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Teething or eruption of first milk teeth is a milestone in your child’s development. As a parent, it is always fascinating to watch those tiny little milk teeth to sprout out of the jaw bones. It’s a time of happiness as well as of some concern about how the teeth formation will be, What to do, and what not to do? Sometimes, you may get concerned when your child’s teeth do not erupt on time. Mostly, it is not of a major concern because your child’s teeth might just be following the pattern of your milk teeth eruption, i.e., if your teeth erupted late in your childhood, chances are that your child’s teeth will also have a slow pace of piercing through the gums. Hence, if your child’s teeth do not erupt even after one year of age, it is known as delayed tooth eruption. This is the time when you should go to a general dentist or a pedodontist (a dentist who specializes in children’s dental health) to find out the underlying cause of it.

There can also be a delay in the eruption of your adolescent’s permanent teeth. This is also associated with many local and general factors. If the teeth do not erupt till 6 months of the expected time of their eruption, you should take your child to a dentist to figure out the cause of it.

  1. Tooth eruption age
  2. Causes of delayed tooth eruption
  3. Treatment of Delayed Tooth Eruption
  4. Prevention of Delayed Tooth Eruption
  5. Complications of Delayed Tooth Eruption
Doctors for Delayed Tooth Eruption

Tooth eruption occurs over a period of time in both babies and adults. Here is how:

Tooth eruption age in babies

The first teeth to erupt in your baby’s mouth are lower central incisors (middle front teeth) followed by upper central incisors (middle front teeth), upper lateral incisors (either side of the upper-middle front teeth), lower lateral incisors (either side of the lower middle front teeth), upper and lower first molars (back or rear teeth), canines (between incisors and molars), and lastly by second molars (teeth behind first molars).

Upper Teeth Eruption time (in months)
Central incisors 10 (8-12)
Lateral Incisors 11 (9-13)
Canines 19 (16-22)
First molars 16 (13-19)
Second Molar 29 (25-33)

 

Lower Teeth Eruption time (in months)
Central Incisor 8    (6-10)
Lateral Incisor 13   (10-16)
Canines 20   (17-23)
First molar 16   (14-18)
Second molar 27   (23-31)

Tooth eruption age in adults

The first permanent teeth that replace their predecessor milk teeth are the lower first molars. These are followed by lower central incisors, upper central and lower lateral incisors, upper lateral incisors, lower canines, upper first premolars, lower first and upper second premolars, upper canines and lower second premolars, upper and lower second molars and lastly by third molars.

Upper teeth Time of eruption (in years)
Central Incisor 7-8
Lateral Incisor 8-9
Canine 11-12
First Premolar 10-11
Second Premolar 10-12
First Molar 6-7
Second Molar 12-13
Third Molar 17-21

 

Lower teeth Time of eruption (in years)
Central Incisor 6-7
Lateral Incisor 7-8
Canine 9-10
First Premolar 10-12
Second Premolar 11-12
First Molar 6-7
Second Molar 11-13
Third Molar 17-21

The following are some of the causes of delayed tooth eruption:

Delayed tooth eruption in babies

Tooth eruption is more related to heredity than environmental factors. As it has been mentioned above, the pattern of eruption runs in the family, hence it determines the time of teething to a large extent. The reasons for delayed milk tooth eruption can be local or general.

General factors for delayed tooth eruption are:

  • Inheritance
    The pattern and timing of tooth eruption largely depend on the inherited genetic makeup of the child. Hence, some children are early teethers (eruption of teeth earlier than normal), some are normal, while the others are late teethers (eruption of teeth later than normal teething time).
  • Nutrition
    Lack of nutrition due to any reason causes a defective overall development of the child. This also leads to slow or faulty development and a late eruption of the child’s teeth.
    Vitamins such as vit A and vit D are very important in tooth and bone development. Deficiency of these severely affects the same.
  • Hormonal disorders (Endocrine disorders)
    Disorders or defects in the thyroid, parathyroid or pituitary gland prevents the production and release of hormones which are necessary for the normal growth and development of the child. These can also cause delayed tooth eruption.
  • Diseases
    Diseases like HIV, anemia, kidney diseases, cancer, heavy metal poisoning, etc. affect a child’s development and the immune system significantly and cause a delay in tooth eruption too.
  • Medications
    Long-term chemotherapy, drugs like phenytoin (used for epilepsy or seizures) cause changes in the body that affect normal tooth and body development.
  • Other causes of delayed tooth eruption include low birth weight, tobacco smoke in the environment, developmental defects, etc.

