Tooth agenesis
==============

* Upendra Jain
* Amitabh Kallury
* Gagan Thakur

## Description

A 27-year-old male reported with the chief complaint of forwardly placed front teeth and unpleasant smile. Medical history was not significant. Extra-oral examination revealed mesoprosopic face, reduced lower anterior facial height, deep mentolabial sulcus and lip trap (figure 1). On intra oral examination there was Angle’s class I molar relationship with severely proclined maxillary central incisors. All the teeth mesial to first molars except maxillary central incisors and right mandibular first premolar were absent. The deciduous maxillary right and left canines, right maxillary first and left maxillary second deciduous molars were still retained (figures 2 and 3). Queries revealed that missing teeth were absent since childhood and his sister had similar dental pattern. The prevalence of congenitally missing teeth varies greatly according to geographic location and race, ranging from 1.6% to 9.6 %.1 Permanent teeth are more frequently affected than deciduous teeth. The mandibular second premolar is the most frequently reported missing tooth, followed by the permanent maxillary lateral incisor and maxillary second premolar.2 This condition can present as stand alone problem or may be associated with syndromes. Both genetic and environmental factors have been implicated in the aetiology.3

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.08.2011.4681/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2011/bcr.08.2011.4681/F1)

Figure 1 
Extra-oral view.

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.08.2011.4681/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/2011/bcr.08.2011.4681/F2)

Figure 2 
Intra oral view.

![Figure 3](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.08.2011.4681/F3.medium.gif)

[Figure 3](http://casereports.bmj.com/content/2011/bcr.08.2011.4681/F3)

Figure 3 
Orthopantomograph.

## Footnotes

*   Competing interests None.

*   Patient consent Obtained.

## References

1.  Clayton JM. Congenital dental anomalies occurring in 3,557 children. J Dent Child 1956;23:206–8.
    
    

2.  Symons AL, Stritzel F, Stamation J. Anomalies associated with hypodontia of the permanent lateral incisor and second premolar. J Clin Pediatr Dent 1993;17:109–11.
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=8466838&link_type=MED&atom=%2Fcasereports%2F2011%2Fbcr.08.2011.4681.atom) 

3.  Kokich VG, Kokich VO. Congenitally missing mandibular second premolars: clinical options. Am J Orthod Dentofacial Orthop 2006;130:437–44.
    
    [CrossRef](http://casereports.bmj.com/lookup/external-ref?access_num=10.1016/j.ajodo.2006.05.025&link_type=DOI) 
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=17045142&link_type=MED&atom=%2Fcasereports%2F2011%2Fbcr.08.2011.4681.atom) 
    
    [Web of Science](http://casereports.bmj.com/lookup/external-ref?access_num=000241242100007&link_type=ISI)