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What if My Child's Permanent Tooth is Growing Behind Another?

Have you ever heard the term "shark tooth" when speaking of a child's mouth? This occurs when the permanent adult tooth erupts behind the baby tooth and does not loosen it. In most children's mouths, the permanent tooth comes in from behind the baby tooth, absorbing the baby tooth's roots, loosening the baby tooth, and eventually causing it to drop out. The permanent tooth takes over the space of the baby tooth and continues to grow. When the root does not get absorbed, both the baby and the permanent tooth remain. This causes the "shark tooth" appearance, or two rows of teeth as in a shark, and may seem a little strange when first discovered. Actually, this occurrence is quite common and rarely causes dental problems when cared for properly.

Baby Teeth and Permanent Teeth

So, what is the difference you ask? Baby teeth look more bright white than the more ivory color of permanent teeth. Baby teeth are smooth, whereas the permanent teeth have a jagged ridge that helps them push through the surface of the gums.

Did you know that a child's permanent teeth, also called secondary teeth or adult teeth, begin to develop at birth? They are present (under the gums) when they are born and erupt as the baby teeth start to fall out. They can also come in earlier than expected if a baby tooth decays or breaks from an accident, making it necessary for the dentist to remove it. This may cause the teeth to be crowded, but our dentists can guide you and your child through alleviating this issue.

Usually, the baby teeth begin to loosen around the age of four to six. Your child will have 20 baby teeth, but after the permanent teeth erupt and the wisdom teeth come in during the teenage years, they will total 32. Many young adults need to have one or more of their wisdom teeth removed to allow room in the mouth and deter overcrowding.

The typical sequence of tooth loss is predictable. Usually, your child loses their bottom front middle teeth, which are called the lower central incisors. Next, the top front middle teeth fall out, also called the upper central incisors. From there, they fall out in this sequence:

  • Lateral incisors – including the middle teeth already mentioned, the incisors are the eight thinner teeth in the front of the mouth (four on top and four on bottom). The incisors help support the lips, aid the biting of food, and help with pronouncing words.
  • Canines – there are four total, one on each side of your incisors, on the top and the bottom. Cutting food, supporting the lips, and guiding your jaw to its place when you close your mouth are the functions of these teeth. They are called canines as they are in the same position as the prominent “fangs” you see in a dog’s mouth.
  • First molars or premolars – located behind the canines, you have eight of these teeth too, four on the top and four on the bottom. They are flat on the biting surface, which helps you chew and provides structure to maintain height in your face.
  • Second molars – in the back of your mouth, the last three teeth on each side (top and bottom) are the molars. These 12 teeth are the flattest and widest in your mouth and come in right behind your premolars. They also are what you use to chew food, and they support the height of your face.
  • Third molars – the “wisdom teeth” that come in around the age of 17-21 if they are present in the young adult’s mouth. They do not have a baby tooth to fall out, but they are present in the mouth and do not erupt until this time.

Why Might Your Child's Baby Teeth Not Fall Out?

There may be several reasons for the retention of your child's baby teeth:

  • Permanent teeth growing behind the baby teeth may miss the roots, causing the baby tooth roots not to dissolve, and the tooth may not fall out.
  • Severe crowding may not allow permanent teeth to grow correctly.
  • The permanent teeth may not be fully developed or may be missing.

Be patient if you start to see the permanent teeth before the baby tooth falls out, especially if the baby tooth is loose. Encourage your child to wiggle the tooth, and eventually, it should fall out. If the baby tooth does not loosen and the permanent tooth continues to grow behind it, contact us for an appointment to assess your child’s mouth and discuss treatment. If one baby tooth has not started to loosen and the permanent tooth is visible, be aware that it is not uncommon for the adjacent tooth to have the same result.


Some children do not need treatment if the additional tooth is not causing dental issues. Others may have one of the following issues:

  • They can't chew properly, or the extra tooth causes cuts in the mouth from being displaced.
  • Overcrowding – may cause pain or generalized discomfort.
  • Oral hygiene may be compromised because the child may not be able to brush or floss in between the teeth. Dental decay and gum disease can happen because of this.
  • The appearance of your child's teeth may cause them to be embarrassed or self-conscious of their extra teeth.

Our dentists will discuss options and may need to recommend removing the extra tooth. Our team may take X-rays of the child's teeth to correctly diagnose what is causing the extra teeth or the lack of permanent teeth. If the x-rays show that the permanent tooth has not formed, the baby tooth will remain as the permanent tooth. With good oral hygiene and dental appointments, there should be no problems with this tooth staying where it is.

When to Contact Our Office

Suppose you are concerned that your child’s baby teeth are not starting to loosen or fall out when they pass the ordinary age range. Call us for a consultation with our experienced pediatric dental team. We can evaluate their teeth and take the necessary steps to diagnose and treat your child’s dental condition. We may want to give it more time if the x-rays show the permanent teeth are in proper alignment to push out the baby teeth.

If Jungle Roots is your child’s dental home, we will discover and note the condition during your child’s regular dental exams. If it does not need to be treated right away, we will continue to monitor and assess it during their regular exams.

In the case of a permanent tooth coming in without the loosening of the baby tooth, tooth extraction may be needed. If extraction of the baby tooth is recommended, we will explain the procedure and answer any questions that you have. Sometimes, we may use a topical numbing agent or inject numbing solution around the tooth. Your child may feel a slight pressure as the tooth comes out, as the entire tooth with the root will be removed. Extraction of the baby tooth will allow the permanent tooth to move into the space, but it may require wearing braces to assist in aligning the teeth.

No matter what your child’s dental needs are, our Jungle Roots team can provide assistance and support in a safe, secure, and comforting environment that your child can continue to go-to for all of their oral health needs! Schedule an appointment today.

At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.

Call Us - (480) 759-1119

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