Wednesday, April 24, 2013

When will my child loose his first tooth?

I get this question all the time:  When will my child's first baby tooth fall out?  The answer is that it varies form child to child.  There are a lot of children who are really excited to get a loose tooth.  Their friends are loosing theirs, why not them?




Generally, if a child got his first tooth at an early age as a baby, he will loose it at an earlier age as well.  If he got his first tooth a little late, then he will loose his first tooth later than most.

The typical age to loose the first baby tooth is 6 years of age.  About 90% of kids loose their first tooth at age five or six.

The first tooth to be lost is almost always one of the mandibular (bottom) front central incisors.

If you look at a chart of tooth exfoliation from the ADA, you will see they list the lower front central incisor as falling out around 6 to 7 years of age.  That's pretty normal, however, I see lots of 5 year old kids with their first loose tooth.  If I'm making a chart, I'm putting 5-6 rather than 6-7.  I see just a few children loosing their first tooth at age 4, and there are many that do not loose a tooth till age seven.  There are a few loosing a tooth age eight, but that's definitely on the late side.  They key is that it varies a lot.  Four is definitely early, seven or above is later than most, but it's all normal.  If you are not sure, ask your pediatric dentist if your child's eruption pattern is right on track.  Also, some baby teeth do not fall out till age 12 on average.

There are a few syndromes or medical reasons for delayed eruption, but that's pretty rare.

See here for something that happens often:

Permanent tooth coming in behind baby teeth

In case you were wondering , the first baby tooth usually comes in any where from 4 to 12 months of age; usually 6 months of age is average.  This varies a lot as well.

51 comments:

Amanda said...

Dear Dr. Dean,

My 3 year old fell and broke a part of his front tooth. The other front tooth was pushed in.
I was so worried and took him to emergency and there I was referred to a pediatric dentistry.
The next morning he was seen by my family dentist first and he took a x-ray and temporarily sealed the part where the nerves were exposed (with sealant). His suggestion was to fill the broken part in about a week.
I also followed up with the pediatric dentistry and they looked at the x-ray and ask me to watch out for 2 months for tooth discoloration. If that happens they said they'll have to pull
off the tooth. If the color doesn't change they'll fix the broken part with a filling when the tooth is stable(in 2 months).
After 3 days the sealant came off and the nerves were exposed again. I took him back to the family dentist and he fixed it back again. He was quite surprised why the pediatric dentists would keep him 2 months without do the filling. He recommended to do the filling in the the coming week.
I'm confused with what action to take. I 'm afraid that the sealant would come off again. I dn't know how many times it would happen if we wait 2 months as they said.

Please help me to take a decision. I have a copy of the xray in my email if you want to see it.
Also, if the tooth get discolored does that necessarily mean that it has to take off? I've read
that the discolored tooth can get lighten over time. Please help me I dn't want my son to
stay without front teeth for 3-4 years. Please help me.
What can I do to make sure they are healthy?

Thanks in advance.

Dr. Dean Brandon said...

Well, I can't really advise you as to the "right" thing to do. You can read here on the blog about a tooth turning dark after a trauma--a common occurrence. If a baby tooth is literally broken into the pulp/nerve, bacteria get in there and would likely cause an abscess. If it's just a large fracture and not into the pulp, you might be able to restore it with a filling or a crown. These are just generalizations. This all presumes pretty good cooperation. You can read more here on the blog about trauma, restorations and the like.. Good Luck.

tooth turning dark

andrew said...

Dr Dean, I saw a much older post on dental insurance and whether it's worth it or not. I have a slightly different question. We just learned that our 7 year old is not covered by our dental HMO plan to go to a pediatric dentist. Apparently, they cut off dental care at pediatric dentists at age 6, and 7+ must go to a general dentistry practice. Is this common, in your experience? What is the rationale? That most kids have a few permanent teeth by then? Thanks.

Dr. Dean Brandon said...

Well, the reason is that they seem to have no clue as to what a pediatric dentist does. We see children and teens up to age 21.

The rationale is that they are trying to save money. How, I am not sure, because Pediatric Dentist's fees are comparable with general dentists for similar procedures. This situation is not that common in my experience. Many specialists (endodontists, pediatric dentists, periodontists, oral surgeons, and orthodontists) do not sign up for HMOs. The HMO company cannot hold an "out of network" specialist or non-HMO dentist to the same severe restrictions. There is some degree of involvement of pediatric dentists in PPO type plans, but it all depends. The HMO is likely trying to force enrollees to go to an in-network general dentist because there are no pediatric dentists on the HMO plan. Many general dentists feel uncomfortable dealing with the behavioral and cooperation issues that tend to crop up with preschoolers, so the HMO knows the HMO general dentists will not see every child and will end up referring them. Too bad that they do it that way, as there are a lot of growth and development (and behavioral issues) that continue throughout the school age and teen years. Good luck.

