It is a common developmental stage for children to lose their baby teeth and have them replaced by permanent ones. Parents often monitor this process closely, and it is natural to feel concerned when a tooth does not follow the expected timeline. Understanding the typical progression of tooth development can help parents recognize when professional guidance might be beneficial.
The Natural Process of Tooth Eruption and Shedding
Children’s primary, or baby, teeth typically begin to erupt around six months of age and continue until about two to three years old. These 20 teeth serve various functions, including aiding in speech development and guiding the eruption of permanent teeth. As a child grows, usually between ages six and twelve, these baby teeth begin to shed.
This shedding occurs because the developing permanent tooth beneath the baby tooth exerts pressure, triggering a natural biological process called root resorption. During root resorption, the roots of the baby tooth gradually dissolve, weakening its attachment to the jawbone. This allows the tooth to loosen and eventually fall out, creating space for the permanent successor.
Why a Baby Tooth Might Not Fall Out
Sometimes, a baby tooth remains in the mouth longer than expected, which can be a source of parental concern. One common reason for this is the absence of a permanent successor tooth. If the permanent tooth that is supposed to replace the baby tooth never forms in the jawbone, there is no underlying pressure to stimulate root resorption and push the baby tooth out. In such cases, the baby tooth may stay in place for many years, sometimes even into adulthood.
Another condition that prevents a baby tooth from shedding is ankylosis, where the root of the tooth fuses directly to the surrounding jawbone. This fusion eliminates the natural ligament that normally holds the tooth in its socket, preventing it from loosening and falling out as the jaw grows. Ankylosed teeth can appear slightly submerged compared to neighboring teeth. Insufficient root resorption can also occur if the baby tooth’s roots do not dissolve completely, keeping the tooth firmly in place.
Dental crowding can also impede the natural shedding process. If there is not enough space in the dental arch, nearby permanent teeth may erupt in positions that block the baby tooth’s path to exfoliation. This physical obstruction can prevent the baby tooth from loosening as it normally would.
Why a Permanent Tooth Might Not Erupt
Just as baby teeth can be slow to depart, permanent teeth can sometimes fail to emerge into the mouth. Impaction is a frequent cause, occurring when a tooth is physically blocked from erupting by another tooth, dense bone, or thick gum tissue. Wisdom teeth are commonly impacted, but other permanent teeth, such as canines, can also experience this issue. The tooth remains fully or partially submerged within the jaw.
Crowding in the jaw can also prevent a permanent tooth from erupting properly. If there is insufficient space in the dental arch, the permanent tooth may become trapped or emerge in an incorrect position. This lack of available room can lead to the tooth remaining beneath the gums. Extra teeth, known as supernumerary teeth, may also obstruct the eruption path of normal permanent teeth, preventing their emergence.
Agenesis refers to the congenital absence of a permanent tooth, meaning the tooth never formed in the jawbone at all. This condition can be diagnosed through dental X-rays, which show the missing tooth bud. Cysts or benign tumors can also develop within the jawbone, creating a physical barrier that obstructs the path of an erupting permanent tooth. These growths can occupy the space needed for eruption, requiring professional intervention.
When to Consult a Dentist
Parents should consider consulting a dentist if a permanent tooth begins to erupt behind or in front of a still-present baby tooth, a phenomenon sometimes called “shark teeth.” This indicates that the baby tooth is not shedding as it should, and intervention may be needed to ensure proper alignment of the permanent tooth. Persistent pain, swelling, or signs of infection around a tooth that is not loosening or erupting also warrant immediate dental evaluation. These symptoms can suggest underlying issues like abscesses or impacted teeth causing pressure.
A noticeable gap in a child’s smile where a permanent tooth should have appeared for an extended period, especially if other teeth have erupted, is another clear sign to seek professional advice. Dentists can use X-rays to determine if the permanent tooth is present and if there are any obstructions to its eruption. Any ongoing concerns about the general timeline of tooth eruption or shedding should prompt a visit to a dental professional. Pediatric dentists specialize in children’s oral health and can offer tailored advice. An orthodontist may also be consulted for space issues or misalignments.