Losing baby teeth: When they should — and shouldn't — fall out

May 5, 2015
Losing baby teeth: When they should — and shouldn't — fall out

You probably have vivid memories of losing at least some of your own baby teeth — but that was a while ago. Now you're the grown-up in the situation, and you need to know more than how much to adjust the Tooth Fairy's "gift" for inflation. If there's a problem with one or more of your kid's teeth, how big of a deal is it?

Here's what to do if your child's pearly whites fall out early — or decide not to come out at all.

When do teeth fall out naturally?

Baby teeth — also known as primary, milk or deciduous teeth — are the first 20 teeth your child has. Starting around age 5 or 6, he'll start losing these temporary teeth. 

"The first teeth that a child loses are the lower anterior (center) — the first teeth the baby got in the first place," says Dr. Rogel Carlos, a dentist in practice for more than 20 years. "The reason they fall out is because the roots of the teeth start shrinking — or 'resorbing' — so they get loose on their own," he says, adding that the roots are broken down by the permanent teeth pushing against them.

Through this process, permanent teeth replace all the primary teeth by about 12 years of age. Around that time, the first permanent molars also appear.

Lost a tooth too soon?

Sometimes, tooth loss is not on schedule. If your child loses one or more primary teeth early, it could cause dental complications. 

"Premature loss of baby teeth must be evaluated by an orthodontist," says Dr. Ronald E. Inge, the chief dental officer at Western Dental. "Depending on the age and location of the tooth or teeth, interceptive orthodontics may be necessary."

Interceptive treatment starts earlier than traditional orthodontics and works to deal with problems as they come up to avoid more serious issues. 

"The loss of baby molars is usually treated with space maintainers until the age of 8," says Inge. "Age 8 is the average age for interceptive orthodontics — usually to alleviate future crowding."

What if your kid has an accident?

Though you want all your child's first teeth to fall out naturally, accidents happen. Primary teeth can get knocked loose or out of the mouth entirely. If your child's tooth is hit or falls out, MedlinePlus says to apply a cold compress to the mouth and gums to ease the pain, apply direct pressure with gauze to control any bleeding and contact a dentist right away.

Your dentist may have you come in immediately or make an appointment for later. Meanwhile, she may suggest acetaminophen or ibuprofen and recommend that you monitor your child for swelling, bleeding and signs of infection.

A baby tooth typically can't be re-implanted the way a permanent tooth can. 

"If a baby tooth gets knocked out, I wouldn't try to place it back into the mouth — it's pretty much done," says Dr. Carlos. In fact, the American Dental Association says not to try inserting a baby tooth back into the socket, because an accident that knocks out a baby tooth could also harm the permanent tooth underneath, potentially leading to long-term dental problems.

What if baby teeth don't come out?

Coming out early isn't the only problem that can afflict primary teeth — sometimes, they sit tight for longer than usual. 

According to Carlos, "If the permanent adult tooth is not following right behind the baby tooth, the roots will not resorb and the baby teeth won't loosen up." 

In many cases, says Carlos, the stubborn tooth has to be pulled so the permanent tooth has room to move into its proper place.

However, don't assume every baby tooth that decides to stick around must be removed. Sometimes an X-ray shows that a permanent tooth — most often, a mandibular second premolar, according to the British Dental Journal — hasn't developed, leaving the primary molar in place. 

In that case, "A retained baby molar may not represent a problem and can be retained into adulthood," says Inge.

Whether your child's baby teeth come out too soon or not at all, know that modern pediatric dental care is centered on making the patient feel comfortable and calm. So don't worry — you'll be seeing your child's big, bright smile again soon!

Tips and stories from parents and caregivers who’ve been there.

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