When to worry about baby teeth not coming in?

When to worry about baby teeth not coming in

Baby teeth are temporary, first set of teeth in your child’s mouth, which are later replaced by permanent teeth. Teething or tooth eruption is a critical milestone in your child’s life. Like other child’s milestones, it is also an important indicator of their growth and development. Teeth erupts in a particular sequence and at a precise time. However, there are certain variation in the appearance of baby teeth that is considered normal. In this article, I will discuss the average time of baby teeth eruptions and when to worry about baby teeth not coming in.

Let’s get started; 

What is the average eruption time of baby teeth?

Teeth eruption is a process that strongly influences the baby’s face and jaw development. The first pair of lower baby incisor teeth erupt between 6-10 months, followed by upper central incisors (8-12 months) and lower lateral incisors (10-16 months). 

Generally, it is accepted that a child has four teeth at 11 months, eight at 15 months, and 20 teeth as they turn 27 months. 

Baby tooth eruption chart

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When to worry about baby teeth not coming in?

You should wait for six months after the average eruption time of a tooth has passed. It is prevalent among children to have delayed teeth eruptions and there is no need to worry about baby teeth not coming in.

You need to take your child to the dentist if their first pair of teeth doesn’t appear by the first birthday.

Even if your child is meeting all their milestones on time, it’s recommended to have your child’s first dental visit on their first birthday. 

How do dentists determine the baby tooth’s eruption time?

The dentist will examine your child’s mouth and take an x-ray of their mouth. The x-ray reveals the number of teeth your child has in their mouth. Also, the stage of root development will tell how long the tooth takes to emerge. Generally, a tooth erupts when its ¾ root is formed. 

What causes a delay in teeth eruption 

Several reasons can lead to delayed tooth eruptions and if you think your child suffers from any of the following factors, talk to your healthcare provider about it;

Malnutrition 

Diet and nutrition are the key factors in the growth and development of a child. 

A good protein intake is required to form different layers of the tooth. The organic matrix of dentin is primarily made of collagen (protein). 

It may be surprising to know that protein is essential for enamel formation, too. However, it is mainly (95%) composed of minerals. During the early formative phase of enamel, a protein framework is laid down that is later replaced by calcium and other minerals. Therefore, protein intake directly influences the quality of enamel and dentin in the tooth. 

Protein deficiency not only leads to defective tooth formation but also delays the tooth eruption of milk and permanent teeth and is frequently seen in children of low socioeconomic status. 

Other vitamins that play a crucial role in tooth development are vitamins A, B, C, D, calcium, and phosphorus. 

Moreover, the introduction of a soft diet coincides with the eruption of the first tooth because the nutritional needs of your child increase as they grow. So, mothers should consult primary care providers and follow their instructions about their child’s dietary requirements. 

Premature birth and low-birth babies

If your baby was premature birth, it could be the reason for delayed baby teeth eruptions. 

The baby teeth buds begin to form in the sixth week inside the mother’s womb and continue to develop till they erupt in the mouth after the birth. 

The tooth development may be disturbed in preterm infants due to nutritional deficiencies, oral intubation (a tube inserted from the mouth assists breathing in babies with respiratory distress), and intake of medicines. 

Birth is a stimulus for teeth eruption, and healthy pre-term babies often catch up and show timely teeth eruptions. 

According to a research, low-weight babies less than 1000g and babies born before 30 weeks have an increased risk of delayed teeth eruptions. Almost 60% of pre-term babies show late first-baby tooth eruption. 

The enamel defects in the upper front teeth frequently occur in babies who had oral intubation. The injury is thought to be caused by damage to the upper developing incisors from the laryngoscopic blades and oral (endotracheal) tube. 

Syndromes

Different genes control the development of the face, jaws, and teeth. Any gene alteration will also impact your child’s teeth development and eruption.

Several syndromes, for instance, Down, Book, Apert, Gardener’s, Anhidrotic ectodermal dysplasia, Hutchinson–Gilford syndrome, Bloch–Sulzberger, Axenfeld-Reiger, and cleidocranial dysostosis are linked to dental problems in kids.  

These children have either extra or fewer chromosomes (genetic material) and hence, have altered facial appearances. Moreover, they also presents with defective and delayed tooth development. 

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Hormonal disorders 

Hormonal disorders can cause delayed baby tooth eruptions, and problems in face and jaw development. Late eruptions often appears as a first sign of a systemic disease.

The disorders linked to delayed tooth eruptions are hypothyroidism, hypopituitarism, and hypoparathyroidism. 

Hypothyroidism affects 1 in 5000 to 1 in 1000 children in Europe. Infantile hypothyroidism appears as thick lips, small mouth, large tongue, very dense bones, delayed milk and adult teeth eruptions, and defective teeth formation (enamel defects).  

Childhood hypopituitarism (the pituitary gland produces eight hormones, including growth hormones) most commonly affects growth hormone production in children. It manifests as small penis, jaundice, excessive urination, low blood sugar, short stature and slow growth, weight gain that’s out of proportion, and delayed tooth development and eruptions in your child. 

Primary failure of eruption

Primary failure of eruption is a phenomenon where the eruption path is formed, but the tooth fails to erupt. The tooth partially erupts and then stops or doesn’t erupt at all. The failed eruption is not related to any syndrome. 

The back teeth (molars) are most often affected. It affects both the dentitions, baby and permanent teeth.

Fusion of tooth to the bone (Ankylosis)

Fusion of the tooth with the bone can result from a disturbance in the intervening fibers attaching the tooth to the bone. In this situation, the teeth fail to erupt or lie below the adjacent teeth submerged in the gums. This condition often affects the baby second molars. In dentistry, fused tooth are referred to as ankylosed tooth. 

Ankylosis doesn’t affect the eruption of other teeth in the mouth. Only the ankylosed tooth fails to erupt and remain hidden under the gums or bone. The surrounding teeth may tilt into the missing tooth space. 

The children with ankylosed tooth/teeth are otherwise healthy. There is no need to worry if your child has an ankylosed tooth. However, the primary concern is the status of the permanent tooth, as the baby tooth has to shed to allow the eruption of permanent tooth.

In most cases, the permanent tooth successfully erupts after the removal of ankylosed baby tooth.

Eruption cysts 

An eruption cyst is a benign tissue cyst that forms due to fluid accumulation between the tooth and its surrounding formative follicle or cover. 

The cyst may form in the milk or adult tooth and prevents it from eruption. It affects 1-2% of individuals. 

The cyst causes no harm to the child. It forms as result of collection of fluid or blood in the space between the tooth and its follicle. Moreover, it commonly affects the molars (back teeth).

It appears as a soft bluish swelling on the gums. Consult your dentist to confirm it. The use of baby teething toys breaks the it and allows the eruption of the baby tooth

Missing teeth 

The prevalence of missing baby teeth is rare and accounts for 0.5-1% of the missing teeth. Permanent teeth are frequently missing, with the highest incidence of wisdom teeth followed by lateral incisors (second front tooth from the center) and second premolars (5th tooth from the center).

Conclusion

Delayed baby teeth eruption is common among children, and there is no need to worry about baby teeth not coming in the mouth. It would help if you wait for six months after the average time of tooth eruption has passed to clear all the doubts.

There are several reasons for delayed teeth eruptions. Malnutrition is the most common cause of it. Others are hormonal disorders, syndromes affecting head and neck region, missing teeth, premature birth, and ankylosed teeth.

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