Most children lose their first baby tooth around age six, usually a lower front tooth, and their last between ages ten and thirteen. Teeth generally fall out in roughly the order they came in, and a year early or late is normal.
Baby teeth leave on a schedule set by the permanent teeth underneath them. As a permanent tooth develops and begins moving up, it dissolves the root of the baby tooth above it. Once enough root is gone, the baby tooth loosens, wobbles for a few weeks and comes out, often with very little blood. That is why a tooth that falls out naturally looks like it has almost no root at all.
The order is fairly predictable, even if the exact ages vary from child to child. Standard dental eruption charts put it roughly like this:
Girls often run a little ahead of boys, and children who got their first baby teeth early tend to lose them early too. A child who is six months or a year off the chart is almost always fine. What matters more is the pattern: teeth coming out roughly in sequence, on both sides, with permanent teeth following.
Around age six, a set of permanent molars comes in behind the last baby molars without replacing anything. Parents often miss them because no tooth fell out to make room. These "six-year molars" are some of the most important teeth your child will ever have, and their deep grooves trap food easily. That is why they are usually the first teeth considered for dental sealants as soon as they are fully through the gum.
A tooth that falls out naturally a little ahead of schedule is rarely a concern. A baby tooth lost years early is different, and it usually happens for one of three reasons: a fall or sports injury, decay that was too advanced to save the tooth, or a condition that affects the teeth or gums. If an injury knocks a tooth out, call us the same day. Our pediatric emergency care covers knocked-out and broken teeth, and we will check that the permanent tooth underneath was not affected.
The bigger issue with early loss is space. Baby teeth hold the place for the permanent teeth that follow them. When one goes years ahead of time, the teeth on either side can drift into the gap, and the permanent tooth can end up blocked or pushed out of line when it finally arrives. This matters most with back teeth. A baby molar lost at five, with its replacement years away, is a much bigger concern than a front tooth lost a few months early.
No. A space maintainer is a small appliance that holds the gap open until the permanent tooth is ready, and whether your child needs one depends on which tooth was lost and how far along the permanent tooth is. An x-ray answers that question. If the permanent tooth is close to coming in, the gap usually takes care of itself. If it is years away, holding the space is far simpler than creating room later with braces.
Sometimes a baby tooth hangs on well after the teeth around it have gone, or a permanent tooth starts coming in while the baby tooth is still firmly in place. Most of the time the baby tooth is simply slow, and it will loosen on its own in the following weeks. Occasionally the root has not dissolved the way it should, or there is no permanent tooth underneath to push it out.
Parents sometimes call this "shark teeth": a permanent tooth appearing behind a baby tooth, creating what looks like a double row. It happens most often with the lower front teeth, because the permanent teeth there develop slightly behind the baby teeth. It looks alarming, but it is common. If the baby tooth is loose, it usually comes out within a few weeks, and the tongue gradually pushes the new tooth forward into place.
If the baby tooth is still firm after a couple of months, or the permanent tooth is well through and the baby tooth has not budged, we will take a look. Removing a stubborn baby tooth is a quick, gentle procedure, and our pediatric tooth extractions are done with the area fully numbed. Nitrous oxide is available for children who are nervous.
Some children are simply missing one or more permanent teeth. It runs in families and is found on an x-ray, not by looking. When that happens, the baby tooth may stay in place much longer than usual. Sometimes the best plan is to keep that baby tooth healthy for as long as possible. Other times the plan involves orthodontics. Either way, it is a decision made with x-rays and a look at the whole bite, not a reason to rush.
Let it come out on its own schedule. Wiggling a loose tooth with clean hands or the tongue is fine and helps it along. Pulling a tooth that is only slightly loose, or tying it to a door, hurts more than it needs to and can tear the gum. Most loose teeth come out while eating or brushing, and many are never found.
When the tooth does come out, a small amount of bleeding is normal. Have your child bite gently on a clean piece of gauze or a damp paper towel for a few minutes. Keep brushing the rest of the mouth as usual and brush gently around the empty spot. The new tooth will usually start to show within a few weeks to a few months.
Call us if a tooth becomes loose after an injury rather than on its own, if the gum around a loose tooth is swollen or has a pimple-like bump, if your child has pain that does not settle, or if a baby tooth loosens years before the chart would expect. Those are signs that something other than normal shedding may be going on.
The years when baby teeth are coming out and permanent teeth are arriving are when bite problems show themselves most clearly. Crowding, a crossbite, teeth coming in at odd angles or permanent teeth with nowhere to go all become visible during this stretch. That is the reason the American Association of Orthodontists recommends an orthodontic check by age seven.
Most children who are seen at seven do not need treatment then. For the ones who do, early interceptive orthodontics can guide jaw growth and make room while the child is still growing, which often makes any later treatment shorter and simpler. Because Dr. Tiffany Lu, our board-certified orthodontist, works in the same office as our pediatric dentists, that check happens alongside your child's regular visits rather than as a separate referral.
The mixed-teeth years, when your child has both baby and permanent teeth, are when decay risk quietly rises. New permanent teeth have enamel that is still maturing, gaps and uneven edges trap food, and kids in this age range are often brushing on their own for the first time. A few habits make a real difference:
Regular cleanings and exams are when our pediatric dentists, Dr. Spencer Mauseth and Dr. Avi Willis, track this change over time. That makes it much easier to notice when a tooth is late, early or coming in off course.
Often, yes. Some children lose their first tooth at five, especially if their baby teeth came in early. If the tooth loosened without an injury and the others are following in sequence, it is usually just an early start. If you are unsure, we can confirm it with a quick look.
Usually not. A year or so behind the typical timeline is common, particularly if the first baby teeth came in late. If your child is well past seven with no loose teeth, an x-ray can show whether the permanent teeth are developing and on their way.
Permanent teeth are larger than baby teeth and naturally a little less white, so they stand out next to the small, bright baby teeth beside them. New front teeth also have ridged edges that wear smooth over time. The contrast fades as more permanent teeth come in.
It depends on how long it needs to last. A front tooth that is due to fall out in a few months may only need monitoring, while a back molar that has years left usually needs to be treated so it stays comfortable and keeps holding space. We will explain the reasoning for your child's specific tooth.
If a tooth is coming out early, hanging on too long or leaving a permanent tooth coming in crooked, a quick visit usually answers the question. Contact Encinitas Pediatric Dentistry & Orthodontics to schedule a checkup, and we will let you know whether your child's teeth are right on track.
