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Orthodontics and the Premature or Delayed Loss of Baby Teeth

Orthodontic Issues with Early or Late Baby Teeth Loss

A common question that I get asked by parents at my St. Louis orthodontic practice is whether their child’s loss of baby teeth is occurring in a normal fashion. In many cases, there can be a wide variation of the ages at which children lose their baby teeth in a natural and healthy manner, so I decided to devote this blog post to cover the topic in detail.

Sequence and timing of the loss of baby teeth

The process of a child’s baby teeth falling out often lasts 6 or more years from start to finish. These teeth begin to loosen and fall out on their own to make room for permanent teeth at about the age of 6. Some children begin to lose their teeth as early as 4 or as late as 7, but in general the earlier they come in the earlier they will begin to fall out. The teeth usually fall out in the same order in which they erupted and in most cases the sequence of the tooth loss is much more important than the precise age at which the tooth loss occurs.

There is usually a basic pattern for the loss of baby teeth: first the two bottom front ones (lower central incisors), followed by the two top front ones (upper central incisors) and then the lateral incisors, first molars, canines and second molars. The two charts at the end of this blog post provide the average times for the eruption and shedding of baby (or primary or milk) teeth and the eruption of adult (or secondary or permanent) teeth. Remember that these times are merely averages and some kids lose them quicker and some lose them slower than what you will find in these charts. The primary matter to focus on is the order in which the teeth are lost.

Potential issues with the loss of baby teeth

That being said, if baby teeth are not lost in the correct order or if a baby tooth is lost and is not replaced by a permanent one within three months, there could be a number of issues that I can diagnose and treat at my St. Louis orthodontic practice:

  • Crowding: It is important to note that baby teeth preserve space for adult teeth until they are ready to erupt. Thus, if baby teeth fall out too early, space can be lost in the mouth and it can cause crowding of the underlying adult ones. Similarly, if baby teeth fall out too late, this can force the underlying adult ones to come in crooked. In some cases, if the concealed adult teeth are or become too crowded, they may not be able to push out the visible baby teeth. But in any case, removing baby teeth will not correct the crowding that created the problem. Any inherent crowding problem that exists will have to be fixed with orthodontic treatment. In contrast, some adult teeth may come in before the baby teeth are gone creating what can appear to be two rows of teeth and crowding in some areas in the mouth. This condition is usually temporary but if it persists it is something that should be checked by an orthodontist.
  • Premature tooth loss: It is possible for a baby tooth to fall out before the permanent tooth is ready to erupt, often because of a traumatic accident or tooth decay. In such cases, a spacer/space maintainer is often put in the location where the baby tooth fell out prematurely to preserve the space for the adult tooth and to prevent future crowding problems. In general, if a child loses any teeth before the age of 4, an orthodontist should be consulted to determine that there are no inherent dental problems that have developed.
  • Late tooth loss: Some children may reach the age of 8 without losing any teeth and in such cases there may be nothing wrong, but an orthodontist should be consulted and take an X-ray to evaluate the situation.
  • Missing teeth: A baby tooth typically does not loosen until the permanent tooth below pushes it up to take its place. As a result, if a child is missing some permanent teeth this process will not occur in certain locations in the mouth.
  • Extra Teeth: When this occurs, it can block the natural eruption process of the regular adult teeth.

Other tooth loss considerations

On the other hand, there are number of matters that you should not be concerned about in terms of your child’s new permanent teeth: they will look bigger because they actually are bigger than the baby teeth they are replacing, they usually are less white than the baby teeth and they often have prominent ridges because they have not been used yet.

In addition, it often takes a few months from the time when a baby tooth starts to become lose until it falls out. Some children are bothered by loose teeth, but it is important to remind them not to yank them out because doing so breaks the root of the tooth and leaves a space that is prone to infection.

In any case, I have treated the problems described above many times and almost all such cases can be corrected with orthodontic care as long as they are caught in time and are properly diagnosed and treated.

Dental chart for children

Dental chart for adults

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