That first baby tooth is always a special milestone. There’s just nothing cuter than a drooly pair of bottom front teeth in a tiny mouth. But not every baby gets her teeth at the same time, and not every child loses her baby teeth on the same schedule. While dental professionals offer general guidelines on timing for both primary and permanent teeth, there’s usually no need to worry if your little one is behind or ahead of the curve. However, there are some situations involving delayed emergence of baby or adult teeth that call for a visit to your pediatric dentist.
When Should My Child’s Teeth Come In?
Did you know that when babies are born, their teeth are already formed in their gums waiting to come out? Most children end up with a total of 20 baby teeth and 32 adult teeth by their early 20s.
Baby teeth usually start to come in when your little one is around 6 months old. The pattern usually starts with those adorable lower front teeth (the central incisors), followed by the top front teeth. Your toddler’s first molars usually come through before her canines (those slightly pointy teeth next to the four front incisors). Most children will have all 20 of their baby teeth by age 3.
Children start losing their first baby teeth (again, usually the lower front incisors go first) around 6 or 7 years old. The pattern for permanent teeth eruption is similar to primary teeth but with lots of extra molars. Usually, the lower and then upper front teeth come out around age 6 or 7, followed by so-called first molars near the middle of the mouth. The difference between primary and permanent teeth is there are twelve additional teeth added to the mouth, including bicuspids (transitional teeth that come in between the canines and molars). Usually the incisors and first molars show up in early elementary school, followed by the canines, bicuspids and second molars between ages 9 to 13. Most children have 28 teeth by their early teen years until those final wisdom teeth (or third molars) make their appearance between 17 and 21. The American Dental Association offers a useful chart with a typical tooth eruption schedule. https://www.mouthhealthy.org/en/az-topics/e/eruption-charts
What If My Child’s Baby Teeth Don’t Come in on Schedule?
It’s important to remember that the schedules your dentist uses are guidelines. Most experts agree that a delay of up to a year should not cause alarm. However, if your baby doesn’t have teeth by 18 months, it’s definitely time to schedule an appointment with a pediatric dentist. When we consult with a family whose toddler has delayed emergence of primary teeth, we’ll work with parents and their pediatrician to rule out illness and find out what factors may be contributing to the delay. Here are some of the factors that can contribute to delayed emergence of primary teeth:
- Genetic factors: in some cases, family history simply pushes out the timeline for teeth to appear
- Genetic conditions that may impact bone development
- Premature birth or low birth weight
- Environmental factors like mother smoking
- Nutritional deficiencies
- Certain diagnoses like cerebral palsy and Down syndrome
What If Baby Teeth Don’t Fall Out or Permanent Teeth Are Delayed?
Many parents and older children know and love the actor Gaten Matarazzo who plays Dustin on the popular television show “Stranger Things.” Both the actor and his character have a condition called cleidocranial dysplasia (CCD), a rare genetic mutation that affects the development of bones and teeth and often means patients are unable to lose their baby teeth.
While Gaten’s diagnosis is rare, there are numerous reasons that permanent teeth may be delayed. Most of them offer no cause for concern, but in some cases, families will want to see their pediatric dentist and/or orthodontist. The general rule of thumb is to check with your pediatric dentist if your child has not started losing her baby teeth by age 8.
According to a 2010 study published in a European dental journal, some of the main causes of delayed emergence of permanent teeth include:
- Genetics: it’s hard to overestimate the role family history plays in oral health and development
- Nutrition deficiencies
- Gender: girls tend to lose baby teeth before boys
- Body size: bigger kids lose their teeth earlier in general
- Hormonal issues related to pituitary and thyroid issues
- Bone structure: sometimes the jaw isn’t big enough for larger teeth, and crowding may result
We sometimes see permanent teeth come in behind the baby teeth in the bottom front of the mouth. This usually resolves itself without intervention, but sometimes your pediatric dentist may need to pull a stubborn baby tooth to avoid crowding.
Can Delays In Losing Baby Teeth Cause Orthodontic Problems?
While most delays in losing baby teeth are harmless, in some cases, losing teeth too early or too late can cause problems with spacing and crowding of permanent teeth. For this reason, when a young child loses primary teeth because of injury, we usually recommend a spacer to prevent crowding and save space for the permanent teeth when they’re ready to come in. Baby teeth that refuse to budge can also cause permanent teeth to come in crooked. We may need to remove those baby teeth and consult with an orthodontist to make a plan for straightening the permanent teeth.
Teeth, Timing and Your Child at NOVA Pediatric Dentistry & Orthodontics
One of our mantras at NOVA Pediatric Dentistry & Orthodontics is to view every child as an individual. We know that every patient is different and develops at his or her own pace. In general, a delay is nothing to worry about and just requires regular check-ups–and a little patience. Given this, our goal is to help parents become aware of guidelines and benchmarks without becoming alarmed or worried unnecessarily. If your child is experiencing a significant delay involving primary or permanent teeth, we’ll want to see her to rule out illness or other conditions. Our dentists have extensive training and experience in pediatric dental development and can tell you when to take action and when to wait and see. Our in-practice orthodontist is also an excellent resource for elementary and middle school-aged children who may experience issues with crowding of permanent teeth as they erupt.