Local factors for delayed tooth eruption include

  • Impacted teeth
    Those teeth which get blocked (due to their tilted positions or a lack of jaw space) while pushing through the bone and gums are known as impacted teeth. These teeth fail to come out and are one of the reasons for a delay in tooth eruption.
  • Excessively thick gums
    Sometimes, the gum tissue grows excessively thick (known as fibrosis or hyperplasia) and prevents the tooth to push through the same and erupt in the mouth.
  • Supernumerary teeth 
    Presence of an extra tooth in the place of a tooth which is about to erupt reduces the available space in the jaw.
  • Injury
    Injury or trauma at the site of tooth eruption either due to surgery, or accident, or a sudden blow to the jaws can cause damage to the tooth buds in the bone. This can prevent the development of a tooth, and hence prevent its appearance in the mouth.
  • Ankylosis
    Sometimes, the bone surrounding the tooth or near the roots of the tooth might get hardened and prevents eruptive movements of the tooth.
  • Ectopic eruption
    The eruption of the tooth at a place other than its expected site of eruption is known as an ectopic eruption. It can occur due to tilted position or displacement of the tooth bud from its original position.
  • Odontogenic tumours
    These are the tumours which arise from the lining that forms the tooth buds. The tooth may sometimes be involved and get surrounded by the tumour mass. This tumour prevents the eruption of the involved tooth and causes a delay in its eruption.
  • Radiation damage
    Exposure to therapeutic radiation or accidental exposure to large doses of radiation may cause defective development and eruption process of the teeth.
  • Oral Clefts
    In this condition, a cleft is present either on the lips or on the palate. Clefts cause displacement, damage, or non-development of tooth buds, thus delaying the eruption process. Read more: Cleft lip and palate causes

Delayed tooth eruption in adults

Besides the above-mentioned causes, delayed eruption of permanent teeth has other causes as well. These causes are as follows:

  • Early loss of a milk tooth
    If the milk tooth of your baby sheds before its normal time then the period between the shedding and the eruption of the permanent tooth will be long and you might think that it is delayed.
    Also, early loss of a milk tooth causes changes in the positions of the adjacent teeth, leading to the loss of space for the permanent tooth to come. It gets stuck inside the bone and may lead to a delayed eruption.
  • Retained milk tooth
    Milk teeth usually dissolve in the bone when the permanent tooth beneath them applies pressure on them when it starts erupting. Sometimes, the milk tooth roots may not resorb. As a result, the milk tooth fails to shed and the permanent tooth fails to erupt.
  • Harmful habits of the child
    Some children have a habit of constantly touching their teeth with their hands, tongue or other objects. This causes a change in the position of milk teeth and may cause obstruction in the path of an erupting permanent adult tooth. 

If the delay in tooth eruption is due to the family pattern, treatment is not required. However, if there are other underlying medical conditions and local factors causing the delay, treatment is done. Following are a few treatment strategies applied to treat delayed tooth eruption:

Surgery

  • Removal of the milk tooth which is not shedding (extraction).
  • Removal of the thick gum tissue lying over the tooth which needs to erupt.
  • Surgery to unite oral clefts. 

Read more: Cleft lip and palate repair surgery

Orthodontic treatment (Treatment using wires)
Your dentist might remove the gums over the erupting tooth and tie it with a wire. A regular tightening of this wire slowly pulls out the tooth over a period of time. This is called traction.

Treatment of the systemic diseases
This involves the treatment or controlling of underlying medical conditions such as malnutrition, anemia, HIV-AIDS, kidney disease, etc.

