For children aged 5 to 6 years old, the process of teeth replacement is more important than having piano lessons and excelling in mathematics. The newly emerged permanent teeth will accompany them for the rest of their lives and this would influent your child’s diet, appearance and psychology. Proper dental care is important to ensure that your child has a full set of healthy and nice teeth. Therefore parental supervision is necessary in keeping your child’s teeth healthy and clean.

Recently I met a child patient that is frequently upset by the process of changing teeth. She keeps asking her mother why she had to go to the dentist to get her tooth extracted so often. Everyone has to go through the process of changing teeth. When we become parents, we can appreciate more what our kids have to undergo. The eruption of permanent teeth has a sequence. Normally permanent teeth erupt on either side of the jaw in pairs (le and right). Lower teeth will erupt earlier than upper teeth. Permanent teeth erupt faster in girls compared to boys.

First permanent tooth at 6 years old

Baby teeth start to erupt into the oral cavity when the baby is 5 to 6 months old. The baby will gain a full set of 20 baby teeth at the age of 2 to 3 years old. Baby teeth will be slowly replaced by permanent teeth between the ages of 6 to 13.The most common tooth to be neglected by parents is the rst permanent tooth (6 years tooth).

The first permanent tooth is a molar that will erupt at the age of 6. Parents o en mistaken this early erupted permanent molar as part of the baby teeth and there’s substitute after extraction. So when they turn up in dental clinic asking for removal of this molar they are often surprised by the fact that this is actually a permanent tooth. Moreover, children at 6 years old do not have the ability to brush their teeth properly. Most of them still drink milk and often being bottle fed to sleep. This will lead to baby bottle tooth decay. Therefore, parents need to give more attention on to this first permanent molar before the anterior baby teeth start to fall out.

Most frequently asked questions:

1. Why there is no substitution after a baby tooth has fallen out for such a long me?

A primary school standard one child may start to have loosened teeth. When the loose tooth falls out, you may be able to see the edge of permanent tooth that is going to erupt inside the wound. It is normal if you only spot the permanent tooth weeks after extraction. If you do not see a permanent tooth erupting after several months of tooth falling out then it is better to bring your child to see the dentist.

Normally, dentist will take an x-ray examination for your child. If there is no permanent tooth bud underneath the tooth fallen out spot, this shows that your child is having congenitally missing tooth. There will be no substitution to replace the toothless spot. If there is permanent tooth bud, delayed eruption on may be due to excessive thick and hard gums covering the permanent tooth causing it difficult to emerge through the gums.

Gingivectomy is one of the most common procedures performed to deal with gum tissue that is excessive. It is performed by cu ng the excessive gums away to allow the smooth eruption on of the permanent tooth. There are also situations where the child has extra tooth which is more than the supposed numbers of permanent teeth. This extra tooth (supernumerary) often locates itself in between upper milk incisors disrupting the eruption  of permanent tooth. In this case, the supernumerary has to be extracted to allow the  eruption of permanent tooth.

At times, milk teeth fall out or being extracted too early while the permanent tooth bud is not fully developed yet. This will cause delay in eruption of the permanent teeth. When milk tooth is extracted too early, the missing tooth changes the balanced position of adjacent teeth. This causes adjacent teeth to lose support and slowly lean towards the gap of missing tooth. As a result, there will be no sufficient space for the permanent tooth to erupt.

2. Why is there an extra tooth erup ng from the outer or inner part of the milk tooth?

If the position of permanent tooth bud is not exactly below the milk tooth, the root of the milk tooth will not be dissolved and the milk tooth will not fall out. This forms crowding of milk teeth and permanent teeth. The parents should bring their child for tooth extraction if this situation occurs. The doctor might give the child local anesthetic because the root of the milk tooth is still quite long. Frequently, the permanent tooth will grow to its proper position after the milk tooth is extracted.