Tooth agenesis, including oligodontia, may be rare but it can cause issues if your child has it. Here's what parents need to look out for.
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Portrait of boy with missing teeth
Credit: Getty Images/ Tetra Images

When he was younger, Dylan Cuffin noticed his friends were all losing teeth, but he was not. Then his parents laid it out for him: he didn't have 14 permanent teeth. At first, he felt confused.

"I didn't know if it was my fault," says Cuffin, 21, of Midlothian, Texas.

He soon learned the culprit was a condition called oligodontia.

Oligodontia is one of three forms of tooth agenesis, or when teeth are missing. There's also anodontia, which refers to the absence of all teeth, and hypodontia, when a person is missing one to six teeth. Those with oligodontia are missing six or more teeth. These conditions can involve the baby teeth or adult teeth.

Here is what every parent needs to know about how to ensure your child has a full set of teeth, now and in the future.

Oligodontia Facts

The condition can hide and ambush unsuspecting parents during a child's panoramic x-ray, which is usually recommended after permanent teeth starting growing in (around 6 or 7 years old). That was the case for my son, whom we discovered had oligodontia when an x-ray showed the absence of a few permanent teeth in those cute gums.

Oligodontia is genetic and is often associated with an underlying syndrome. It's also rare, occurring in less than 1 percent of people, according to a study in the Ethiopian Journal of Health Sciences. Kids with oligodontia also typically have family members with oligodontia or hypodontia. The latter is more prevalent, affecting up to about 7 percent of people, yet is often fixed with crowns, implants, or bridges without mention of a possible genetic condition. That's because the field of dentistry is typically focused on fixing problems rather than understanding the causes and linking conditions like these, says Naif Sinada, DMD, MS, of Ozark Prosthodontics in Fayetteville, Arkansas.

That was the experience for the Cuffin family. Mom Amy Cuffin was blindsided when her otherwise thriving child was missing almost half of his adult teeth. She has three missing teeth herself. "Nobody really made a big deal out of it," says Amy Cuffin, until her son's dental x-ray revealed his condition.

The good news is oligodontia is fixable. "Nothing is a problem unless we can't fix it," says Dr. Sinada.

How To Know if Your Child Has Oligodontia

Primary teeth, the first set of 20 teeth, usually all grow by 3 years old. Around age 5 and 6, these baby teeth start falling out because permanent teeth are trying to take their spots. All permanent teeth (there are 32) are generally in place by age 12 to 14 (except for wisdom teeth). But if a permanent tooth never comes out, then the baby tooth either does not fall out or gets replaced with nothing, explains Dr. Sinada.

If you notice teeth missing or that certain baby teeth haven't fallen out, take your kid to see a pediatric dentist. Each case of missing teeth is unique, so there isn't a hard deadline for certain teeth to fall out or grow in. Dental experts say the most important tip to detect missing teeth is to go for regular six-month checkups. (It's recommended children head to the dentist by the first birthday or after the first tooth erupts.)

There are different types of oral x-rays, but the pediatric dentist will likely recommend a panoramic x-ray, which provides a full view of the upper and lower jaws and teeth. Tests like these can trigger a child's anxiety and the impulse may be to forego the x-ray. If you must regroup for next time, that's OK. But get the x-ray if you can because early detection of missing teeth is crucial.

When she was younger, Allie Steelman, 15, struggled with anxiety at the dentist. Then her panoramic x-ray showed 10 missing teeth. "I was completely shocked," says her mom Amy Steelman of Paris, Tennessee. That started a long and fruitless process of finding help for her daughter until they drove over 400 miles to see Dr. Sinada, who repeated his magical phrase—it is fixable.

If your pediatric dentist does not mention missing adult teeth, make sure to ask—especially if you have a family history. "Do your research," advises Amy Steelman. "Don't just sit and wait for your dentist to tell you because so many times they don't know what to tell you."

When To Treat Oligodontia

With an oligodontia diagnosis, the first step is to arm yourself with information. Most patients will need dental implants, but specialists recommend young patients wait until they reach full facial growth and developmentusually by their late teens—to receive permanent solutions. The quarterback of the treatment team should be a prosthodontist because they are trained to fix missing teeth.

Left untreated, oligodontia could affect facial features, jawbone growth, and the ability to chew properly. Dylan Cuffin experienced the latter—since baby teeth are weaker than permanent teeth, his 14 remaining baby teeth wore down from use and felt so weak he couldn't bite into an apple or eat freely without worrying about how to chew.

The mouth is what Dr. Sinada calls "the gateway to the body" and teeth not only perform the life-sustaining task of chewing, but they are one of first ways people see you, so teeth—and their absence—can carry psychological effects as well. According to a comparative study in the National Library of Medicine, children with oligodontia experienced high negative psychological effects from the condition.

But the condition is often labeled as cosmetic by health insurance companies and not a medical necessity. That leaves many families with children with oligodontia struggling with the financial impact of the condition. A bill could change that—the Ensuring Lasting Smiles Act, which was reintroduced in Congress in March 2021, would require private health insurance plans to cover procedures and services for congenital conditions like missing teeth. It passed the House of Representatives in April 2022, and now moves to the Senate.

For Dylan Cuffin, he finally passed the finish line in the quest for a full set of functional teeth. In February, he received his last oral surgery. After which he chewed gum and had a nice steak dinner with his parents. He says he gets compliments on his teeth all the time now. And before Allie Steelman received her long-term temporary teeth, she only smiled with lips closed. Now she offers a toothy grin.

My 10-year-old is at the beginning of his journey, made easier by families like the Steelmans and the Cuffins, who fought so hard for their kids to smile, eat, and chew gum.