Are you one of those parents whose kids believe in a tooth fairy? The tooth fairy usually has a pretty solid business model: kids lose their tooth, parents scramble for change, put it under the pillow, your kid is happy, and everyone moves on. But when your kid’s teeth decide to be rebellious, and your kid is the only one in the class still waiting on the tooth that should have been under a pillow 2 years ago, parents get worried. Retained baby teeth can have several different causes, and the appropriate response depends on what is happening underneath the gum surface.
In some situations, the most suitable approach is simply to monitor the situation over time. In other situations, the position of the permanent tooth, the condition of the baby tooth itself, or the way the bite is developing may mean that treatment is needed. So, that’s where pediatric dentistry comes in.
In this blog post, Dr Chelsea Taing explains why retained baby teeth happen, what may be happening underneath the gums and if your kid needs tooth
removal or treatment.
What’s With the Retained Baby Teeth?
Children typically have 20 primary teeth, also known as baby teeth. As the permanent teeth come in from underneath, the roots of the matching baby teeth gradually break down and disappear. In simple English, the root of the baby tooth slowly dissolves. As a result, the baby tooth becomes loose and eventually falls out, making space for the permanent tooth to move into position. Most children start losing their teeth around the age of 6, although the exact timing differs from one child to another.
The first permanent teeth also begin to appear around the same time, which is why this stage is called mixed dentition. It’s a period when both baby teeth and permanent teeth are present in the mouth at the same time. A retained primary tooth is simply a baby tooth that stays in place longer than it would normally be expected to fall out. There is no single fixed age by which every baby tooth is required to fall out. Some children naturally lose their baby teeth later than others. What we tell parents is whether something is interfering with the usual process of the normal eruption process.
What Can Stop a Baby Tooth From Falling Out?
There is no single explanation that can be applied to every situation. A number of different factors can cause a baby tooth to remain in place.
Permanent Tooth Is Simply Late
One possibility is that the permanent tooth is developing but simply taking longer than average to erupt. In some cases, the permanent tooth is not ready to come into the mouth. A child’s teeth do not follow a perfectly coordinated schedule. One side of the mouth can progress faster than the other, and individual teeth can appear earlier or later than expected. This situation by itself does not require massive treatment.
Tooth is Coming Through Unusual Position
Another possibility is that the permanent tooth is erupting along an unexpected path. In some cases, the permanent tooth does not follow the usual route into the mouth. This situation is known as ectopic eruption. Rather than moving into the space left by the baby tooth, the permanent tooth may erupt at an angle or in a different location. As a result, the baby tooth can remain in its original position while the permanent tooth begins to appear in an unintended place.
Baby Tooth Isn’t Resorbing Normally
A further possibility is that the root of the baby tooth is not breaking down as it should. For a baby tooth to loosen and fall out on its own, its root must gradually dissolve through a process called resorption. If resorption is not occurring as it should, the baby tooth can stay firmly fixed in place. This is one reason we choose to examine the situation more carefully instead of simply advising the parent to wait.
The Tooth May Be Ankylosed
Another more specific possibility is that the tooth has become ankylosed. This is one of the more technical explanations that can apply. Ankylosis happens when the root of the tooth fuses directly to the bone around it. The usual connection provided by the periodontal ligament is lost, so the tooth can no longer respond normally to the natural movement of the surrounding teeth as they erupt. The affected tooth seems to remain at the same height while the neighbouring teeth continue to move upward into the mouth. Over time, the retained tooth can appear to sit lower than the tooth next to it. Current pediatric dentistry guidelines suggest ankylosis, ectopic eruption, and delayed or failed eruption require professional assessment while they are still developing.
There May Not Be a Permanent Tooth Underneath
Another important possibility is that there is no permanent tooth waiting underneath the baby tooth. This is another reason not to assume that every retained baby tooth should be extracted. In some children, the permanent tooth that would normally replace the baby tooth is simply absent. IF no adult tooth is present underneath, the overall treatment approach can be entirely different. In that situation, the baby tooth may still serve a useful role for a longer period, depending on its condition, its position, how well it functions, and the child’s overall bite. AnX-ray can help answer key questions that cannot be resolved just by looking inside the child’s mouth.
Does Every Retained Baby Tooth Need to Come Out?
No. This is actually something of a critical point. In some situations, there can be absolutely no harm in monitoring and waiting.
Monitoring may be an option when:
- The permanent tooth is erupting normally.
- The baby tooth is healthy.
- There is no infection.
- The eruption course is normal.
- The bite is developing normally.
- The baby tooth is becoming mobile.
- There is no interference with oral hygiene or function.
In this case, we may decide to take no action for now. Sometimes, no action is in fact the best action.
When Might Removal Be Considered?
When there is an obvious indication for extraction, such as:
- The retained primary tooth may be causing malposition of the permanent one.
