Excerpted from the Norwegian news article:
“Yes, we Norwegians are a bit toothless.”
Yes, we Norwegians are a bit toothless.
We like to think of ourselves as well equipped. Yet when some of us open our mouths, the dental arrangement can appear somewhat sparse.
When he meets a Norwegian patient, he often finds himself wondering:
Do you have all the teeth you are supposed to have?
The person asking the question is Mark Lowey, an orthodontist practicing in Stavanger. He has worked in Norway for many years, but also has extensive clinical experience from his native England. One striking difference he has observed between the two countries is that congenitally missing teeth appear to be considerably more common in Norwegian patients than in English ones.
“Here in Stavanger, I encounter incomplete dentitions two to three times a day. In England, I would see the same pattern perhaps two to three times a week,” says Lowey.
A complete adult dentition normally consists of 32 teeth. Scientific studies indicate that individuals in Nordic countries, on average, have a higher prevalence of missing permanent teeth compared with populations in more southern parts of Europe. Genetics plays a significant role in this variation.
A Norwegian study from 1993 found that 6.5 percent of a sample of nine-year-olds were missing one or more permanent teeth. In 2002, researchers reported that 4.5 percent of a group of 18-year-olds showed the same condition.
Higher figures have been reported in neighboring countries: 7.8 percent among Danish nine-year-olds and 7.9 percent among Icelandic children aged 8–16 years. By comparison, the prevalence in England and several other European countries is around 2 percent.
The most extensive case Dr. Lowey has encountered in Stavanger involved 12 congenitally missing teeth.
What explains this pattern among parts of the Nordic population?
Orthodontists point to human evolutionary history. Over time, different populations developed distinct characteristics — not only in skin color, facial structure, and body proportions, but also in dental development. The exact reason for the higher prevalence of missing teeth in Nordic populations remains uncertain.
Research has identified associations with specific genes, including PAX9, MSX1, and AXIN2, which are known to influence tooth development. Variations in these genes may contribute to congenital absence of permanent teeth.
The absence of certain teeth is unlikely to have offered a direct evolutionary advantage. Rather, it may represent a genetic variation that co-occurred with other inherited traits.
A possible explanation, the orthodontist reflects, is that a group of people carrying these genetic traits at some point became smaller and relatively isolated, before later expanding again. In such circumstances, certain inherited characteristics may become more common within a population.
“When I met a patient in England with missing teeth, I would sometimes say: You must have a Viking somewhere in your family tree. That usually made them quite pleased,” Lowey recalls with a smile.
Congenitally missing teeth are often discovered when patients are referred to him by general dentists in the public or private sector for treatment of underbite, overjet, crossbite, or other orthodontic concerns. It can be difficult for the referring dentist to detect missing permanent teeth, as specialists typically have access to more comprehensive radiographic imaging.
“Missing teeth can be difficult to identify. In some cases, a retained primary tooth remains in place where the permanent tooth was expected to develop. As a result, many individuals are unaware that they are missing one or more permanent teeth,” Lowey explains.
Can one function well with missing teeth?
“In the past, people often managed without teeth, using full dentures. Today, providing a denture to a young patient would not be considered appropriate treatment. A dentition that appears well aligned is usually also the one that functions most effectively,” he notes.
When many teeth are absent, restorative solutions such as bridges or implants may be required. If one to four teeth are missing, orthodontic treatment is often used to gradually close the space. Over time, adjacent teeth are carefully repositioned to reduce or eliminate the gap.
Early detection is preferable. For example, it is not ideal for an 18-year-old to require two to three years of orthodontic treatment because impacted canines or other teeth were not identified earlier. Parents naturally wish to know whether their child is missing permanent teeth.
However, routine radiographic screening of all young children solely to detect missing teeth is not recommended. Radiographic examinations involve exposure to radiation, intraoral imaging may cause temporary discomfort, and widespread screening would carry significant cost.
While some Norwegians have a higher prevalence of missing teeth, are extra teeth also common?
“Supernumerary teeth are much rarer. I encounter them perhaps two or three times a year,” says Lowey.
He adds that Stavanger is well served in this field. “We are six orthodontic colleagues in the city. With modern orthodontic techniques, we are well equipped to manage patients with missing teeth and provide appropriate treatment solutions.”