When do milk teeth fall out? The order, a permanent tooth behind a milk tooth and when a dentist removes one

In what order do milk teeth fall out?

Milk teeth fall out in much the same order in which they came through: the central incisors first, at around 6 to 7, then the lateral incisors, and finally the molars and canines, between the ages of 9 and 12. The American Academy of Pediatric Dentistry (AAPD) calls the period when milk and permanent teeth are in the mouth at the same time the mixed dentition, and places it roughly between the ages of 6 and 11.

The table combines two charts from the American Dental Association (ADA): one for the shedding of milk teeth and one for the eruption of permanent teeth. These are typical ranges, not deadlines, because every child goes through the change at their own pace; the criteria for when a delay calls for an X-ray are described later in the article.

According to the ADA, all 32 permanent teeth have usually come through by the age of 21, the last being the wisdom teeth, which appear between the ages of 17 and 21.

The six-year molar: a permanent tooth that comes through without a milk tooth falling out

The first permanent molar, the six-year molar, comes through at around 6 to 7 behind the last milk molar and does not replace any milk tooth. So nothing falls out ahead of it, and it appears at the end of the arch rather than in a gap left by a milk tooth, even though it is a permanent tooth that will never be replaced.

During the same period, as the lower incisors and six-year molars come through, the AAPD says the dentist may, where indicated, order X-rays that show the tooth buds, their number and their shape. The preventive check-up funded by the NFZ (Poland’s National Health Fund) in the 7th year of life includes an assessment of whether the change began with the incisors or with the molars, and of how the six-year molars meet.

The grooves of the six-year molars can be protected with a sealant, which the NFZ funds once up to the 8th birthday; the details are in the article on fissure sealing.

A wobbly milk tooth: what to do at home?

A wobbly milk tooth is usually a sign that a permanent tooth is growing underneath it. New Zealand’s public health service describes the process like this: the growing tooth bud causes the root of the milk tooth to dissolve, the tooth loosens and eventually falls out, making room for its successor.

In most cases, patience and a few simple rules are all that is needed.

• Let the tooth fall out on its own; your child can gently wiggle it with their tongue or a finger.
• Do not force out a tooth that is barely loose: when a permanent tooth is already coming through beside it, the decision is made by the dentist.
• If the gap bleeds after the tooth comes out, have your child bite on a clean, damp piece of gauze. Leaflets on care after an extraction advise pressing for 15 to 20 minutes, and pink saliva for a day or two is normal.
• If the tooth came out after a knock, do not put it back, because milk teeth are not replanted; your child should be seen by a dentist.
• Heavy bleeding that cannot be stopped with pressure is an emergency: call 112, the emergency number, or go to a hospital emergency department (SOR).

A permanent tooth growing behind a milk tooth: when is it normal, and when should you see a dentist?

A permanent tooth coming through behind a milk tooth, for example a lower front tooth on the tongue side, is a common and usually temporary situation. It happens when the tooth bud does not lie exactly beneath the milk tooth and the milk tooth’s root dissolves more slowly; New Zealand’s health service calls this completely normal.

In a study of 105 children aged 5 to 7.5, followed for 2 years, the milk tooth fell out without any intervention in about 70%, and 14.8% needed an extraction. An older clinical paper states that a lower incisor coming through on the tongue side usually straightens by itself by around the age of 8.

It is worth seeing a dentist when the milk tooth is not loose and the permanent one is already clearly visible and drifting off its path of eruption. A milk tooth still in place at the age of 8 next to its erupted successor is regarded as over-retained, and removing it is then sometimes advisable.

A milk tooth that will not fall out: when does a delay call for an X-ray?

A delay in the change of teeth calls for an X-ray when it clearly differs from the other side of the arch or from the usual order. UK guidelines from the Royal College of Surgeons on upper incisors recommend a check or treatment when the tooth on the other side came through more than 6 months earlier, when both upper central incisors have not appeared more than a year after the lower ones, or when the lateral incisors come through before the central ones; X-rays are then taken.

An over-retained milk tooth can be a sign that there is no tooth bud beneath it. The AAPD states that congenital absence of at least one permanent tooth affects 4.4% to 13.4% of people, depending on the region, and that apart from wisdom teeth, the teeth most often missing are the lower second premolar and the upper lateral incisor.

Another cause is ankylosis, in which the root of a milk tooth fuses with the bone. Such a tooth, most often a molar, seems to sink over time because the neighbouring teeth keep growing; the AAPD estimates its frequency in the milk dentition at 7 to 14%, and when there is a successor beneath the tooth, it usually recommends monitoring as long as the tooth does not hinder the successor’s eruption.

For children, the NFZ funds up to 5 intraoral X-rays a year, and from age 5 to 18 a panoramic X-ray once every 3 years where medically justified (legal position as of 18 October 2026).

A milk tooth lost too early: what next?

Early loss of a milk tooth, through decay or injury, can reduce the space for the permanent tooth, because the neighbouring teeth drift into the gap. A 2026 meta-analysis showed that after early loss of a first milk molar, the gap shrinks on average by 1.78 mm in the lower jaw and by 0.52 mm in the upper jaw.

After such an extraction, the dentist assesses whether a space maintainer is needed, a simple appliance that holds the space for the successor; the advantages and limitations of this solution are described in the article on treating milk teeth. On the NFZ, a space maintainer is available up to the 12th birthday, as part of orthodontic services.

When does a dentist remove a milk tooth?

A dentist removes a milk tooth when it does not fall out on its own and is getting in the way of the permanent tooth, or when it cannot be treated. The most common situations are listed below.

The price list distinguishes between removing a resorbed and a non-resorbed tooth. A resorbed milk tooth has had much of its root dissolved and is usually only loosely held, while a non-resorbed one still has its root, so removing it is like a small extraction.

For children and adolescents up to 18, the NFZ funds extraction of a single-rooted tooth, of a multi-rooted tooth and surgical extraction; the list does not single out milk teeth (legal position as of 18 October 2026).

• The milk tooth is not loose, and the permanent tooth is coming through beside it and drifting off course.
• The milk tooth is over-retained, for example a lower incisor still in place at the age of 8 beside its erupted successor.
• A milk molar fused to the bone is hindering the successor’s eruption or causing the neighbouring teeth to tilt.
• The tooth has been destroyed by decay or infection and cannot be treated.
• The orthodontist recommends removal to make it easier for a permanent tooth, for example a canine, to come through.

How much does it cost to have a milk tooth removed privately?

The cost depends mainly on whether the root of the tooth has already dissolved, and on whether a space maintainer is needed after the extraction. In the clinic’s price list, removal of a resorbed milk tooth costs 250 zł, of a non-resorbed one 300 zł, and a space maintainer 400 zł. The final scope and cost are set at the visit, and prices may change.

How it works at DentalBlue

At DentalBlue in Białystok, children are looked after by the paediatric dentistry department, and they are treated at their own pace, starting with an adaptation visit. When the change of teeth is not going as expected, a panoramic or intraoral X-ray is taken in the clinic’s own radiology unit, and where there is malocclusion, the orthodontic department prepares a plan on the basis of cephalometric analysis. The clinic is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00. An appointment can be booked by phone.