There are a lot of factors which you cannot control to prevent delayed tooth eruption, such as genetic factors, diseases, medical conditions, etc. However, the following are a few things which you can do to prevent this condition in your child:

  • Give proper and complete nourishment to your child. This will help your child to build a good immune system, and will not only prevent diseases but will also help them in fighting against them if they do get any.
  • Take your child to a pedodontist if there are no signs of milk teeth till one year of age or if there is a delay beyond six months for a permanent tooth to erupt, or if the milk tooth is not shedding on time.
  • Get your child’s milk tooth removed by a pedodontist if it is there beyond the time when it should have been replaced by a permanent tooth.
  • Take good care that your child does not develop oral habits like thumb or finger sucking even after growing up, biting pencils, lip sucking or lip biting, etc. when all these habits are continued, they start pushing the teeth in a certain direction leading to a change in the normal position of the teeth.

Read more: How to break thumb sucking habit in your baby

  • Train your child to brush their teeth using the correct technique twice a day. Tooth brushing techniques are different for milk teeth and adult teeth. Ask your dentist to demonstrate both of them. This will prevent the development of cavities and early loss of milk teeth.

Read more: Oral hygiene tips

  • Children often imitate their parents and other kids their age. Make sure you and other people set a good example for your child to follow. This will help in better development of your child as a whole.

Ignoring the delay in tooth eruption for a long time may lead to certain complications. A few complications of delayed tooth eruption are as follows:

  • Delayed milk tooth eruption also causes a delay in the eruption of permanent teeth. Tooth eruption is also related to facial development and growth of the jaws. A delayed tooth eruption might cause abnormal growth of the same.
  • Hindered development of permanent teeth eruption will also lead to crowding of teeth, impacted teeth, poorly aligned teeth, and sometimes missing teeth (the teeth that fail to erupt).
  • Crowding of teeth is also a very common reason for the early development of cavities and gum diseases.
  • A delay in eruption of permanent teeth causes a change in the positions of the rest of the teeth as they try and occupy the space available to them. As a result, the set of adult teeth may give a different appearance to the face where teeth are less in number and have huge spaces between them.
  • If a permanent tooth doesn’t erupt on time, it also affects the growth of the jaw. This is because crowding of teeth does not push the jaws to grow to their proper size.
  • Poor growth of the jaw changes the whole appearance of the child’s face and may prevent the child from having an open social interaction in their teenage due to a lowered self-esteem.
  • A tooth might get stuck in the bone and may not erupt. This impacted tooth may sometimes get surrounded by a tissue lining which can get filled with fluid. Thus causing the formation of a cyst. The cyst will cause a swelling in that area and may also lead to the displacement of the adjacent teeth. Such a condition requires surgery to correct.
Dr. Nida Mirza

Dr. Nida Mirza

Pediatrics
5 Years of Experience

Dr. Vivek Kumar Athwani

Dr. Vivek Kumar Athwani

Pediatrics
7 Years of Experience

Dr. Hemant Yadav

Dr. Hemant Yadav

Pediatrics
8 Years of Experience

Dr. Rajesh Gangrade

Dr. Rajesh Gangrade

Pediatrics
20 Years of Experience

References

  1. Suri L1, Gagari E, Vastardis H. Delayed tooth eruption: pathogenesis, diagnosis, and treatment. A literature review.. Am J Orthod Dentofacial Orthop. 2004 Oct;126(4):432-45. PMID: 15470346
  2. van der Linden FP. [Recognizing and preventing disturbances in eruption]. Ned Tijdschr Tandheelkd. 2014 Apr;121(4):203-8. PMID: 24881261
  3. Triratana T1, Hemindra, Kiatiparjuk C. [Eruption of permanent teeth in malnutrition children]. J Dent Assoc Thai. 1990 May-Jun;40(3):100-8. PMID: 2127420
  4. Johnsen DC. Prevalence of delayed emergence of permanent teeth as a result of local factors. J Am Dent Assoc. 1977 Jan;94(1):100-6. PMID: 264301
  5. Ohtawa Y1, Ichinohe S, Kimura E, Hashimoto S. Erupted complex odontoma delayed eruption of permanent molar. Bull Tokyo Dent Coll. 2013;54(4):251-7. PMID: 24521551
  6. Huber KL1, Suri L, Taneja P. Eruption disturbances of the maxillary incisors: a literature review. J Clin Pediatr Dent. 2008 Spring;32(3):221-30. PMID: 18524273
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