Brittany S said...

My son is 19 months old & I noticed a pencil eraser sized lesion above his tooth #E yesterday. He had fallen on the tooth & injured it in the past. We went to a pediatric dentist & the dentist said there was no other option but extracting the tooth. He said the tooth wasn't discolored but did find it to be mobile. I have pictures of the X-ray & the ?abscess?. I was reading your post on these sorts of things, & I am wondering if a pulpectomy would be an option for my son. I can't decide if the tooth REALLY needs to come out or if there are regional practice differences/this dentist isn't comfortable with other options. What would you advise? Thanks

Dr. Dean Brandon said...

Removal of an abscessed baby tooth is almost always the best option. mainly because there is no good way to fix it. Mobility of an abscessed baby tooth indicates there is bone loss and perhaps resorption of the root. Those things make baby tooth root canals not work well. In rare cases you can do a baby tooth root canal but I find they only "work" les than half the time (in ideal conditions. Read more here on the blog about what is a pulpotomy and about root canals. The main objective is to protect the growing permanent tooth.

Dr. Dean Brandon said...

An abscessed baby front tooth over time (especially at ages 1-3) can affect the permanent front tooth, meaning cosmetic damage, hypoplastic areas, in addition to the obvious infection. The only times I have done baby tooth root canals on front baby teeth is if there are no signs of abscess and we are doing it to prevent the chance of abscess.

daryl @ Sarasota dentist said...

This does sound like a tough situation and difficult decision to make. I haven't had anything like this happen to my children but my kids have been in a situation where their adult teeth started coming in while their baby tooth still remained firmly in their mouth. I think this is known as shark teeth.

Orthodontist Treatment said...

title is really sweet. i like this post a lot. thanks a lot for sharing such an nice post. its amazing.

marcus said...

Well done Dr. Brandon! I always enjoy the simplicity with which you write.

Longmont Dental Health said...

This is a great blog. I will check back often.

Bruce Howell
http://www.longmontdentalhealth.com

Tara said...

@ Amanda - it sounds like you really should just take your baby to a dentist or pediatrician!

dentista zapopan said...

It will always depend on the child. Some will lose the tooth earlier. But I liked your experience, nothing talks better than real life experiences. Hope to see more posts from you.

Regards.

embmarketing@yahoo.com said...

Dr. Brandon,
I would like some input on one of your older topics regarding pedo-partials.
This has been recommended by two different pediatric dentists for my 2.5 year old as he is having his front 4 top teeth pulled, caps/crowns on his upper canines, and other fillings in the back molars.

My question, that gets ignored every time I ask either of these dentists is how does this partial effect palate/jaw growth? And is there an increased risk of infection? I read on another site that there was a risk of fungal infection from the partial?

If you could please provide your insight I would highly appreciate it.

Thank you,
Marie

Dr. Dean Brandon said...

Pedo partials are hard to clean around, but I do not see significant problems with infections. Reasonable care and periodic dental checkups are helpful. I'd rather not do partials of this kind at all. They are usually only for cosmetic reasons. They do not affect growth during the time frame they are worn. The "jaw" grows in the back to accommodate the permanent molars. It does not expand like a balloon. So, a partial worn in the preschool years is not a growth concern. They should be removed when the new teeth are approaching eruption however. We sometimes purposefully expand the palate withe things like the quad helix or hyrax to correct a crossbite, but that is something different than a partial.

Shelly Williams said...

Dr. Brandon,
My 5 year old daughter began to tell us about 2 weeks ago her front lower tooth was lose. We looked at it and saw that she was wiggling with her finger and it was lose. So we figured it must be time for her to start losing her baby tooth. Well it finally came out the other night. However, when I looked at the tooth up close it appeared to have broken off at the base. Then I remembered shortly before her pre k class let out for summer, a dentist came to their class to talk about caring for their teeth and that their baby teeth would begin to start falling out soon. Afterwards, she kept telling me look mommy, my tooth is loose. And it was that tooth and she would tug on that very tooth. It was not lose that I could see. She had just been so taken with her baby teeth getting ready fall out that she was tugging on one saying it was lose. I think she may have broken it doing that and that's why it came out. Do I need to take her to a dentist for an extraction so, that it does not hurt her future permanent tooth underneath? Or do we leave it alone? She has never expressed any pain regarding the tooth.
Thank you.

Dr. Dean Brandon said...

Very doubtful that a child would "break" off a loose tooth with remaining root structure, but it never hurts to get the pediatric dentist to take a look at the new erupting teeth.

Clare Manders said...

Dear Dr Dean.

Firstly can I say how useful your blog and webpage are and I will be recommending to friends. Especially all the teething details. Wished I found this page sooner.
I also wish I was writing on here in better circumstances.

