By Dr. Mark Kaley with Kaley Orthodontics

February is National Children’s Dental Health month! It’s a good time to promote good habits and regular dental visits with your children. Here’s an article from one of our sponsors that helps answer an age-old question every mom seems to have. But the information is always needed and timely for many of us! – Katie

If you have a five to seven-year-old, chances are you are wondering when they will lose their first tooth. Some of their friends may already have semi-toothless grins, and that could prompt the question, “When is the tooth fairy going to visit me?” While it can be concerning, a large variability between kids is natural. The pattern of losing those first pearly whites, however, remains relatively constant.

There are two distinct periods when groups of teeth fall out, which are interrupted by a one to two year break. The first baby, or primary, teeth usually start to fall out when a child reaches age six. These are the two lower front teeth, also know as the central incisors. They start wobbling as the permanent tooth resorbs the root structure below, leaving only the crown to fall out when no support is left. The central incisors are accompanied roughly at the same time by the eruption of the six-year-molars, the first permanent molars in the back of the mouth. This action may cause some discomfort, as the child is basically teething again when the molars erupt. As the parent of a very unhappy teething 10-month-old, I can vouch for the trauma this may also cause you.

Within a few months, the upper central incisors get loose, closely followed by the two lower teeth on either side of the central incisors, called the lateral incisors. Finally, the loss of the upper laterals completes this initial period of losing teeth. Usually, this transition happens from about age six to eight.

Many kids are excited to lose those first teeth, but others worry about the loss. While your little one may be scared, some bleeding and discomfort around a loose tooth is normal. However, significant swelling or pain could be a sign of an infection and should be looked at by a dentist. Generally, the teeth will fall out, and the most painful part for the kiddo will be posing for all the pictures you’ll require of his new grin!

After all of this quick movement, there is a lull in the action for about two years. Parents and patients can get a little nervous and wonder why everything stopped. Don’t worry – it’s a normal pattern, and it will pick up again in time. Around age nine to ten, things start moving with the lower canines (the “fangs”), then the first premolars, and finally the upper canines, second premolars, and second molars (otherwise known as the twelve-year-molars). This transition period typically lasts from age ten to twelve. The child will then have full permanent dentition, and the tooth fairy can retire (if you’re keeping count, that’s twenty baby teeth in all).

While I’ve mentioned the “usual” timing, these are just estimates and can vary greatly from person to person. Typically, boys lose their teeth later than girls; while a girl can have full permanent dentition by age eleven, boys can still be waiting on their twelve-year-molars when they are fourteen. My wife likes to say that we are later than girls for the rest of our lives too, but that’s her opinion. However, I’ve seen ten-year-old boys with all of their permanent teeth and sixteen-year-old girls with twelve baby teeth still hanging on. The timing isn’t necessarily concerning, but there are some things to look out for that may warrant a trip to the dentist.

On occasion, certain teeth don’t form or are blocked by an obstruction. One possible signal of this is a drastic change in the sequence of the eruption pattern above. For example, if a child is fourteen and doesn’t have his upper canines in, but the rest of the teeth have been in for two years, the canines may be positioned in a way that requires help to make them erupt. Also, while companion teeth don’t erupt at exactly the same time, a large gap in between the eruption of one side versus the other could signal a problem. If a lower lateral erupts and more than six months elapse without any sign of the other lateral, it may be smart to take an x-ray to see what’s going on. Fortunately, there are ways to treat any of these issues, and they are nothing to panic about. Good communication between you and your dentist will ensure that your child gets the proper proactive care.

Everyone is different, and that goes for teeth, too. While your child may get impatient for the tooth fairy to make her trade, tell them that it will happen! Soon they, too, will be singing “All I want for Christmas is my two front teeth” and the tooth fairy’s wallet will be a little lighter.

Selected information from Proffit et al. Contemporary Orthodontics, Fourth Edition. Mosby, 2007. 93-97.