Why Won’t My Tooth Come Out? Reasons and What to Do
Tooth emergence and replacement are normal parts of human development. Most individuals experience baby teeth falling out to make way for permanent ones without complications. However, sometimes a tooth does not follow this expected pattern, leading to concerns about delayed or failed eruption.
Normal Tooth Development
Tooth development begins before birth, with primary, or baby, teeth typically emerging around six months. Lower central incisors are often first, followed by upper incisors and other teeth, usually in pairs. By age three, most children have their full set of 20 primary teeth.
Around six years, primary teeth begin shedding, making room for 32 permanent teeth over several years. Permanent molars often erupt first, appearing behind existing baby teeth. Incisors, canines, and premolars then replace their primary counterparts, with most permanent teeth, excluding wisdom teeth, typically present by age 12.
Causes for Retained Baby Teeth
A baby tooth may remain in the mouth longer than expected, a condition known as an over-retained primary tooth. A common reason is the absence of a successor permanent tooth underneath. Without pressure from an erupting permanent tooth, the baby tooth’s root may not resorb naturally, causing it to stay in place.
Ankylosis is another factor, where a baby tooth’s root fuses directly to the jawbone. This fusion prevents the tooth from loosening and falling out. Additionally, an underlying permanent tooth might be impacted or growing incorrectly, failing to exert the necessary pressure to resorb the baby tooth’s root and push it out. Crowding in the dental arch can also impede the permanent tooth’s ability to move into position. In rarer cases, cysts or tumors can obstruct the normal shedding process.
Causes for Non-Erupting Permanent Teeth
When a permanent tooth fails to emerge into its proper position, it is often impacted. This frequently occurs when the tooth is blocked by bone, dense gum tissue, or another tooth. Wisdom teeth and upper canines are commonly affected.
Lack of adequate space within the jaw is a common cause for non-eruption. Permanent teeth are generally larger than baby teeth, and insufficient room can prevent proper eruption. Supernumerary teeth (extra teeth) can also block the eruption path of normal permanent teeth.
Cysts or tumors within the jaw can prevent a permanent tooth from erupting. Genetic factors or certain medical conditions can also influence tooth development and eruption patterns. Previous trauma to a baby tooth can sometimes damage the developing permanent tooth underneath, affecting its ability to emerge later.
Seeking Professional Dental Care
If a tooth has not emerged as expected, consulting a dentist or orthodontist is important. Dental professionals use clinical examinations and X-rays to diagnose the underlying issue. X-rays help identify missing teeth, impaction, or other obstructions.
Treatment options vary depending on the specific cause, ranging from observation for minor delays to more active interventions. These might include extracting a retained baby tooth or surgically exposing an impacted permanent tooth, sometimes followed by orthodontic traction to guide it into place. Removing extra teeth or other obstructions may also be necessary to create space. Early intervention can improve outcomes and help guide the tooth into its correct position within the dental arch.