The changeover takes several years and usually goes smoothly. But a few situations, if missed, follow a child right through to adulthood.
- The pace of losing baby teeth varies considerably between children, so being early or late compared with classmates is usually not a concern.
- The molar erupting at around six years is a permanent tooth, not a baby tooth, even though nothing falls out beforehand. This misunderstanding causes decay in that tooth to be overlooked.
- Do not tie thread around or yank at baby teeth that are still firmly attached, as the remaining root can fracture inside the bone.
- Extraction of baby teeth at a clinic falls within health insurance cover when prescribed by the dentist.
The first wobbly tooth is a happy milestone at home. From there to the last baby tooth is a fairly long stretch, and there are a few things worth keeping an eye on along the way.
How the changeover works
Permanent teeth sit waiting inside the jaw, beneath the roots of the baby teeth. When the time comes, the permanent tooth moves upward and the root of the baby tooth gradually resorbs. Once the root has gone, the baby tooth loosens and falls out, making way for the permanent tooth.
The sequence generally follows the order of eruption: central incisors first, then lateral incisors, then the teeth further back. The whole process spans several years, and the pace varies considerably between children. A child may be a year ahead of classmates and still be entirely normal.
So there is no need to worry simply because your child is slower than the neighbour's. The signs listed below matter far more.
One important permanent tooth that is often mistaken for a baby tooth
This is the most important point in this article. A child's first permanent molar erupts at around six years of age, appearing behind the last baby teeth without replacing any baby tooth at all.
Because it arrives quietly, with no tooth falling out beforehand, a great many parents assume it is a baby tooth that will be replaced later. In fact it is a permanent tooth, and once it arrives it is there for life.
The consequence of that misunderstanding: a child develops decay in this tooth and the family does not seek treatment, on the basis that "it is a baby tooth, it will be replaced". By the time it is recognised, the damage has often progressed. This tooth also sits where chewing load is heavy and helps guide the developing bite.
It is also the tooth for which fissure sealants are most often considered, soon after it erupts.
Should you pull a loose tooth yourself?
Where a baby tooth is already very loose, barely attached and not painful, it is perfectly normal for it to come out while eating or with the child wiggling it.
But you should not tie thread around a tooth and pull, or yank at it by hand when it is still firmly attached. The reason: the root of the baby tooth may not have fully resorbed, and pulling hard can fracture the remaining root inside the bone, causing pain, bleeding and infection. Non-sterile implements are a further risk.
Bring your child in rather than dealing with it yourself if:
- A baby tooth is loose but has not come out for a long time and hurts when eating.
- The permanent tooth has appeared while the baby tooth is not yet loose.
- The gum around the baby tooth is red and swollen or discharging.
- Your child has a blood disorder or is under treatment for a medical condition. This group should be managed by a dentist.
Extraction of baby teeth and retained baby roots at a clinic falls within health insurance cover when prescribed by the dentist.
A permanent tooth coming through behind the baby tooth
This situation is common with the lower front teeth: the permanent tooth erupts behind while the baby tooth is still in place, giving two rows of teeth.
The sight alarms many parents, but it does not always need immediate intervention. In some cases the baby tooth falls out shortly afterwards and the permanent tooth gradually moves into place under the influence of the tongue and lips. In others the baby tooth needs removing to make room.
Since the two paths differ, bring your child in for assessment rather than deciding to wait or to pull it yourself.
Signs worth an appointment
- A permanent tooth erupting while the baby tooth has not come out.
- A baby tooth lost very early through decay or injury. Neighbouring teeth may drift into the space, leaving too little room for the permanent tooth later.
- A baby tooth lost some time ago with no sign of the permanent tooth.
- Newly erupted permanent teeth already looking crowded or noticeably crooked.
- Pain, swollen gums, or a tooth darkening after a knock.
- Persistent thumb sucking, tongue thrusting or mouth breathing.
Care during the changeover
- Keep brushing twice daily with fluoride toothpaste, using an amount appropriate to the child's age.
- Help your child clean the back teeth thoroughly, which is where they tend to miss and where that six-year permanent molar sits.
- Introduce interdental cleaning once teeth are in contact.
- Reduce how often your child snacks or drinks something sweet during the day.
- Attend regular check-ups so the dentist can follow the changeover and spot anything unusual early.
To have your child checked, visit Ky Hoa Dental at 266A - 268, Duong 3 Thang 2, Hoa Hung Ward, Ho Chi Minh City. The clinic is open on Saturdays, which suits children who are at school during the week.
Frequently asked questions
My child is losing teeth later than classmates. Is that a problem?
The pace varies considerably between children and most of that variation is normal. The signs that matter more are things like a permanent tooth erupting while the baby tooth is still in place, or a baby tooth lost long ago with no permanent tooth appearing. If you are concerned, an examination is the surest way to know.
Is the molar that appears at six years a baby tooth?
No. The first permanent molar erupts at around six years behind the baby teeth, without replacing any of them. It therefore does not fall out and is not replaced later. This is a common misunderstanding and it leads to decay in that tooth being overlooked.
Should I tie thread around a loose tooth and pull it?
Not for a tooth that is still firmly attached, because the baby root may not have fully resorbed and pulling hard can fracture the remaining root inside the bone, causing pain and infection. A tooth that is already very loose and painless usually comes out on its own. If it lingers or hurts, bring your child in.