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Children's teeth

"My tooth is loose!"

Those words represent a big milestone in your child's life. Baby teeth have to fall out to make way for permanent teeth to grow — a process that lasts six or more years from start to finish.

Most kids are excited to feel a tooth wiggle (and perhaps get a visit from the tooth fairy), while some worry about whether it will hurt when it falls out. If your child is a worrier, you can reassure him that he probably won't feel anything.

First in, first out

A child's 20 baby teeth, which typically come in by age 3, usually fall out in the order in which they came in.
That means the lower centre teeth (lower centre incisors) are usually the first to go, around age 5 or 6. The top centre pair is next. A baby tooth typically doesn't loosen until the permanent tooth below pushes it up to take its place.

Some children lose their first tooth as early as 4 or as late as 7. Generally, the younger the child was when the teeth came in, the earlier they fall out.

It's also possible for a child to reach 7 or 8 without losing any baby teeth. In such cases, there's probably nothing wrong, but it's a good idea to consult a dentist for X-rays to assess the situation.

Out with the old

Encourage your child to gently wiggle a wobbler. Some loose teeth can actually be rotated because the root underneath has almost completely disintegrated.

But remind your child not to pull a tooth before it's ready to fall out on its own because it makes the broken root more vulnerable to infection. A loose tooth that refuses to come out may need to be extracted by a dentist, though this is hardly ever necessary.

Losing baby teeth is seldom as painful a process as teething. If your 5- or 6-year-old complains of pain in the back of his mouth, it's probably the 6-year molars coming in. (He has no baby teeth there to fall out first). A painkiller formulated for children can ease the ache, though it's unlikely to last long.

In with the new

The new teeth may look bigger, especially those first few. That's because they are! Adult teeth also tend to be less white than baby teeth and have pronounced ridges because they haven't been used yet for biting and chewing.

Sometimes, not often, a couple of new teeth come in before the old ones are gone, creating two rows of pearly whites. This is a temporary stage, sometimes called shark's teeth.

Brushing is now more important than ever. You'll probably need to supervise the process until your child is around 8, and until then he won't need to use more than a pencil-eraser-size dot of toothpaste. Some doctors recommend using toothpaste without fluoride until the child can spit, if tap water contains enough fluoride.

Replace toothbrushes every two or three months to reduce harmful bacteria and keep them working at their best. And make sure your child sees a dentist twice a year or however often the dentist recommends.

Most kids lose their last baby teeth around age 12 or 13, about the time the 12-year molars appear.