My 19t month old baby boy fell over yesterday, over the top of his walker and onto our brick patio. Needless to say he snapped off a big chunk on his front left tooth leaving a big gap to one side. The hole was about half way up the tooth, going down to a point at the outer side of the tooth. This managed to stay in tack somehow.

Anyhow last night he OK, all seemed not too bad but maybe a little sensitive. He is also breastfed still which was extremely painful as the tooth was so sharp.

THis morning I tried to brush his teeth and he was noticeably uncomfortable with it. We then went to our dentist as soon as we could and he was fantastic and managed to fill the missing area with a composite and seal it back up. It looks good, and you probably wont notice from far away and hopefully only those that know can tell.

What I am now worried about it if it will go grey/black. Because it was sensitive does this mean it is likely or is this just because the enamel etc.. was broken and therefore exposed the inners of the teeth, or are these inners the nerves?

Also another thing I read was that it an discolour but only temporarily, like a bruise on skin, is this true?

How common is it for a 'shocked' tooth to change colour? If it does could it be covered with a thin layer of something to make it white again?

He's so little and has still got a long wait for his adult teeth.

Thanks in advance for your help.

Clare

Dr. Dean Brandon said...

I get a lot of questions about a tooth turning dark from a trauma. See my post here on that:

Tooth turning dark

Anonymous said...

My six year old pulled her tooth out by tying floss to a door. She has already lost one of her front bottom teeth. The pulled tooth is a front tooth. When she pulled the tooth, her gums bleed a lot. After the bleeding subsided, I noticed that the front of her gums look like they have been ripped ( not the top of her gums, but the front). The tooth had been lose, but when the tooth came out the root was still extremely long. Should I take her to her dentist to see if the gums are damaged permanently?

Dr. Dean Brandon said...

It never hurts to have her pediatric dentist take a look. Most of the time gums heal very well from most kinds of trauma.

Handiman Inc. said...

It is really nice and great post. It is really informative blog and giving me a lot of information about Pediatric Dentistry. Thanks for posting this awesome blog. keep blogging.

Benedwin said...

This Stuff looks really great.Some people don’t laugh even on great joke because they don’t like to smile just because of ugly and broken teeth.But pediatric dentistry gives a new smile.You are doing great job. Thanks for sharing it.

Uday Shah said...

Hi Doctor,

I observed the growth of a permanent teeth, before the fall of a baby teeth. Does this affect the jawline of the baby?

Dr. Dean Brandon said...

not as you have stated, but swellings that do not go away and a new tooth does not erupt, then it may be a concern. If you are concerned, visit your pediatric dentist.

Tabitha said...

Question: my daughters first tooth has been loose for about 2-3 weeks and its now turning grey. Is that normal?

Dr. Dean Brandon said...

Tabitha, it depends on if the tooth is supposed to be loose. In other words, it's getting loose when it's supposed to. Sometimes I see baby teeth turn darker pinkish kind of as the internal part of the tooth begins to dissolve away along with the root. (that's how it gets loose)--no more root. If it's just a shell of a tooth, the gum tissue shines through and looks darker. If the tooth is loose because of a trauma or it's just not time, there could be some concern there. Have your pediatric dentist take a look.

Anonymous said...

My 6 year old son doesn't seem to have any loose teeth yet but...his teeth seem to be turning darker...his dentist said to use a flouride mouth wash with him and since doing so they seemed to get worse? He brushes every morning and night...no cavities. Should I be concerned?

Dr. Dean Brandon said...

Sounds slightly unusual, but likely a brushing issue. Consult your dentist again if it worsens. A darkened tooth can also be caused by trauma.

ashley santiago said...

Hello, My son turned 5 in September. Yesterday he suffered a school ground accident. As a result his 2 front teeth were broken at the roots. His pediatric dentist extracted both broken teeth. The roots are still in. The dentist said the roots might dissolve on their own once it's time for this adult teeth to come in about 2 years. Today his gums have darkened significantly, and I am worried about an infection. What should we do? What are the risks of leaving his roots in? Will his adult teeth still come in normally? I have so many worries.....

Thank you kindly in advance.

Dr. Dean Brandon said...

If your pediatric dentist said it is ok to leave the little root fragments, that is probably the best recommendation. By the way, lips, gums, etc, always look really bad right after an accident or surgery, but heal very rapidly in younger children.

Dr. Dean Brandon said...

Oh, just let your dentist look if you are afraid about an infection. Usually gums heal quite a bit in about 5 days or so.

John Wallace said...

My 3.5 year old daughter has just lost an upper front incisor, apparently for no reason and without any pain. The tooth is totally undamaged and in very good condition. The only possible explanation we can think of is that she ate a chewy sweet a friend gave her in an advent calendar, but she says nothing happened to the tooth - it just started wobbling and came out within 3 hours or so. Took her to the dentist (not a paediatric dentist) almost immediately but she just said there was nothing to be done. I am worried about the effect this might have on the adult teeth. Is there anything that can be done?

