My Child’s Adult Tooth Is Coming In Behind a Baby Tooth — What Should I Do?

You look inside your child’s mouth and see something unexpected: a permanent tooth is coming in behind a baby tooth that hasn’t fallen out yet.

This can happen as children transition from baby teeth to permanent teeth, particularly around the lower front teeth. It does not automatically mean something is seriously wrong or that the baby tooth must be pulled.

What happens next depends on how loose the baby tooth is, where the permanent tooth is erupting and whether there appears to be enough room for the developing teeth.

Why Is the Adult Tooth Coming In Behind the Baby Tooth?

Normally, as a permanent tooth develops and erupts, the root of the baby tooth is gradually resorbed. The baby tooth becomes loose and eventually falls out.

Sometimes the permanent tooth follows a slightly different eruption path and begins appearing behind the baby tooth before the baby tooth has come out.

Parents sometimes describe the appearance as a “double row of teeth” because both the baby tooth and permanent tooth can be visible at the same time.

Does the Baby Tooth Need to Be Pulled?

Not necessarily.

If the baby tooth is already loose and continues loosening, it may fall out on its own. Once the baby tooth is gone, the permanent tooth’s position may change as the mouth continues to develop.

But if the baby tooth remains firmly in place, does not appear to be progressing toward falling out, or the permanent tooth’s position is concerning, your dentist may recommend an examination to determine whether anything needs to be done.

Whether a baby tooth should be removed is an individual dental decision — not something that can be determined simply because a permanent tooth is visible behind it.

Should I Pull the Baby Tooth at Home?

If a baby tooth is naturally very loose, many children wiggle it until it eventually comes out on its own.

Do not forcefully remove a tooth that is still firmly attached. If you are unsure whether the tooth is ready to come out, let your dentist evaluate it rather than trying to remove it yourself.

Will the Adult Tooth Stay Behind the Other Teeth?

Not necessarily.

The position of newly erupting permanent teeth can change as baby teeth are lost, additional permanent teeth erupt and the mouth continues to grow.

However, whether a tooth will move into a better position depends partly on the amount of available space and your child’s overall dental development.

If there is significant crowding or the permanent tooth continues erupting in an unusual position, your dentist can determine whether continued monitoring or an orthodontic evaluation may be appropriate.

Read
Is It Normal for My Child’s Permanent Teeth to Come In Crooked?

When Should I Call the Dentist?

If you notice an adult tooth erupting behind a baby tooth, it is reasonable to mention it to your child’s dentist.

Consider having it evaluated sooner if:

You do not need to figure out the cause yourself. A dental examination can help determine whether the teeth should simply be watched or whether intervention is appropriate.

Will My Child Need Dental X-Rays?

Not automatically.

The dentist may be able to learn a great deal by examining the teeth directly. Dental X-rays may be recommended when additional information about tooth development, position or other structures is clinically useful.

The decision should be based on what information is needed for your individual child rather than taking X-rays simply because two teeth are visible at once.

Read
Does My Child Need Dental X-Rays? Are They Safe?

Could My Child Eventually Need Orthodontic Treatment?

Seeing a permanent tooth behind a baby tooth does not automatically mean your child will need braces.

The dentist will be more interested in the bigger picture: available space, tooth position, how other permanent teeth are erupting and how your child’s bite and jaws are developing.

If there are signs of crowding or another developing orthodontic concern, an orthodontic evaluation may be recommended.

Read
When Should My Child Have an Orthodontic Evaluation?

Keep an Eye on It — But Don’t Guess

A permanent tooth appearing behind a baby tooth can look much more alarming than it ultimately turns out to be.

If the baby tooth is loose, the situation may change naturally as that tooth falls out. But if the baby tooth remains firmly in place or you are concerned about where the permanent tooth is erupting, have your dentist take a look.

The goal is simple: determine whether your child’s teeth are progressing normally or whether something needs attention.

Children’s Dental Care Near Beaverton

Cedar Hills Dental Care provides family dentistry for children and adults near Beaverton. Our practice has served the community since 1986 and has cared for more than 10,000 smiles.

Christine Chin, DMD brings more than 35 years of dental experience and is an Oregon Health & Science University-educated dentist. Regular dental visits give us an opportunity to follow how your child’s baby teeth are being lost and permanent teeth are developing.

If you notice a permanent tooth coming in behind a baby tooth, call us if you are concerned. We can evaluate what is happening and discuss whether the tooth simply needs monitoring or whether another step may be appropriate.

Learn more about our
Dental Care for Children
and our growing collection of resources for parents.

Further Reading for Parents

If you have questions about your child’s permanent teeth and dental development, these Cedar Hills Dental Care articles may also help:

• Is It Normal for My Child’s Permanent Teeth to Come In Crooked?
• When Should My Child Have an Orthodontic Evaluation?
• Does My Child Need Dental X-Rays? Are They Safe?
• How Often Should Kids Go to the Dentist?
• Dental Care for Children: Prevention, Development & Lifelong Oral Health