Why a baby tooth might not fall out?

A deciduous (baby) tooth won’t fall out unless there is a permanent tooth under it.

This tooth model shows baby teeth with permanent teeth under them.

Baby teeth are important!

 Most people think baby teeth are just going to fall out…they don’t give them much thought.

 Baby teeth hold the space for the permanent teeth until they erupt into the mouth.

 It’s not uncommon for parents to be concerned when their child does not lose their baby teeth on time.

While there is a typical pattern and time frame for teeth to erupt into the mouth, we begin to be concerned when a tooth/tooth goes beyond the estimated date and there is a delay in the natural loss pattern.

Dental development and eruption problems are more common than you think.

Take my daughter for instance did not get her first tooth until she was thirteen months.

Which delayed the loss of her first baby tooth?

She was in second grade before she lost her first tooth she asked almost every day when she was going to lose a tooth?

Losing you first tooth if a milestone. In Kindergarten there was a board with the names of kids that lost their first tooth. She did not get her name on the board. you can imagine her disappointment when everyone else was losing teeth except her.

With a Dad as a Dentist and a Mom as a hygienist it was hard to watch and not be able to do anything about it.

I just kept throwing out sayings:

“Good things come to those how wait.”

 “All in due time “

“This too shall pass “

It was not very comforting to her. She finally did lose one but not in the natural order. That is a story for a different blog post.

Missing teeth can be caused by a number of things including genetics, premature delivery, injury, infection and endocrine disorders.

There are several common reasons for what we called “retained” baby teeth, meaning it has overstayed it estimated loss date.

A dental x-ray and examination is needed to determine why the baby tooth is still present and not falling out (exfoliating). 

If there is no permanent tooth under the baby tooth, that baby tooth now becomes your permanent tooth.

 The dentist, patient and parent will then decide the best course of treatment, whether to extract the baby tooth or keep it/them as long as possible.

There are many short and long-term solutions available for consideration. 

If you decide to keep it,you will need to take very good care of it/them as baby teeth are not meant to last past the age if 14-15.

I have seen patients in their 50-60 with baby teeth still present and doing just fine.

If the tooth/teeth get a cavity and keeping them long term is not possible, there are options for replacement available.

 If you are missing a permanent tooth it is considered “congenitally missing” meaning they are not present from birth, however, some teeth that are missing are developmental and occur as a result of environmental factors or trauma during tooth development.

 Anodontia is a genetic or congenital(also known as hereditary) absence of one or several permanent teeth.

 The upper lateral incisors, lower second premolars and wisdom teeth are among the most often congenitally missing.

 Only about of 2% of the population have permanent lateral incisors that never develop.

 Excluding third molars, the reported prevalence of hypodontia ranges from 1.6 to 6.9% of the population.

 Sometimes when there are no permanent premolars the remaining baby tooth that remains becomes “ankylosed.”

 Tooth ankylosis is the fusing of cementum or dentine of a tooth root to the bone. 

 Ankylosis of teeth occurs more often in deciduous (baby) teeth than in permanent teeth.

 Ankylosis of primary molars have been found in 3.7% of adolescents.

 Mandibular primary first molars are ankylosed at an earlier age more frequently than any other tooth.

Below is a link to a great article on Ankylosis with pictures


Options of treatment for missing lateral incisors:

  1. Close the current spaces with orthodontics.
  2. Open the spaces and replace the lateral incisors after the orthodontic treatment by flipper, partial, bridges or implants (done by the general dentist).

Several considerations need to be kept in mind to choose the option of treatment and the patient (or his/her parents) is involved in this decision.

Consult with a general dentist to determine the best way to replace the teeth for your particular set of circumstances.

Replacement and treatment options will depend on age, space involved, location of missing teeth and budget.

If you have dental insurance, they will always pay for the cheapest option available or reduce your benefits. A pretreatment estimation can be sent in to help you make a decision that is right for you and you finances.

 If you choose dental implants to replace lateral incisors (or any other tooth), the position of the teeth on either side to the missing teeth, and their root(s) in particular, are very important to allow adequate positioning of the implant.

 If the roots are badly tipped or misaligned, the placement of a dental implant may be impossible.

 The orthodontist will work in collaboration with the general dentist or other specialists responsible for the placement of the implant (periodontist, maxillofacial surgeon) to position the teeth optimally to allow the placement of the implant so the General Dentist can than place a crown on it to look like the rest of the teeth in the mouth.

 A flipper is a temporary option for teenagers in the process of treatment, so they do not have to go without teeth.

 This is a great article with pictures to show options some available.


 There is so much information available on this subject, I recommend educating yourself on the subject, ask to allot of questions and speak to the specific dentist that is going to do the actual work.

 If you go for a second opinion, it is not uncommon to find differences in treatment options amongst dentists, there are many factors to consider before deciding on a treatment plan, such as cost, preserving bone, aesthetics, function and surrounding and opposing teeth.

 You will hear me repeat and emphasize the importance of regular dental check-ups.

Early diagnosis and intervention is an important part in creating a healthy dental future for you and your family.