- Ankylosis prevents eruption of the permanent tooth
- The primary tooth is decayed or infected
- The primary tooth is interfering with oral hygiene or function
- Permanent tooth is impacted, or
- The permanent tooth will not erupt normally
Lower retained primary teeth should generally not be extracted just because permanent teeth erupt behind them. The dentist must instead evaluate how the retained primary tooth interacts with the erupting permanent one to determine if extraction is indeed necessary.
What Happens If The Baby Tooth Does Need To Be Removed?
This is actually another really good point that many people overlook: in removing the retained primary tooth, you may actually create another problem – namely, the lack of space for the permanent tooth. This is why you should discuss the situation with the dentist or orthodontist in the first place. Depending on what they say and which primary tooth was removed, a space maintainer may be placed to keep the space until the permanent tooth erupts.
The ADA also reminds us that different space maintainers can be used depending on which tooth or teeth are involved, and how many teeth need to be replaced.
Again, this is not always indicated – some children will not develop malocclusion at all as a result of premature primary tooth loss, and so a space maintainer in such cases is unnecessary. Whether it is needed in your case is best decided by the dentist in question.
What Should I Do At Home To Monitor Retained Baby Teeth?
Nothing much, really. You do not need to have a degree in orthodontics to know that something is wrong – but there are nevertheless some signs that you should watch for at the very least. Watch for:
- A retained baby tooth that does not seem to be falling out
- A retained baby tooth that has been retained for long after the normal period of exfoliation
- A tooth that appears to be much lower than the rest of the teeth
- A tooth which is hard to keep clean
- A tooth that causes pain or swelling
- A tooth which appears to be interfering with another tooth
Watch for a permanent tooth that:
- is coming in behind the baby tooth
- appears to be coming in at an odd angle
- appears much later than the permanent tooth on the other side
- is becoming crowded
- is not appearing at the expected time
These observations should give you a good base for deciding when to ask for a dentist’s help. None of these points individually indicate a problem, but they can give you an indication of what to talk with the dentist about when you do see them.
What Can Parents Do About Retained Baby Teeth?
There is unfortunately no simple answer or home remedy for removing a retained baby tooth. You can keep brushing as usual and avoid trying to remove a firmly planted tooth.
As mentioned, a retained tooth will often become mobile on its own – if it is not, then trying to remove it at home can only provide a false sense of security instead of actually diagnosing and treating the problem.
Furthermore, there is no need to worry about “shark teeth” or permanent teeth coming in early. Australian Dental Association statistics show that while these can cause cosmetic concern, they rarely pose any actual problems. The dentist should be able to address any such concerns during routine visits.
It is important to keep those routine visits too – if nothing else, so that the dentist can keep track of any changes to a retained primary tooth and intervene if necessary. It should go without saying that you should not do anything drastic at home without consulting a dentist first. It may also be a good idea if the orthodontist keeps an eye on the situation and takes any actions to manage the space if needed.
Pediatric Dentistry in Mansfield With Dr Chelsea Taing
Sometimes a retained baby tooth can be nothing more than a tooth that is running a little late. It can also be a sign that the permanent tooth underneath is having difficulty erupting into the correct position. Parents cannot always tell which of these situations is happening just by looking at the teeth from the outside.
At Delatite Dental in Mansfield, Dr Chelsea Taing can examine a child’s developing teeth, explain what is happening, and help decide whether the most suitable next step is continued monitoring, further investigation or active treatment.
If a child’s baby tooth is not falling out as expected, or if a permanent tooth is coming through in an unusual position, or if you have any concerns whatsoever related to your child’s dental health, book an appointment at Delatite Dental in Mansfield
Frequently Asked Questions (FAQs)
Q.1. Is it normal for a permanent tooth to come out before the baby one?
It can happen, yes. This situation most commonly occurs with the lower front teeth.
Q.2. Should I remove my child’s retained baby tooth?
Not if it seems firmly planted in the first place. In general, it should be up to the dentist to decide whether to extract a retained primary tooth.
Q.3. What are retained primary teeth?
Retained primary teeth are simply retained baby teeth. There are many possible causes, ranging from delayed exfoliation to eruption issues.
Q.4. What’s ankylosis?
Ankylosis is a condition in which the tooth root fuses directly to the surrounding bone. This often causes the affected primary tooth to appear lower than the others as the rest of the teeth erupt.
Q.5. Can a baby tooth be retained if there’s no permanent tooth to replace it?
Technically speaking, no permanent tooth will replace it, but a retained primary tooth can certainly last much longer than expected. If a permanent successor is absent, the dentist should evaluate the retained tooth to see whether it should be extracted.
Q.6. Do retained primary teeth cause crowding?
It depends – in some cases, they can contribute to eruption and spacing problems, but there are also many other causes of crowding. Crowding should be evaluated in the context of the rest of the dentition as well.
Q.7. Will my child need braces if a baby tooth is retained?
It depends on the situation, but in many cases, no. Some retained primary teeth will erupt on their own or be extracted without further consequence. In other situations, orthodontic treatment may be necessary if the permanent tooth fails to erupt normally.
