One of the questions we hear most often from parents is: "What happens if a baby tooth doesn't fall out?" Usually a parent spots a second row of teeth behind their child's lower front teeth, or notices that classmates are losing teeth while their own child's teeth are not even wobbly. The good news is that most of these situations are normal and sort themselves out. Some signs, however, can point to a problem beneath the baby tooth. This article explains when waiting is enough, when to see a paediatric dentist, and what the treatment options are.
How and When Do Baby Teeth Normally Fall Out?
The permanent tooth develops in the jawbone beneath the baby tooth. As it gets ready to come in, it gradually dissolves the baby tooth's root. With a shorter root, the baby tooth becomes loose, eventually falls out, and the permanent tooth takes its place. The process usually starts around age 6 and continues until about 12-13.
Approximate ages at which baby teeth are lost:
| Baby tooth | Approximate age lost |
|---|---|
| Central incisors (two front teeth) | 6-8 years |
| Lateral incisors | 7-9 years |
| First baby molars | 9-11 years |
| Canines | 9-12 years |
| Second baby molars | 10-12 years |
These ages are averages. Girls tend to start losing teeth a little earlier than boys, and being a few months ahead of or behind classmates is usually not a concern. What matters most is that teeth change in the expected order and at roughly the same time on the left and right sides.
The Most Common Case: The Adult Tooth Comes In Behind the Baby Tooth
Especially with the lower front teeth, it is very common for the permanent tooth to come in behind the baby tooth (on the tongue side) before the baby tooth has fallen out. Parents often call this a "double row of teeth" or "shark teeth". It can look worrying, but in most children the baby tooth soon becomes loose and falls out on its own. The tongue then gradually pushes the permanent tooth forward into place.
If the baby tooth does not start to loosen within a few weeks, if your child finds eating uncomfortable, or if the gum looks inflamed, have a paediatric dentist take a look. Removing the baby tooth is usually a quick, simple procedure that makes room for the permanent tooth to move into the right position.
When Should You See a Dentist About a Baby Tooth That Won't Fall Out?
We recommend booking an exam if you notice any of the following:
- The permanent tooth has come in behind or beside the baby tooth, but the baby tooth is still not loose after a few weeks
- A tooth on one side fell out more than 6 months ago, but the same tooth on the other side is not loose at all
- The baby tooth sits lower than its neighbours, as if it is sinking into the gum
- A baby tooth fell out months ago and no permanent tooth has appeared
- Your child is 13-14 and still has baby teeth
- There is pain, swelling or bleeding around the baby tooth
Why Doesn't a Baby Tooth Fall Out?
1. The Permanent Tooth Is Missing (Congenitally Missing Teeth)
In some children, no permanent tooth develops under the baby tooth. With no permanent tooth to dissolve its root, the baby tooth does not loosen and can stay in the mouth for many years. Apart from wisdom teeth, the teeth most often missing are the lower second premolars and the upper lateral incisors. Missing teeth can run in families, so parents or siblings may have the same pattern.
2. Ankylosis: The Baby Tooth Fuses to the Bone
In ankylosis, the root of the baby tooth fuses with the jawbone. The tooth does not loosen, and as the jaw keeps growing it ends up below the level of the neighbouring teeth, so it looks as if it is sinking into the gum. It is most common in baby molars. Mild cases can be monitored; if it progresses, neighbouring teeth can tip into the space, the opposing tooth can over-erupt and the permanent tooth may struggle to come through.
3. The Permanent Tooth Is Out of Position or Late
If the permanent tooth is developing at an unusual angle, there is not enough space in the jaw, or its development is delayed, it may not dissolve the baby tooth's root as expected. This is most common with the canines. Caught early, removing the baby tooth at the right time can help the permanent tooth correct its own path.
4. An Extra Tooth or Another Obstruction
Rarely, an extra tooth (supernumerary tooth), a small mass of tooth tissue or a cyst blocks the permanent tooth's path. These cannot be seen in the mouth but show up on an X-ray.
5. Less Common Causes
Baby teeth that were injured earlier or had root treatment sometimes do not resorb at the usual pace. If all of a child's teeth are clearly late, the dentist may suggest checking with your paediatrician for hormonal or general developmental causes.
What Happens If a Baby Tooth Doesn't Fall Out? Possible Consequences
If there is a permanent tooth beneath it and the baby tooth stays too long, these problems can follow:
- The permanent tooth comes in out of place: it may come in in front of or behind the baby tooth, causing crowding or a crossbite.
