One question we often hear from anxious parents is, “How do I know my child’s permanent teeth are coming in properly?” For all parents, that is an emotionally loaded question. The arrival of your child’s first permanent teeth is a symbolic signpost marking the beginning of the end of your baby’s adorable grin … and the first glimmer of what you hope will be an attractive adult smile.
In our experience, if the primary teeth and bite have been problem-free or if early problems have been addressed, you can reasonably expect that with regular maintenance the permanent teeth will come along nicely. That’s because those baby teeth have been maintaining the spaces where the permanent teeth will erupt beginning around age 5 or 6. By about age 14, children have 28 of their 32 permanent teeth, and the remaining four wisdom teeth will appear behind the permanent ones in late adolescence.
Over this length of time, things can change, so it’s important to stay on top of this process to avoid crowding and misalignment of the permanent teeth. Often the earliest solution is a simple one. For example, if a baby tooth is lost too soon, we might recommend a space maintainer so that the surrounding teeth don’t start to tilt or rotate to fill in the space. When that happens, it shifts the angle of the permanent teeth below as well, which can result in speech issues and more complicated and expensive treatment later on.
When the primary tooth loosens appropriately because a permanent tooth is coming through, you can have your child gently wiggle it or eat a hard fruit or vegetable to speed up the process, but you can usually let these loose teeth come out on their own.
Once room is made for them, the permanent teeth usually just do what comes naturally and emerge cleanly with no significant tenderness. It isn’t always smooth sailing, though. When the first four permanent molars appear, usually around age 6, it can sometimes be difficult and painful. As the tooth erupts, it slowly pushes through the child’s gum, often leaving a flap hanging over the exposed new tooth. If food gets stuck underneath, it can cause an infection and fever. I urge you to call me at the first sign of this kind of trouble. If necessary, the excess gum can be removed and the area cleaned to allow the new tooth to come in normally.
Rest assured … the arrival of permanent teeth that will blossom into an attractive adult smile is a natural and beautiful thing. The best way to keep it that way, and to keep your child smiling through it, is to come in for regular dental checkups and keep them cavity free.