Baby teeth: when to worry, and when not to

Why does a baby tooth matter if it's going to fall out?

Because it isn't just passing through. Until it falls out on time, a baby tooth does three jobs, and your child gains from each one as long as the tooth stays healthy to its last day:

• A place kept for the permanent tooth. Usually, under each baby tooth a permanent tooth is forming, and the baby tooth holds its place until it's ready. When it falls out on time, the permanent tooth finds its place waiting for it.
• Eating and talking. With their baby teeth your child chews food properly, and learns to say their sounds clearly.
• A relaxed smile. A child with healthy teeth laughs and talks in front of other people without covering their mouth.

So the real question isn't “will it fall out?” It's “will it stay healthy until it does?” That's what separates the two lists below.

When there's no need to worry

These four things worry parents a lot, and most of the time they're normal:

• A tooth wobbling at the right age. The first teeth to wobble are usually the bottom front ones, at around six. A tooth wobbles because its root is slowly dissolving while the permanent tooth comes up underneath. If there's a little blood when it comes out, have them bite on clean gauze for about ten minutes; if it doesn't stop, call us.
• A tooth falling out a little late. Every child has their own timing, and a few months, sometimes up to a year, either side of their classmates, or of a brother or sister, is usually normal. But if a permanent tooth has come through on one side and the matching tooth on the other side still hasn't shown after about six months, it's worth a check, and the doctor decides whether an x-ray is needed to find out why. Approximate ages, tooth by tooth: When your child's teeth come through: the full timeline.
• A slightly darker baby tooth after an old knock, with no pain. It happens after a knock to a front tooth, and it isn't an emergency. But it needs a look at an ordinary appointment, because the colour is sometimes a sign that the knock affected the nerve of the tooth, and the doctor decides whether keeping an eye on it is enough. If the tooth is permanent or you're not sure, don't leave it: book a check soon. And if swelling or a small bump on the gum appears along with the colour, it moves to the list below.
• A permanent tooth coming through behind a baby tooth that hasn't fallen out yet. This is common, especially with the bottom front teeth, and you see two rows. Often the baby tooth falls out on its own, and the tongue gradually pushes the permanent tooth into place. But if the baby tooth stays firm for a while as the permanent one keeps coming through, it's worth a check, and sometimes the doctor decides the baby tooth should come out to make room.

When to worry, and what to do

Here there's no reason to wait “until it falls out by itself”. A check in good time protects something your child still needs:

• Decay, a brown or black spot, or a hole. Decay moves faster through a baby tooth than a permanent one, and it can reach the nerve. A dull white patch along the gum line can be where it starts, and that's the easiest time to catch it. A decayed baby tooth is usually treated, not left because it's “on its way out anyway”: A decayed baby tooth: treat it or take it out?
• Pain, swelling, or a bump on the gum. Most serious first:
  Nearest hospital emergency department, not an appointment: swelling that reaches the eye or the neck, or makes it hard for your child to swallow or breathe.
  Call now: swelling in the cheek or under the jaw, a fever with the pain, or trouble opening their mouth. If the clinic is closed or you can't reach us, go to the nearest hospital emergency department.
  Call today: pain without swelling or fever, a small bump on the gum next to a tooth, or a tooth that has started to move when your child isn't at the age for wobbly teeth. It needs a check the same day, and if we're closed, call as soon as we open.
  And if the pain comes at night and you're not sure what to give: Toothache in children: what to give and what not to.
• A tooth lost early, to decay or a knock. Especially if it's one of the back baby molars: the teeth beside it can slowly lean into the gap and take some of the permanent tooth's space. A front tooth is usually less affected. Either way, a check soon afterwards shows whether the space needs protecting, and the doctor decides whether it needs a small appliance that holds the space until the permanent tooth arrives.
• A tooth knocked out or broken in a fall or a hit. A knock to the head with dizziness, vomiting, even a moment's loss of consciousness, unusual sleepiness or strange behaviour? Hospital emergency first, before the teeth. Otherwise, call now. If the tooth came out whole, hold it by the crown (the white part), put it in a cup of milk and come straight in, and if we're closed, take it to the nearest hospital emergency department. If it's definitely a baby tooth, it isn't put back in, but the check is still needed, because a permanent tooth is forming underneath. What to do in the first hour: Your child knocked out a tooth: the first hour.

Baby tooth or permanent? How to tell

You can tell roughly by eye; the sure answer comes from the examination, sometimes with an x-ray the doctor decides on. These are the differences you'll notice:

Watch out for that molar: many parents take it for a baby tooth, but it's permanent and nothing replaces it.

What to do from today

1. 1

   Let a wobbly tooth come out on its ownMoving it gently with the tongue or a clean finger does no harm. But don't pull it while it's still holding on, because its root hasn't finished dissolving.

2. 2

   Brush twice a day, and don't miss the new molarWith a fluoride toothpaste, and you help until they can brush properly on their own. The permanent molar that has come through at the back needs a brush that reaches it, because it sits at the very back of the mouth and gets forgotten.

3. 3

   Cut down on sugar between mealsSomething sweet with a meal is easier on teeth than sweet things all day long. Juice and sweet drinks between meals are harder on teeth than water, and sticky sweets stay on them longer.

4. 4

   Write down what you noticeWhich tooth fell out and when, any knock, even a light one, and any tooth that changed colour. Those small details save a lot of time at the check-up.

5. 5

   Regular check-ups, not only when it hurtsRegular check-ups help catch decay while it's still small, and follow whether the permanent teeth are coming through in the right place and in the right order.

Questions people ask