A baby's teeth begin to erupt from the age of about 4 to 6 months. By the time he is 3 years old or so, your child will have all 20 of his primary, or baby, teeth in his mouth. Rarely, a baby can be born with natal teeth or teeth that are already present at birth.
Normal Eruption TImes
Generally, lower teeth appear in the mouth before the upper counterparts. For primary teeth, the pattern of eruption is generally central incisors followed by the laterals, then the first molars, then canines and lastly the second molars. Teeth appear in left and right pairs. Girls tend to precede boys, but this is not a rule. By the time your child is 18 months old, 12 teeth would have erupted. All 20 teeth should have appeared by the time your child is approximately 3 years old.
The time it takes for a tooth to go from just being a palpable bump on your baby's gums to being fully erupted is 2 months.
There is wide variation in the timing and pattern of eruption. A dentist can monitor tooth eruption as your child grows.
Causes
Tooth eruption can be delayed due to local or systemic factors. Local factors like a physical obstruction from scar tissue or excess tissue or the presence of extra, or supernumerary, teeth blocking the eruption can lead to a delay. Trauma to the mouth and inadequate space are other local causes. These local factors often affect the eruption of anywhere from one to several teeth in the mouth.
Severe nutritional deficiency, radiation in the head and neck area, certain metabolic conditions, endocrine disorders like thyroid problems, perinatal HIV infection, severe anemia or certain genetic disorders like cleidocranial dysostosis can also cause delayed eruption. These are all generalized and several or all teeth are usually affected.
Low birth weight or preterm babies have also been shown to show delayed eruption of teeth.
Consequences
Late eruption can cause functional, aesthetic and nutritional problems. Large gaps due to absent teeth can make speech and eating difficult. A delay in a few teeth coming in also means that the teeth that are already present will start to move into those spaces and cause crowding. This leads to a problem with your child's bite and is termed malocclusion. This can, in turn, lead to speech and feeding problems. When the bite is uncomfortable and the teeth do not fit in as they should with each other, the muscles around the mouth begin to hurt and cause joint discomfort in the jaw.
Treatment
Treatment of delayed eruption depends on whether the delay is due to a systemic condition or if it is due to local factors. Local factors can usually be dealt with by a team composed of the general dentist, orthodontist, periodontist and oral surgeon. There are several options such as space maintainers, space-regaining appliances, placement of braces or even surgery to expose the underlying tooth and promote its eruption, among others. The dentist will decide which option is best for your child based on his individual needs, age, growth and developmental stage, while keeping in mind your concerns and requirements.
If it is systemic, your child's endocrinologist or other specialists will have to be consulted, and treatment will have to be a concerted effort. The disease or condition will have to be managed and brought under control, along with any dental intervention.
If you have any concerns about the growth and development of your child's teeth and jaws, call your dentist. Visit the dentist when your child's first tooth erupts or at least by his first birthday, so that the dentist can examine and monitor your child's teeth and mouth.
