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The Mystery of the Milk Tooth

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Many a parent particularly first time moms get anxious about the baby girls’ teeth- wondering why the neighbours’ kid has already had their first teeth removed yet her

own little angel’s teeth are as firm as can be. Or perhaps she has removed her milk teeth but the permanent teeth seem to be taking forever to grow or they are growing in the wrong position. Well in this piece we will endeavour to shed light on these puzzles of nature.

  1. Why are baby teeth so tiny and sometimes spaced? Well small because the jaw is small, and spaced in order to accommodate the larger permanent teeth when they erupt. If your child’s milk teeth are not spaced, that is usually an indicator that the permanent teeth will not have adequate space and therefore be crowded.
  2. When should my infant’s teeth start to grow? Below is a chart of the general age range when milk teeth start to be visible in the baby’s mouth.

    Notice that the earliest milk teeth to be shed are the lower central incisors at 6-10 months. This is a general range, some infants may start earlier or later than this- some even later than 1 year. By the time a child is 3 years of age, they will usually have all their milk teeth fully grown. Notice also that there are only incisors, canines and molars at this stage and no premolars present in the set of milk teeth. The baby molars will be shed to give way to permanent Premolars. Permanent molar teeth on the other hand start to grow behind the fully established milk teeth at around 6 years of age.
  3. My baby’s teeth are shaking. How should I remove them? When you notice that baby’s teeth are starting to get lose, at certain times you will find that they’ve ‘hardened’ again. This cycle is normal. Just encourage the child or you yourself to keep applying pressure to it. At the point you feel it has loosened significantly, apply an ice cube to the area to provide a numbing effect, then with clean hands apply pressure in a twisting direction for a minute or so and then in the opposite direction for another minute. This helps to gently tease the tooth out of the socket and is far more effective than rocking the tooth back and forth. Alternatively you can take the child to a dentist to have loosened milk teeth removed under local anaesthesia. This is also an opportunity for the dentist to check the child’s general oral condition and motivate them towards good health habits. You may notice that the two lower permanent central incisors start to grow behind the milk teeth. This is normal even when the milk teeth are removed, the permanent incisors grow in that position and progressively get pushed forward by the tongue in line with the rest of the lower teeth.
  4. My child shed his milk teeth ages ago and there’s no sign of the permanent tooth? When this happens there are two possibilities: One is that the milk tooth was removed earlier than it should most likely by the dentist to create room for another growing tooth or because was very badly decayed. In this case if the permanent tooth was not quite ready to erupt it may take longer than usual to appear in the mouth. The other scenario is that there is some obstruction in the path of the permanent tooth preventing it from erupting fully. This is common particularly when baby molars are extracted too early and the neighbouring tooth drifts in to its space. It is important to have space maintenance treatment to prevent this. Below is a chart showing the eruption pattern of the permanent teeth:

Notice that by age 12 or 13, all the permanent teeth have usually erupted except for the wisdom tooth (third molar) which can grow anywhere between 17 to 21 years of age. The wisdom tooth is most variable in that it may or may not develop and can be impacted in the bone…story for another day. Meanwhile it is important that children be seen by a dentist as soon as practically possible- preferably when they start to grow their first teeth. This will help set them in a positive direction towards good oral health.

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