TIMING

By Dr. Alon Grosman

One of the most common anxieties parents share with us concerns the timing of the eruption of teeth. We are often asked: when are the first teeth scheduled to enter the mouth? Or which is “better” late vs. early erupting teeth? The truth of the matter is that although there are published milestones, there is still a normal variation/range that teeth may be expected to erupt. In terms of which is better, there is no real benefit for early or late eruption. However, extreme deviations may cause a practical challenge as we will discuss.

Let’s start with the primary (or “baby”) teeth. The first primary tooth to erupt is usually the lower central incisor between 5-8 months of age. The teeth will then follow the “rule of twos” which is that two additional teeth will erupt every two months until around 2-2.5 yrs old. There is a total of 20 primary teeth equally divided between upper and lower arches. After the eruption of the lower central incisors, we will see the eruption of the upper central incisors, the lower lateral incisors (as the name suggests, next to the central incisors) followed by the upper lateral incisors. The pattern will continue from the center laterally with the lower erupting earlier than the upper counterparts.

Premature eruption of primary teeth occurs in 1:2000. This can occur in two ways. “Natal” teeth are present at birth and “prenatal” teeth erupt in the first 30 days of life. When teeth erupt prematurely, it is important to consult with your healthcare provider (pediatrician or pediatric dentist) as strategies for feeding will need to be addressed, especially if breastfeeding is planned. There are also structures that are present at birth that resembles premature teeth but are not actually the primary teeth. One of the most common examples of this is “Epstein pearls”. They are visible cysts located in the upper arch in the front close to where the primary teeth are expected to be positioned. There is no treatment recommended for this as long as there is no interference with feeding and no observed discomfort for the child.

As with all published milestones, it is important to acknowledge the fact that these are just averages and that “normal” has a range. We find variation in gender, with females being ahead of males. It is also important to note that deviations in one area may have no bearing on others. For example, there are many children who are either “ahead” or “behind” in dental development but are at the opposite ends of the spectrum in skeletal growth. They do, however, give us an idea of what to plan for and some guidance on timing of interventional treatment, whether dental or orthodontic, when indicated.

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