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Mother’s Day Topic- Dealing with and Understanding your Child Losing Primary Teeth

As a Virginia Dentist working clinically full time for the last ten years, I have seen and heard it all when it comes to stories of children losing their primary teeth.  Look no further than YouTube for home video evidence of the unique ways parents aid children in removing stubborn baby teeth.  My advice is please see a dental professional and make things safe and easy for everyone involved- there is no need to tie floss around your child’s loose tooth and attach it to an arrow head on a Nerf Bow and Arrow (yes, these things actually have happened)!

It’s an exciting time for kids and moms- losing primary teeth or “baby teeth”.  Kids notoriously hang onto their baby teeth, sometimes longer than they should!  I recall various children who have primary teeth hanging by a thread and certainly do not want their dentist or parents to touch them.  It’s a common fear with children, but these teeth are easily removed most of the time with a force no greater than removing a band aid and with a compounded strong topical gel anesthetic.  Many times no local anesthetic by a needle and syringe is necessary.  The goal is to make this as easy as possible on the child and keep them out of pain.  We try to avoid the needles if at all possible.  It’s important to remove baby teeth when they are not naturally exfoliating, because it can be detrimental to the health of the gums, or underlying permanent teeth, if the child does not lose the teeth at the proper time.

The primary dentition consists of a total of twenty teeth, by around age twelve they are all exfoliated and replaced with permanent teeth.  A typical adult dentition of permanent teeth, including third molars total thirty-two.  You might recall a baby getting their first two lower incisors around six months old.  These two lower central incisors are then the first to be exfoliated at around age six.  Two permanent lower central incisors take their place, typically erupting behind the baby teeth.  Some moms become concerned with the permanent erupting behind the primary teeth, but not to worry this is normal.

Children at age six sometimes complain of tenderness in the molar area at this time, this is common as well- along with the two permanent central incisors, they will also gain their first adult molars, which do not replace any primary teeth, but erupt behind the primary molars.  These are sometimes referred to as “six year molars”, appearing at age six, and very important teeth that are cornerstones of the adult dentition.  We like to seal the grooves of these teeth shortly after eruption to limit colonization by the anaerobic bacteria that cause cavities in deep grooves of the teeth.  The final teeth to make appearances are the twelve year molars (second molars), coming in behind the six year molars and then finally the wisdom teeth (third molars) appearing in the teen years.

Most of the time this is a relatively painless process.  On rare occasions we’ve seen kids complaining of soreness and tenderness in the gum area when a tooth is coming in.  We advise children’s ibuprofen in these instances.  If there is any bleeding after losing a tooth, biting on some medical non absorbent gauze for 20-30 minutes typically solves any issue.  More time and pressure biting on the cotton is needed if bleeding continues.  It is rare to have discomfort and pain when losing baby teeth and if your child does have persistent symptoms as such it is time to call the dentist.

The most common issues we see through this eruption process would be congenitally missing teeth and impacted teeth.  Missing teeth can occur, and is likely genetic.  The most common missing teeth are the maxillary lateral incisors and the wisdom teeth.  Some people, (I’ve seen a handful of cases), are born with no lateral incisors.  Others, instead of four wisdom teeth might have three.  I’ve seen people with one or two wisdom teeth only, and even some with none.  Supernumerary teeth are another possibility.  In this case one might be born with an extra incisor, or extra wisdom teeth,  I’ve seen patients with five or six wisdom teeth.  They’ve had one set of four pulled and then one to two more appeared.  We’ve seen one case where a wisdom tooth was pulled and then 2 more subsequent appeared in its place.  Impacted teeth are another issue.  Sometimes it’s a skeletal issue, where there is not enough room in the mouth, maybe the palate is too narrow, the permanent teeth sort of become log jammed and one or more stay stuck in the bone.  Commonly we see this in upper canines- I’ve seen many cases of impacted canines that later surgically and orthodontically need to be pulled down.  We also see wisdom teeth, when there is not enough room in the back jaw area, laying sideways in the bone, never able to erupt normally.  These teeth are typically removed surgically.

What follows from age six to twelve is a series of primary teeth being replaced by permanent teeth, starting in the anterior and working back to the primary molars (being replaced by adult premolars) and canines.  These primary molars are important place holders for the adult dentition that is coming.  Ideally we like to see spacing in a child’s primary teeth, because the permanent teeth that will replace them are wider.  If children lose primary molars (typically through cavities from too much sugar in the diet), it is important to fabricate space maintainers to hold this space for the soon to be coming permanent pre molars.  The best bet to ensure your child is enjoying a healthy transition from primary to permanent dentition is regular dental cleanings under the supervision of a dentist.  If you have any further questions contact our team at Willis & Associates in either our Stuarts Draft, Fishersville or Churchville Dental offices or Crozet Family Dental- we are happy to help!


Keep Smiling,

James W. Willis, D.D.S.

Crozet Family Dental

Willis & Associates Family Dentistry