Permanent tooth eruption is the process of tooth development which occurs over an approximate 7 year period, during which a child’s original baby teeth fall out and are replaced by the adult teeth. The primary (baby) teeth have usually emerged by the time a child is 3 years old, with 10 teeth residing in each jaw. During this time, these first teeth are acting as placeholders for the permanent teeth soon to come.
Permanent teeth typically begin erupting around age 6, although they may appear earlier or later, usually in correlation with when the baby teeth came in. Most of the permanent teeth begin to erupt several weeks after the corresponding baby teeth fall out; however, while there are 20 baby teeth, ultimately 32 permanent teeth will emerge (16 in each jaw). Twelve of these teeth do not replace baby teeth.
How Permanent Teeth Develop
Permanent teeth grow beneath the gums in the jawbone under the existing baby teeth. Over time, the root of each primary tooth begins to resorb (dissolve) and the crown, or top, of the incoming permanent tooth forms in the space where the root of the baby tooth breaks down.
The baby tooth then becomes loose as the permanent tooth continues to form, eventually pushing its way through the pathway left by the lost baby tooth. Because the jawbone grows faster than the rest of the face, it will eventually be able to accommodate 32 permanent teeth where the 20 baby teeth began.
Permanent Tooth Eruption Sequence
Permanent tooth eruption can begin as early as age 4 or as late as age 8. If your child experienced teething early, the permanent teeth will likely come early, as well. By the same token, late teething usually means late permanent tooth eruption.
Permanent teeth typically erupt in pairs, and often in a predictable order; however, if your child’s teeth do not follow the usual sequence, there is generally no need to be alarmed. Just like teething in babies, adult tooth eruption is different for each child.
The first permanent teeth to come in are the 6 year molars (first molars), sometimes called “extra” teeth because they do not replace baby teeth. The baby teeth that are acting as placeholders then typically fall out in the sequence in which they erupted, as they are replaced with their permanent counterparts.
Permanent Tooth Eruption Chart
- The 6 year, or first, molars erupt behind the baby teeth, with 2 appearing on the top and 2 on the bottom.
- The 4 central incisors (top 2 front teeth and top 2 bottom teeth) are usually the first teeth to become loose, fall out, and be replaced by permanent teeth. This often occurs around age 6-7.
- Next, the lateral incisors (the 4 teeth on either side of the top and bottom front teeth) will erupt, taking the place of those lost baby teeth. Lateral incisors typically begin erupting between the ages of 7-9.
- The 2 canine teeth, or cuspids, (the pointy teeth next to the lateral incisors) in the bottom jaw are next in the eruption sequence, followed by the 4 bicuspids which take the place of the first premolars. These all emerge between the ages of 9 and 12 in most cases.
- The top canine teeth (cuspids) and the second bicuspids, which replace the second premolars, arrive next, usually between age 10 and 12.
- The next set to come in are the second molars on the top then bottom. These “extra” teeth, which do not replace any primary teeth, are often called 12 year molars, as they typically erupt between 11 and 13 years of age. The second molars come in just behind the 6 year molars that were the first permanent teeth to appear.
In general, the first eight teeth to fall out (central and lateral incisors) do so in fairly quick succession, usually within a 2 year period from ages 6-8. This exodus is followed by an approximately 2 year dry spell with no tooth loss. The remaining 12 teeth tend to fall out between ages 10-13.
The entire permanent tooth eruption process takes about 7 years, during most of which your child will have a mixture of both permanent teeth and baby teeth (mixed dentition stage). When all the baby teeth are lost, the permanent dentition stage begins.
Keep in mind that there is no definitive age that applies to permanent tooth eruption. However, if your child loses a tooth and its permanent replacement has not emerged within 3 months, contact your pediatric dentist for an evaluation.
All the permanent teeth typically erupt by age 13, except for the third molars, or wisdom teeth which emerge a few years later.
Wisdom Tooth Eruption
The last permanent teeth to come in are the third molars, also called wisdom teeth. Most people do not get wisdom teeth until they are in their late teenage years or early twenties, with some people never having wisdom teeth erupt. Wisdom teeth sometimes need to be extracted before they erupt fully because the patient’s jaw does not have enough space and the teeth are at risk for becoming impacted.
Impacted wisdom teeth do not erupt because they are blocked by the existing teeth. Infection, inflammation, and damage from overcrowding can occur if left unaddressed. Your dentist will keep a watchful eye on your child’s wisdom teeth as they begin to develop.
Crowding of Permanent Teeth
Crowding of the permanent teeth occurs when the jaw does not have enough room to accommodate the incoming teeth. Crowding can be caused by:
- Early loss of baby teeth: When a baby tooth comes out too early, either from early childhood caries (baby bottle tooth decay), dental trauma (injury), or necessary extraction, the remaining adjacent teeth can shift into the space and cause the permanent tooth to be obstructed and erupt misaligned.
- Small jaw size: In some cases, the teeth are mismatched for the size of the patient’s jaw.
- Supernumerary teeth (hyperdontia): While multiple extra teeth rarely occur, it is not that uncommon for one extra permanent tooth to appear and affect the eruption of the other teeth.
The manner in which the teeth erupt is influenced greatly by heredity. If parents have straight teeth naturally, chances are greater that the child’s teeth will also come in straight. If overcrowded teeth run in the family, your child may also inherit crowding issues. Not to worry, crowding can be corrected with extraction and/or orthodontic treatment.
Visiting your dentist regularly and practicing good oral hygiene will help keep your child’s permanent teeth healthy and free of cavities (dental caries-tooth decay). If you have questions or concerns about the eruption of your child’s permanent teeth, please contact our office for an appointment.
If you have questions about your child’s Permanent Tooth Eruption, please contact Dr. Zarmin Lalani and her team at Discovery Kids Pediatric Dentistry Frisco, Texas, by completing an online appointment request or phone 469-365-5437.
Dr. Zarmin Lalani is a board certified pediatric dentist in Frisco dedicated to helping her patients develop and maintain good oral health habits that last a lifetime.