Retained deciduous teeth: the epidemiology, etiology and treatment plans

Retained deciduous teeth (RDT), also known as persistent primary teeth, are commonly observed in children and adolescents. They frequently present in clinical settings, yet there is a lack of comprehensive summaries on this condition. Therefore, this review aims to summarize the epidemiology and etiology of RDT, provide recommendations for treatment and potential prevention, and increase awareness of this condition among dentists and the general public. The prevalence of RDT has risen in recent years, attributed to poor oral habits such as reduced mastication due to the consumption of softer foods, with the highest reported prevalence being 59.8%. The etiologies of RDT include ectopic tooth eruption, developmental issues, dental caries, apical periodontitis, genetic diseases and lifestyle habits. Factors such as race, gender and geographic regions also contribute to its prevalence. If not addressed properly, RDT can have adverse effects on physical and mental health. The treatment plan for RDT depends on whether a permanent tooth is inherited, whether the permanent tooth is positioned correctly, and the patient’s age. Given the scarce reports on RDT, this narrative review is based on limited literature and clinical experience. Future studies should focus on the etiology and large-scale epidemiology of RDT to improve the overall welfare of children affected by this condition.

Retained deciduous teeth; Craniofacial development; Deciduous tooth; Oral health

[1] Parameswaran R, Edathotty T, Mathew A. Clinical considerations for retaining the over-retained deciduous tooth: a rare case report. International Journal of Orthodontic Rehabilitation. 2018; 9: 27–31.

[2] Robinson S, Chan MFW. New teeth from old: treatment options for retained primary teeth. British Dental Journal. 2009; 207: 315–320.

[3] ADA Division of Communications; Journal of the American Dental Association; ADA Council on Scientific Affairs. Tooth eruption: the permanent teeth. The Journal of the American Dental Association. 2006; 137: 127.

[4] Winters J, Cameron AC, Widmer RP. Pulp therapy for primary and immature permanent teeth: an overview. Handbook of Pediatric Dentistry. 2013; 30: 103–122.

[5] Laverty DP, Fairbrother K, Addison O. The current evidence on retaining or prosthodontically replacing retained deciduous teeth in the adult hypodontia patient: a systematic review. European Journal of Prosthodontics and Restorative Dentistry. 2018; 26: 2–15.

[6] Makino E, Tsujino K, Ishii T, Shintani S, Sueishi K. Difference in bilateral timing of eruption of permanent teeth. The Bulletin of Tokyo Dental College. 2018; 59: 277–284.

[7] Sabri R. Management of over-retained mandibular deciduous second molars with and without permanent successors. World Journal of Orthopedics. 2008; 9: 209–220.

[8] Neelesh G, Updesh M, Akshada C. Retained deciduous teeth in Indore, Madhya Pradesh: a retrospective study. International Journal for Multidisciplinary Research. 2023; 5: 1–7.

[9] Jahani MF, Hosseinifar R. Case report: simultaneous presence of primary and permanent teeth. Anatomical Sciences Journal. 2015; 12: 145–147.

[10] Marra PM, Nucci L, Itro A, Santoro R, Marra A, Perillo L, et al. Prevalence of retained/transmigrated permanent and persistence of primary teeth associated with odontomas in young children. European Journal of Paediatric Dentistry. 2021; 22: 215–218.

[11] Shi XT. Epidemiologic study on retention of milk teeth in adolescents aged 12–15 years in Shanxi Province [master’s thesis]. Jinzhong: Shanxi Medical University. 2020.

[12] Henklein SD, Küchler EC, Proff P, Lepri CP, Baratto-Filho F, Mattos NHR, et al. Prevalence and local causes for retention of primary teeth and the associated delayed permanent tooth eruption. Journal of Orofacial Orthopedics. 2023; 50: 469–482.

[13] Iraqi G, Helal N, Arafa A, Helal F. Retained primary molars and related reasons in Umm Al-Qura University, Makkah: a retrospective study. The Open Dentistry Journal. 2019; 13: 190–195.

