I recently polled my TikTok and Instagram followers and asked them what topics they wanted me to cover that I haven’t yet, and I was shocked to hear from people, repeatedly, “loose baby teeth and loose tooth pain.” This resonated with me because my eldest is going through the process of losing his top two front teeth right now and he’s actually having a harder time than I expected, but because of my training as a pediatric dentist, I know how best to help him through and when and if I need to intervene. I can see, though, how as a parent without a lot of dental experience, the process of your child losing a tooth can be overwhelming, especially if they are sensitive and anxious about the process.
Two Types of Loose Tooth Kids: Never Let Go or Rip It Out
I joke sometimes that there are two types of kids with loose teeth, first are the ones who wiggle out their tooth as soon as it gets the least bit loose because they can’t stand the feeling of it being loose and/or they’re ready for their CASH MONEY. The second ones are like my son, they end up eating half their teeth with breakfast or swallowing it while they sleep because they won’t let anyone touch it and it just dangles there for months and months. So let that be my first bit of advice – it’s okay if they swallow their tooth. As long as they didn’t inhale it (aspirate it to the lungs) which is incredibly rare – you’d notice a cough, a fever, or some obvious signs of trouble within a few days – then you’re fine. I tell those kids the tooth fairy takes IOUs, all they have to do is leave a note and explain what happened.
Parents are primarily concerned about the last type of child who holds on to their teeth for ages beyond what seems necessary. Although sometimes parents worry that the over-eager tooth-pulling kid might do some damage, I reassure them that if their child was able to wiggle it out with their finger, it was loose enough and ready to go. Let them cash in that tooth without the guilt! Maybe they’re a future dentist!
But for the second child, the primary worries I hear are:
1. Will it harm their permanent teeth if they leave it in too long?
2. Can they get a gum infection – there seems to be a lot of bleeding? and
3. They’re in pain and bothered by the tooth, should I bring them to the dentist to have them look?
I’ll walk you through these and try to ease your mind.
First, can a loose tooth they keep around for too long harm their permanent teeth?
The biggest impact an over-retained baby tooth can have on the permanent tooth coming in is that it may cause the permanent tooth to erupt, or come in, out of position. You notice this most often with the back baby molars – the premolar will start to break through the gums above the baby tooth and deviate to the lip or cheek side. Sometimes this can end up wedging the baby tooth making it challenging for the child to get out on their own, so this is a case when a dentist will typically monitor for a brief period to see if a Laffy Taffy can assist in extracting the tooth at home along with some good “pinch and twist” wiggles, and if not, they’ll schedule to have the child in to have the tooth extracted by the dentist. These extractions are often very quick and easy because the tooth has little root left to hold it in. Once the baby tooth is out, the permanent tooth corrects its course and shifts back to position. This often happens in children with very crowded teeth, not just children who don’t like to wiggle their teeth, and it could be a sign that braces may be needed to ultimately align all the teeth in the future.
Next, can an over-retained baby tooth lead to a gum infection?
Anything is possible, but usually, as long as the child is able to brush and keep the area clean, nothing more than gingivitis arises. That means they may have some tenderness there and a burning or itchy feeling accompanied by bleeding when they brush or touch the area, but it’s nothing that won’t quickly resolve once the tooth comes out. Should this loose tooth limit the child's normal daily activities, though, like eating and drinking or brushing, it’s best not to let it persist beyond a week or two, as leaving food debris and plaque in that area could ultimately lead to an abscess or even early cavities on the surrounding baby teeth or the erupting permanent tooth. My rule of thumb is two weeks, if they remain unsuccessful at wiggling the tooth out on their own and they’re refusing to brush the area or to eat on that side, you may want to involve a dentist to at least evaluate the tooth and then consider having them help remove the tooth.
Lastly, if they’re experiencing loose tooth pain or discomfort, how do I know when to see the dentist?
Perhaps they bite on it funny, and it bleeds a little, and they run to the mirror screaming and crying, but they refuse to let you touch it. When do you need to call in backup AKA the dentist? This is where it gets tricky. Here’s the most important thing you can do – stay calm and try not to react to their high emotional state. Staying calm will help them see that you’re not concerned and that losing teeth is a normal, albeit weird, thing and not a big deal. You’ve been through it at least 20 times, and you’re confident they can do it too. You’re there to serve as their wise, experienced, and knowledgeable guide to help them through this new process.
So please please, don’t “threaten” the child that you’ll take them to the dentist to pull the tooth out if they keep screaming about it every time they eat. What you want to do is try to have a conversation about losing teeth, that it’s a natural thing every kid goes through where the root holding the baby tooth in the bone is ‘eaten away’ by the growing permanent tooth that’s moving up to replace it so that all that’s left is the top of the tooth, and that is why it’s loose! Talk about the exciting things that happen with losing teeth – getting new big kid teeth and getting a visit from the tooth fairy. Regardless of their feelings, validate them. “I can see you’re worried about your tooth being loose and it’s a little uncomfortable, I remember feeling that way, too,” and assure them that you’ll help them through.
Ultimately you’ll encourage them to either work more to wiggle it out themselves (using a dry gauze or washcloth to grip the tooth and then TWISTING it in a circle), or to let you help (if you want to), or to visit the dentist to have them take a look and see what they think. If they want help wiggling the tooth, the dentist can apply a numbing jelly to be sure they’re comfortable, and they can get the tooth out in a matter of seconds! They’ll probably even give them a super cool container to bring their tooth home in and leave it for the tooth fairy. Assure them that you and the dentist both want to help them feel comfortable and if the tooth is really bothering them to the point that they worry about it all day and can’t play, eat, drink, or talk like normal – they should go in for a visit!
I hope this eases your mind about your child losing their teeth and gives you some guidance about how to help them through this process. I love the above comic by Nathan Pyle because it touches on our kids’ experience – losing your teeth really is a little bit horrifying. We have to assure them that it’s normal and we’re right there to support and guide them through. You’ve got this!
