Baby Teeth: What to Worry About (and What Not To)

What's usually fine

Spaces between baby teeth

Good sign — suggests room for the adult teeth. No action needed.

Teeth that erupt slightly out of line

Baby teeth don't need to be straight. Many straighten themselves as the jaw grows.

Delayed eruption by 3–6 months

Variation is wide. Some children get their first tooth at 4 months, others at 14 months. Both are normal.

Grinding at night

Common in children up to age 6 or 7. Usually resolves without treatment. Mention at check-ups but no nightguard needed typically.

Smooth white flecks present since the tooth came through

Often developmental, such as mild fluorosis or enamel hypoplasia, and usually cosmetic. Chalky white patches along the gumline are different: they can be the first sign of decay (see baby bottle tooth decay below), so point out any white marks at the next check-up.

What to see a dentist about

Brown, yellow, or black spots on teeth

Early decay needs prompt attention. Decay in a baby tooth can progress quickly and affect the adult tooth below.

Pus, swelling, or a pimple on the gum near a tooth

Sign of infection. Always needs evaluation.

Chipped front tooth after a fall

An x-ray may be needed to check for damage to the developing adult tooth above. Our guide to toddler dental accidents covers first aid.

Late eruption past 14–16 months

Worth an x-ray to rule out missing or impacted teeth.

Teeth erupting very crooked with jaw asymmetry

An orthodontic check around age 7 is commonly recommended; visible jaw asymmetry is worth raising sooner. See your child's first orthodontic visit.

Bleeding gums that don't settle

Usually a sign of gum inflammation from plaque along the gumline. If bleeding continues after a week or two of careful twice-daily brushing, have it checked.

Baby bottle tooth decay

Baby bottle tooth decay happens when milk, formula, juice or any sweetened drink pools around the teeth during sleep. Bacteria feed on the sugar for hours, and decay can form rapidly, usually on the upper front teeth first. Early signs are chalky white spots near the gumline, followed by brown discolouration, visible holes and pain on eating.

Prevention is simple: only water in a night-time bottle, stop bottles altogether by 15 to 18 months, wipe or brush the teeth after the last feed, and avoid sippy cups of juice through the day. If decay has already started, early lesions can be halted with fluoride treatment; established cavities need fillings, heavily damaged baby molars may need stainless steel crowns, and extraction is reserved for teeth that cannot be saved. Our children's dentistry page explains these treatments.

The myths

"Baby teeth don't matter because they fall out." False. Premature loss affects jaw development, adult tooth eruption, speech, and self-esteem.

"My child is too young for x-rays." Not necessarily. Bitewing x-rays can be taken safely from age 4–5 if clinically needed, and digital x-rays use less radiation than older film.

"Fluoride is dangerous for children." Disproven. All major health bodies recommend age-appropriate fluoride toothpaste from first tooth; see is fluoride safe for children?

Thumb sucking

• Normal and common until age 4
• After age 5, can start to affect how the teeth and jaws develop
• Gentle behavioural approaches first; habit-breaking appliances reserved for persistent cases after 6

More in thumb sucking: when does it become a problem?

When to start check-ups

• By age 1 (see your child's first dental visit)
• Every 6 months thereafter
• More often if cavity risk is high (genetics, dietary patterns)

Common questions

Can baby teeth get cavities?

Yes, and decay can progress quickly in baby teeth. They matter more than many parents expect: they hold space for the adult teeth, and an infected baby tooth can affect the adult tooth developing beneath it. Small cavities are usually treated with fillings and more extensive decay with a crown. Extraction is generally reserved for a tooth that can't be saved, because losing a baby tooth early affects the space its successor needs.

Which teething symptoms are normal, and which are not?

The first tooth usually arrives around 6 months. Normal teething causes increased drooling, chewing on objects, mild fussiness, disrupted sleep and red gums. It does not cause high fever over 38°C, diarrhoea, a rash beyond the drool area or genuine illness; those signs need a doctor rather than being blamed on teeth. Cold teething rings, firm rubber toys and gentle gum massage help, and a sugar-free paracetamol suitable for the child's age can be used on a doctor's or pharmacist's advice (never aspirin). Avoid benzocaine teething gels in children under two and amber teething necklaces, which are a choking and strangulation risk.

When should baby teeth fall out?

Baby teeth are lost in roughly the order they arrived. The lower central incisors go first, typically around age 6 to 7, followed by the upper centrals. The baby molars are the last to go, usually between 10 and 12, and most children have completed the exchange by 12 to 13. Wide variation is normal, so a child who is a year ahead or behind these ages is rarely a concern. If a tooth is very late, or an adult tooth appears while the baby tooth is still firm, ask at the next check-up.

What if a baby tooth won't fall out?

A baby tooth that stays put past the expected age usually needs a dentist to check what is happening underneath. An x-ray is essential: it shows whether the adult tooth is present, where it is heading, and whether the retained baby tooth is blocking its path. If the adult tooth is erupting behind or beside it, the baby tooth is often extracted to let the adult tooth move into place. This is uncommon but straightforward to manage once identified.

Does my child's tongue tie need treatment?

Tongue tie ranges from mild to restrictive, and whether it needs treatment depends on what it is affecting. In babies the main concern is feeding difficulty, in toddlers it can contribute to speech delay, and in older children it can make oral hygiene harder or cause self-consciousness. Many mild cases need no treatment. When release is recommended, the usual procedure is a frenectomy, a quick release of the band of tissue under the tongue with sterile scissors or a laser, and recovery is usually quick. Assessment is by a dentist or a doctor, such as an ENT surgeon, who weighs the functional impact before recommending anything.

Practical decision guide

Children's dental care is about preventing disease early, building trust, and timing growth-related decisions before they become harder to treat. Parent routines matter more than any single product.

Check this first

• Age, eruption stage, brushing supervision, fluoride exposure, sugar frequency, thumb sucking, mouth breathing, trauma risk, and family cavity history.
• Whether the child needs prevention only, sealants, fluoride varnish, orthodontic screening, or treatment for active decay.
• Whether the child can tolerate routine visits or needs sensory, behavioural, or sedation planning.

When to book sooner

• A baby tooth is painful, brown, swollen, fractured, knocked loose, or associated with a gum pimple.
• A permanent tooth is knocked out, chipped, delayed, crowded, or erupting behind a baby tooth.
• A child has facial swelling, fever, or avoids eating because of dental pain.

Topic-specific notes

• For children, prevention depends on age-appropriate fluoride, supervised brushing, sugar-frequency control, sealants when indicated, and early visits that make dental care normal rather than frightening.

Questions to ask at the appointment

• Is my child's fluoride amount correct for their age and ability to spit?
• Do the first permanent molars need sealants?
• Should we screen orthodontics now or simply monitor growth?

Dubai patient note

For families in Dubai, choose a clinic that can handle prevention, behaviour, emergencies, and orthodontic referral under one plan, so children are not bounced between providers late.

References

• American Academy of Pediatric Dentistry
• NHS — Children's oral health