[14] Henklein SD, Küchler EC, Proff P, Lepri CP, Baratto-Filho F, Mattos NHR, et al. Prevalence and local causes for retention of primary teeth and the associated delayed permanent tooth eruption. Journal of Orofacial Orthopedics. 2023; 85: 73–78.

[15] Olatosi O, Oyapero A, Akinwande K, Ayedun O, Aladenika E, Obe O. Pattern and prevalence of dental anomalies among a paediatric population in Lagos, Nigeria. Nigerian Postgraduate Medical Journal. 2022; 29: 167.

[16] Bandaru B, Thankappan P, Kumar Nandan S, Amudala R, Annem S, Rajendra Santosh A. The prevalence of developmental anomalies among school children in Southern district of Andhra Pradesh, India. Journal of Oral and Maxillofacial Pathology. 2019; 23: 160.

[17] Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID‐19 epidemic in Wuhan: a retrospective study. International Journal of Paediatric Dentistry. 2021; 31: 5–11.

[18] Al-Abdallah M, AlHadidi A, Hammad M, Al-Ahmad H, Saleh R. Prevalence and distribution of dental anomalies: a comparison between maxillary and mandibular tooth agenesis. American Journal of Orthodontics and Dentofacial Orthopedics. 2015; 148: 793–798.

[19] Aktan AM, Kara I, Sener I, Bereket C, Celik S, Kirtay M, et al. An evaluation of factors associated with persistent primary teeth. The European Journal of Orthodontics. 2012; 34: 208–212.

[20] Manekar VS, Chavan A, Wadde K, Dewalwar V. Cysts in periradicular region of deciduous molars in mixed dentition: retrospective study of five cases. International Journal of Clinical Pediatric Dentistry. 2014; 7: 229–235.

[21] Yawaka Y, Kaga M, Osanai M, Fukui A, Oguchi H. Delayed eruption of premolars with periodontitis of primary predecessors and a cystic lesion: a case report. International Journal of Paediatric Dentistry. 2002; 12: 53–60.

[22] Arhakis A, Boutiou E. Etiology, diagnosis, consequences and treatment of infraoccluded primary molars. The Open Dentistry Journal. 2016; 10: 714–719.

[23] Paradowska-Stolarz A. Wolf-Hirschhorn Syndrome (WHS)—literature review on the features of the syndrome. Advances in Clinical and Experimental Medicine. 2014; 23: 485–489.

[24] Babich SB, Banducci C, Teplitsky P. Dental characteristics of the Wolf-Hirschhorn Syndrome: a case report. Special Care in Dentistry. 2004; 24: 229-231.

[25] Meixner I, Hagl B, Kröner CI, Spielberger BD, Paschos E, Dückers G, et al. Retained primary teeth in STAT3 hyper-IgE syndrome: early intervention in childhood is essential. Orphanet Journal of Rare Diseases. 2020; 15: 244.

[26] Singh A, Bhatia HP, Sharma N. Coexistence of fusion and concrescence of primary teeth: in a child with down syndrome. Special Care in Dentistry. 2017; 37: 147–149.

[27] Asokan S, Muthu M, Sivakumar N. Oral findings of down syndrome children in Chennai city, India. Indian Journal of Dental Research. 2008; 19: 230–235.

[28] Downs AT, Crisp T, Ferretti G. Hunter’s syndrome and oral manifestations: a review. Pediatric Dentistry. 1995; 17: 98–100.

[29] Ramalingam K, Bhadrashetty D, Gajula P. A rare case of mucopolysaccharidosis: hunter syndrome. Journal of Natural Science, Biology and Medicine. 2012; 3: 97.

[30] Al‐Raeesi S, Kowash M, Hassan A, Al‐Halabi M. Oral manifestations and dentofacial anomalies in β-thalassemia major children in Dubai (UAE). Special Care in Dentistry. 2018; 38: 25–30.

[31] Nagarathna C, Shakuntala BS, Mathew S, Krishnamurthy NH, Yumkham R. Cleidocranial dysplasia presenting with retained deciduous teeth in a 15-year-old girl: a case report. Journal of Medical Case Reports. 2012; 6: 25.

