When to worry if baby teeth don’t fall out, and can it be due to disease?

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Teeth are one of the main concerns of parents from the time babies’ first teeth appear. The first concern is that they come in on time, that they don’t hurt when they come out… and, as the child grows, that they don’t have cavities or that the permanent teeth come out without any unforeseen problems, that they don’t come out crooked, etc. But what happens if the milk teeth do not finish falling out or if they do so later than expected? Could there be a serious cause?

A child’s maturation process is not linear, and much less is it similar in all children. The loss of milk teeth is part of this maturation process and, therefore, it is neither linear nor the same in all children. Although we think that it is ‘normal’ for some teeth to have fallen out by the age of five or six, the range is much wider, “the fall of primary or milk teeth occurs because the permanent teeth reabsorb the roots of the primary teeth until they loosen and end up falling out. The moment when this happens varies greatly, but in general it usually begins around the age of 6 years”. If the teeth do not start to fall out at that age, it would not be a cause for concern, as “there are very wide temporal margins”. Even so, Dr Toya recommends starting to ‘take care’ of the issue if no teeth have changed by the age of eight, “it is not common for no teeth to have fallen out by the age of eight, but it is common for a tooth not to fall out at the right age at some point in the replacement process”, she warns.

If we think that our child’s teeth are taking too long to fall out, the best thing to do is to consult a dentist, who should be seen regularly from the age of four. According to Dr. Toya, the most common cause of this is that “there is a mechanical obstacle (a supernumerary tooth, a cyst, etc.) or the non-existence of a permanent tooth that prevents it from ‘pushing’ the temporary tooth and causing it to fall out”. The most common causes of this delay are:

  • Agenesis. Agenesis is the non-existence of a permanent tooth that has not been formed. As it has not formed and absorbed the root, it does not push the milk tooth and the latter does not fall out. Its origin is genetic, so it is common for it to occur in several members of the same family and for it to be present in the same teeth. To check for agenesis, an imaging test must be carried out.
  • The permanent tooth does not erupt, although it is present, for various reasons: crowding or lack of space for the tooth to erupt, having had a blow to the milk tooth, which would dislodge the permanent tooth, or due to the loss of the eruption guide, such as the presence of an obstacle, an extra tooth, out of place…
  • Ankylosis. The milk tooth is stuck to the bone and prevents it from falling out. In addition, it usually appears sunken or lower than the surrounding teeth. It can have a genetic origin or be caused by trauma.

In addition to the mechanical problems mentioned above, there are factors or diseases that can delay or influence tooth loss.

  • Genetics. Both the anomalies in the teeth and the rate at which they erupt have a lot to do with our family history. In other words, if it took parents a long time to get their permanent teeth, it is likely to happen to their children as well.
  • Gender: girls develop permanent teeth earlier than boys.
  • Prematurity. According to the WHO, premature children – those born before the 37th week of gestation – are more likely to have delayed teething, both in the eruption of milk teeth and permanent teeth.
  • Some important nutritional or endocrinological alterations (anaemia, malnutrition, poor nutrition, growth hormone deficiency, etc.) or some syndromes, such as Down’s Syndrome or Cleidocranial Dysostosis, although in general they have other much more severe symptoms which mean that they are diagnosed before the delay in teething.

Whether or not there are problems or doubts about the eruption of teeth, it is advisable to go to the dentist as soon as you have teeth for control and prevention of diseases that may occur, as well as when any significant alteration in the normal chronology of tooth eruption or falling teeth is detected”. The best way to prevent or detect any anomaly prematurely is to visit the dentist regularly.

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