instruction: hello doctor this query is for my daughter who is years and months old she lost her top primary incisor teeth universal numbering before four months she still has not got the permanent teeth until now she however has lost the other three incisors and got the permanent teeth kindly do let me know if the above delay in the growth of these teeth is normal she is taking eltroxin 25 my since birth
output: hello as you mentioned your daughter is years and months old please confirm if she has lost all her upper primary teeth or lowers where the permanent teeth have come other thing is if all the upper four primary incisors are gone and three have come generally we need to see which tooth incisor has not come out of four permanent incisors if missing tooth is lateral incisor means next to two central incisors then we can wait and watch for another two to three months other scenario is if only one upper incisor is lost three to four months ago and the rest of the milk primary incisors are intact then we can still wait two to three more months but if out of four upper permanent incisors only one that too central permanent incisor has not come out then it is better to take radiograph iota intraoral periapical radiograph ray first to rule out any hindrance in the eruption of the tooth or any permanent missing tooth if possible click and share the picture of mouth oral cavity with teeth and send it across generally a delay of one year in an eruption of permanent teeth is quite normal but we need to confirm which tooth is missing and need to see the chronology of other teeth simultaneously to rule out any abnormal changes eruption delay if only one primary tooth was lost and counterpart permanent tooth is missing for the past four months iota ray of upper front teeth first need to examine clinically and then if needed iota ray and depending on iota findings treatments to be planned