X-rays may reveal the absence of tooth buds.
• Age-based observation: If a child’s primary teeth do not erupt by age 4 or permanent teeth do not erupt by age 14, parents should consult a dentist to address concerns about the child’s missing teeth.

Treatment depends on age, number of missing teeth, and overall oral health. Methods for treating hypodontia include:

• Orthodontic devices (braces or aligners): To correct spacing and alignment.
• Partial dentures: Removable dental prostheses that replace missing teeth in the lower and/or upper jaw, especially in children until permanent treatment can be done.
• Dental bridges: Fixed prostheses that replace missing teeth by taking support from two adjacent teeth.
• Dental implants: Titanium-based screws fixed in the jaw bone for replacing a missing tooth permanently without any support from the adjacent teeth.

Patients/parents should approach a dentist if:

• A child’s teeth do not appear within expected timelines
• Gaps, missing teeth, or chewing difficulties are noticed
• Hypodontia is suspected in association with a syndrome or genetic condition

Hypodontia is usually a congenital condition and cannot be completely prevented. However, early dental checkups can help in timely diagnosis and prevent complications such as jawbone underdevelopment and bite problems.

For diagnosis and treatment of hypodontia, consult a:

• Paediatric dentist: for children
• Prosthodontist: for tooth replacement options like dentures, bridges, and implants
• Orthodontist: for alignment and spacing corrections