Dr. Dean Brandon said...

Well, three is young to loose a tooth, however, once it is lost there is usually no continuing concern other than esthetics. So long as your dentist did not find anything else going on, I would think just follow up dental visits.

lakishaboyce said...

My daughter is 4 and will be 5 in two more months. Her front bottom tooth is loose. She sucks her thumb so my question is, can thumb sucking cause the teeth to come out early?

Dr. Dean Brandon said...

Sucking habits can sometimes cause slight mobility of affected baby teeth, but not premature loss. An x-ray will usually show if if the tooth is actually ready to fall out or not.

Odontologai said...

But what's if the first tooth is loosen at the age of 8? It isn't very normal, is it? How often does it occur?

Dr. Dean Brandon said...

The average age to loose the first tooth is 6-7 years old. Eight is a little slower than normal, but if overall development is slower as well, then everything is slower. The child's physician can tell if that is the case or if there are other metabolic disturbances. Mostly, eight is not common, but not unheard of and is usually not a major concern.

Robert Reed said...

When my baby was about 1 she fell and broke her top baby tooth, its dark now. Im wondering when it will fall off.

Dr. Dean Brandon said...

An upper front baby incisor tooth will fall out about 7 years of age. If you are concerned with the darkness of a tooth, see my post on My child's tooth is dark

Concerned Mom said...

Hello. My 5, almost 6, year old daughter has lost 4 baby teeth already. At first, I was a little concerned that she was loosing teeth too fast because none of her friends have lost that many. Now I'm concerned because the last 2 teeth have split in half after they fall out. The first one was dropped on the floor and split in half, so I didn't think much of it. This last one was laying flat in a baggie and we went back and looked at it and it had broke in half, about 24 hours after it fell out. Why are her teeth breaking in half after they fall out? Is that normal? My mom still has my baby teeth in a jar (kinda weird, I know) and they aren't split 20 years later. Am I overthinking this or could there be a problem? Thanks!

Dr. Dean Brandon said...

Exfoliated teeth (the ones that fell out) get dried out and can become brittle. Sounds like a normal eruption timing though. Ask you rPediatric Dentist if your are concerned.

Anonymous said...

Hello Dr. Dean,

My son is 3 years old. I could see a pink spot on one of his lower teeth since one and half months.But that spot has increased in size than it was earlier. there is no pain in the same tooth. I am worried why its turning pink. What may be the reason. Related to any underlying medical condition? please help me.

Dr. Dean Brandon said...

Internal resorption (see my post on that) can cause a pink looking tooth. I'd get a pediatric dentist to take a look as it could be anything.

Joni Lee said...

My 5 yr old son has been saying his tooth is loose for about a month now. Now it is REALLY loose and his gum around that tooth only is really dark and the bottom of his tooth is turning grey and he says it hurts to touch. Is this normal or should I be concerned?

Dr. Dean Brandon said...

Sound pretty "normal" to me.

Curtis Kokenos said...

My 3 year old has to get some of his teeth capped due to decay...I am very scared for my son to be "put to sleep" I have even put it off cause I'm so scared but he complains now when I brush his teeth...I'm all for getting his teeth fixed but is it really worth the risk of something going wrong?

Dr. Dean Brandon said...

Please read all my posts on sedation behavior management and hospital dentistry. There is a small risk in anything, but also a known risk of doing nothing as well. If a child needs to be asleep, we do it in the operating room at the hospital under general anesthesia. Sedation (conscious) in the office is where the child is sedated, but still awake. Different pediatric dentists do things slightly differently. It's always ok to ask them questions to understand better. Cooperation improves with time, but decay does get worse with time as well.

Anonymous said...

Hello Dr. My sister is 8 years old and her top front tooth has been loose for a couple of months now and has not fallen out yet. We just realized today that the permanent tooth started growing WAY behind the baby tooth. It has started growing quite a bit behind the baby tooth, not close at all. I saw your article about shark teeth but I could not comment there as comments were disabled. Please advise as we are very worried about her teeth and whether that new tooth would ever make its way to the front (since it is way in the back). Thank you.

Dr. Dean Brandon said...

I see this often. Have you pediatric dentist take a look. It is not uncommon to need to remove retained baby teeth to allow forward movement. In addition, in a few cases, orthodontic treatment may be needed.

hope fernandez said...

My 5 year old has silver crown on her bottom front tooth. I noticed the tooth was loose today. It moves alot. Shes had them since before she was two. My question is what does a loose silver crown looks like? She teethed early so there is a chance she's losing teeth early.. the whole tooth is silver and the whole tooth is very wiggly. Is she losing the tooth or is the crown falling off?