- The permanent tooth becomes impacted: with its path blocked, it can get stuck in the bone.
- Harder cleaning: food collects between the double row of teeth, raising the risk of decay and gum inflammation.
- Lost space and midline shift: teeth can tip into the gap and the centre line of the front teeth can drift.
If there is no permanent tooth beneath it, things are different: a healthy, well-placed baby tooth can keep working for many years, even into adulthood. The aim is then to keep it for as long as possible and review the plan together as the child grows.
Diagnosis: Why Is an X-Ray Needed?
You cannot tell why a baby tooth hasn't fallen out just by looking in the mouth. After the exam the dentist usually asks for a panoramic X-ray or a small dental film, which shows:
- Whether there is a permanent tooth under the baby tooth
- The permanent tooth's position, angle and stage of development
- How much of the baby tooth's root has dissolved
- Whether anything is blocking the permanent tooth's path
The radiation dose from digital dental X-rays is very low, and X-rays are taken only when needed.
Treatment Options
Treatment is planned individually, based on the X-ray findings and the child's age. The main options are:
| Situation | Likely approach |
|---|---|
| Permanent tooth on its way, baby tooth not loose for only a short time | Wait and monitor with regular check-ups |
| Permanent tooth has come in behind or beside it, baby tooth still firm | Remove the baby tooth |
| Baby tooth removed early, permanent tooth still a long way off | Space maintainer |
| No permanent tooth, baby tooth healthy | Keep the baby tooth and monitor it |
| Permanent tooth out of position or impacted | Orthodontic assessment, with surgical support if needed |
In children, removing a baby tooth is usually a few minutes' procedure under local anaesthetic. When a baby tooth is lost early, space maintainers and preventive orthodontic treatment can keep the gap open. For children with a missing permanent tooth, the baby tooth is kept as long as possible; if it is eventually lost, options such as an implant, a bridge or orthodontic space closure are considered once growth is complete. You can read more about baby tooth treatments on our treatment page.
What You Can Do at Home
- It is fine for your child to wiggle a loose tooth gently with their tongue or a clean finger.
- Don't try to pull out a baby tooth that isn't loose with string, a door or similar tricks. It can cause pain, damage the gum and make your child afraid of the dentist.
- Brush the area with the double row of teeth extra carefully; trapped food can inflame the gum.
- Note which tooth fell out and when. It helps the dentist at the exam.
Frequently Asked Questions
Will a baby tooth that hasn't fallen out come out on its own?
When the permanent tooth comes in behind it, the baby tooth usually loosens and falls out on its own within a few weeks. If it is not loose, or there is no permanent tooth beneath it, it may not fall out by itself; an exam and an X-ray are then needed.
The adult tooth came in behind: should the baby tooth be removed?
If the baby tooth is loose, waiting is usually enough. If it has not started to loosen within a few weeks, removing it may be recommended so the permanent tooth can move into place. A paediatric dentist makes the decision.
Does removing a baby tooth hurt?
Before the extraction a numbing gel is put on the gum, followed by a local anaesthetic, so the child feels no pain during the procedure. Paediatric dentists use behaviour management techniques to prepare the child beforehand.
How long can a baby tooth last with no adult tooth underneath?
It varies. A healthy, well-placed baby tooth can last many years into adulthood. It is monitored at regular check-ups, and if it is lost, a permanent solution is planned once growth is complete.
Will my child need braces if a baby tooth doesn't fall out?
Not always. If the baby tooth is removed in time, the permanent tooth often settles into place by itself. Orthodontic treatment may be needed if the permanent tooth is impacted, there is not enough space, or the teeth have shifted noticeably.
At what age is it unusual to still have baby teeth?
The last baby teeth usually fall out around 12-13. If your child still has baby teeth after 13-14, or there is more than 6 months' difference between the left and right sides, see a paediatric dentist.
Book an Appointment at DUODENT
If your child's baby tooth isn't falling out or an adult tooth is coming in behind it, our paediatric dentists at our Atasehir, Istanbul clinic will assess it with an exam and, if needed, an X-ray. To book, use our contact page, call 0216 766 73 86 or message us on WhatsApp at +90 505 766 73 86. Read why baby teeth need treatment in what happens if baby teeth are left untreated, and about tooth and jaw alignment problems in orthodontics for children. Learn more about the author, Dt. Selena Su Denizer, on the profile page.
This article is for general information only and is not medical advice. Please consult a paediatric dentist about your child's oral health.