[32] Lu XX, Yang K, Zhang BZ, Wang JH, Du Y, Chen YJ, et al. Measurement of the morphological data of primary teeth in northwest China. Frontiers in Pediatrics. 2022; 10: 1010423.

[33] Gu Y, McNamara JA, Sigler LM, Baccetti T. Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults. The European Journal of Orthodontics. 2011; 33: 205–211.

[34] Khan N, Abbasi SA, Khan H, Baloch MUR, Chohan A. Effect of dietary pattern on the emergence of permanent teeth of the children of Larkana, Pakistan. Ibnosina Journal of Medicine and Biomedical Sciences. 2022; 14: 028–034.

[35] Saadoon R, Mohammed D, Mohamed Refaat M. Prevalence of retained primary teeth without permanent successors among orthodontic patients in Basrah city/Iraq. Systematic Reviews in Pharmacy. 2021; 11: 94–99.

[36] Chantic SF, Ismah Nada, Anggani HS, Purwanegara MK. Identification of dental factors associated with crowding malocclusion in primary school children in Jakarta. Journal of International Dental & Medical Research. 2020; 13: 1147–1150.

[37] Zou J, Meng M, Law CS, Rao Y, Zhou X. Common dental diseases in children and malocclusion. International Journal of Oral Science. 2018; 10: 7.

[38] Anand T, Garg AK, Singh S. Effect of socioeconomic, nutritional status, diet, and oral habits on the prevalence of different types of malocclusion in school-children. Acta Bio-Medica. 2022; 93: e2022161.

[39] Kutesa A, Nkamba EM, Muwazi L, Buwembo W, Rwenyonyi CM. Weight, height and eruption times of permanent teeth of children aged 4–15 years in Kampala, Uganda. BMC Oral Health. 2013; 13: 15.

[40] Simsek-Kaya G, Melih-Omezli M, Yapici G, Dayi E, Ertas U. Prevalence of impacted premolars in a Turkish population and considerations for surgical treatment. Medicina Oral Patología Oral Y Cirugia Bucal. 2011; 16: e781–e786.

[41] Dimaisip-Nabuab J, Duijster D, Benzian H, Heinrich-Weltzien R, Homsavath A, Monse B, et al. Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR. BMC Pediatrics. 2018; 18: 300.

[42] Butera A, Maiorani C, Morandini A, Simonini M, Morittu S, Trombini J, et al. Evaluation of Children Caries Risk Factors: A Narrative Review of Nutritional Aspects, Oral Hygiene Habits, and Bacterial Alterations. Children. 2022; 9: 262.

[43] Bin-Shuwaish M. Ceramic veneers for esthetic restoration of retained primary teeth: a 4-year follow-up case report. Operative Dentistry. 2017; 42: 133–142.

[44] Parise Gré C, Schweigert Bona V, Pedrollo Lise D, Monteiro Júnior S. Esthetic rehabilitation of retained primary teeth—a conservative approach. Journal of Prosthodontics. 2019; 28: e41–e44.

[45] de Oliveira RR, Macedo GO, Muglia VA, Souza SL, Novaes AB Jr, Taba M Jr. Replacement of hopeless retained primary teeth by immediate dental implants: a case report. The International Journal of Oral & Maxillofacial Implants. 2009; 24: 151–154.

[46] Jang JY, Lee SJ, Lee JD. Considerations in the replacement of over-retained primary teeth with implant restorations in the esthetic zone: a case report. Journal of Esthetic and Restorative Dentistry. 2020; 32: 272–279.

[47] Xue DJAF. Combined orthodontic-surgical treatment for skeletal class III malocclusion with multiple impacted permanent and supernumerary teeth: case report. The Open Dentistry Journal. 2014; 8: 43–48.

[48] Tenelanda-López D, Valdivia-Moral P, Castro-Sánchez M. Eating habits and their relationship to oral health. Nutrients. 2020; 12: 2619.

[49] de Cock P. Erythritol functional roles in oral-systemic health. Advances in Dental Research. 2018; 29: 104–109.