The process of losing primary teeth, often called exfoliation, is a predictable developmental milestone for children. This transition replaces a child’s initial set of 20 teeth with a larger, stronger set of permanent teeth, typically beginning around age six and continuing for several years. While the exact timing varies significantly, the order in which the teeth are shed usually follows a consistent pattern.
Why Primary Teeth Must Fall Out
Primary teeth serve multiple functions beyond aiding in chewing and speech. They act as natural space maintainers, ensuring the dental arch has the necessary room for the larger, permanent teeth developing beneath the gums. These first teeth also help guide the permanent teeth into their correct positions as they erupt.
The biological necessity for their loss is driven by a process called root resorption. This is a natural, healthy mechanism where the developing permanent tooth pushes against the root of the baby tooth above it. Specialized cells called odontoclasts dissolve the root structure and the surrounding bone tissue. This slow dissolution of the root is what causes the baby tooth to gradually loosen and eventually fall out without requiring forceful removal.
The pressure exerted by the growing permanent tooth triggers the body to resorb the primary tooth’s root, effectively clearing a path for the successor tooth to emerge. If a permanent tooth is missing or misaligned, the root of the primary tooth may not resorb correctly, causing the baby tooth to remain firmly in place longer than expected. This coordination ensures that the permanent teeth have a clear space to erupt when they are ready.
The Standard Sequence of Tooth Loss
The order in which children lose their teeth is consistent, often mirroring the order in which they originally erupted. The process generally starts with the lower central incisors, the two bottom front teeth, which are typically lost between the ages of six and seven years old. These are followed closely by the upper central incisors, the two top front teeth, also usually shed around the same six-to-seven-year age range.
Next in the sequence are the lateral incisors, which are the teeth immediately adjacent to the central incisors. Both the upper and lower lateral incisors generally become loose and fall out between seven and eight years of age. Around this time, parents should also be aware that the first permanent molars—which do not replace a baby tooth—erupt behind the last baby molars, marking a significant change in the back of the mouth.
The remaining teeth are lost in the following order:
- The first molars are lost between nine and eleven years of age.
- These are followed by the canines, or pointed teeth, shed between ten and twelve years old.
- The second molars, the last teeth in the primary set, are the final baby teeth to be lost, typically between the ages of ten and twelve years.
This entire process usually concludes by age twelve or thirteen, leaving the child with a full set of permanent teeth, with the exception of the wisdom teeth.
Caring for Loose Teeth and Gaps
Once a tooth becomes loose, gentle wiggling with the tongue or clean fingers should be encouraged to help the natural process along. Attempting to forcefully pull a tooth before it is ready can potentially cause unnecessary pain, bleeding, or an increased risk of infection in the open socket. The goal is to allow the root to fully dissolve so the tooth can fall out easily on its own.
When the tooth finally comes out, minor bleeding is normal and can be managed by having the child rinse their mouth with lukewarm water or by applying gentle pressure with a clean, damp washcloth. Maintaining excellent oral hygiene is important, and children should continue to brush carefully around the loose tooth and the newly formed gap. New permanent teeth are often more susceptible to decay immediately after they erupt, making consistent brushing and flossing around the area necessary.
New permanent teeth may appear slightly yellow or oversized compared to the remaining baby teeth, which is normal because the jaw is still developing to accommodate them. If the gap is tender, over-the-counter pain relievers can be used, and soft foods are recommended until the area feels comfortable again. Proper care during this transition helps ensure the new teeth come in healthy and correctly positioned.
When to Consult a Pediatric Dentist
While the timing of tooth loss has a wide normal range, certain situations warrant a professional evaluation to prevent future complications. If a child begins losing teeth significantly early, such as before the age of five, it is important to consult a dentist. Early loss, often due to trauma or extensive decay, can cause the remaining baby teeth to shift, potentially leading to alignment problems for the permanent teeth.
Similarly, if the first tooth has not been lost by the age of seven, or if a baby tooth remains firmly in place while the permanent tooth is erupting behind it, a condition sometimes called “shark teeth,” a dentist should be consulted. Retained primary teeth may need to be professionally removed to allow the adult tooth to move into its proper place. A dental evaluation is also necessary if a tooth is lost due to an accident or injury, as the permanent tooth underneath may have sustained damage.
If a child experiences excessive pain, persistent swelling, or signs of infection like pus around a loose tooth, these are not typical and require prompt attention. A pediatric dentist can assess the situation, determine if a space maintainer is needed in the case of premature loss, or decide if an extraction is necessary to guide the permanent teeth into the correct position. Regular dental check-ups are the best way to monitor this developmental phase.