As a child’s teeth grow, something fascinating happens. The roots of their baby teeth begin to dissolve, signalling the arrival of the permanent teeth waiting underneath. This gradual change causes the baby tooth to loosen and, over time, gently make way for the permanent tooth. However, in some children this gradual process takes longer time than expected, which is called retained milk tooth.
Oviya P (11), a fifth-grade student experienced something similar as her milk tooth did not fall. “The milk tooth in the front was taking longer to fall. But permanent front tooth had already erupted,” says her father, Parthasarathy S. They consulted a dentist for an oral examination.
The dentist examined Oviya’s mouth and told her that her permanent front tooth was developing in a crooked position. The dentist said that this alignment issue was due to the retained milk tooth. So, the dentist removed the milk tooth and asked them to follow-up every six months for similar condition with other teeth.
“If a milk tooth is not shedding on time and is staying for longer, it is known as retained milk tooth. However, this is completely manageable,” says Dr Sowndarya Gunasekaran, assistant professor and paediatric dentist at Vinayaka Mission’s Research Foundation, Salem, Tamil Nadu.
A natural process
In children, the process of losing milk teeth is natural. This process plays an important role in the development of oral structures. If the deciduous tooth (milk tooth) does not shed naturally, it can be an indication of underlying dental issues.
According to Indian Dental Association, the milk teeth begin to fall out around the age of six or seven years. Meanwhile, it makes way for the permanent teeth to erupt. Experts say that in some children, the process may take longer due to trauma or injury, gum infections, developmental disorders or genetic disorders.
Dr A Lavanya, dentist from Chennai and Dr Sowndarya explain the following dental issues associated with delayed milk tooth loss:
· Space issues – Delayed loss of milk teeth can cause inadequate space for permanent teeth during the eruption. It results in crooked teeth or teeth alignment issues.
· Delayed eruption – If the milk tooth does not shed on time, it could be the main reason for the delayed eruption of permanent teeth.
· Speech and eating difficulties – A retained milk tooth can affect the pronunciation of certain words by the child. The crooked or tilted tooth can interfere with the movement of tongue while chewing and cause eating difficulties. In addition, the tilted tooth can cause irregular bite and affect chewing.
· Increased risk of tooth cavity – Crooked tooth can interfere with brushing and there are high chances of food accumulation in between the teeth. It results in the increased risk of tooth cavities.
Read more about the Milk tooth: significance of early intervention for cavities here
· Facial changes – Retained milk teeth can also lead to facial asymmetry and jaw problems.
· Impacted tooth – A 2012 study published in the European Journal of orthodontics states that deciduous tooth does not fall out due to the absence of a corresponding permanent tooth. In some children, the permanent tooth gets trapped inside the gums due to developmental issues.
Guide to manage retained deciduous tooth
Experts say that parents can take measures to minimise the complications associated with delayed tooth loss. Here are the following management measures:
· Dental check-ups – Regular dental consultations once in six months for your child are important. It helps the dentist to monitor their oral health and identify the issues earlier.
· Oral hygiene – Parents should monitor their children and help them maintain their oral health. It includes brushing, flossing, and using fluoride-based toothpaste. These measures aid in the prevention of tooth cavities.
· Orthodontic treatment (teeth alignment) – Jaws and bite alignment is done by the experts. Based on the requirement, the dentist may suggest braces or appliances for the procedure.
· Removal of tooth – “X-rays are taken to examine the condition. It is followed by the removal of milk tooth, to make way for the eruption of the permanent tooth,” says Dr Lavanya. Tooth removal is done when the milk tooth shows no signs of falling out naturally.
A 2009 study published in the British Dental Journal states that the retained milk tooth should be removed when there is loosening of the milk tooth, gum issues, underlying dental conditions involving the jaw bones, unfavourable tooth position, and poor aesthetics. However, it should be retained when the corresponding permanent tooth is missing.