When the permanent front teeth come through between the ages of 6 and 8, most parents notice: the new teeth are larger than the baby teeth and sometimes come in crooked or crowded. Some of this is a normal part of development; some of it needs assessment.
What can be normal?
- Lower front incisors erupting behind the baby teeth (after the baby tooth falls out, tongue pressure usually brings them forward)
- Mild crowding while the permanent front teeth erupt
- A gap between the upper front teeth with the teeth fanning out (the "ugly duckling stage")
Some of these resolve on their own as the jaw grows and the canines erupt.
Signs to watch for
- Marked and increasing crowding
- Permanent teeth erupting from a different direction before the baby teeth have fallen out
- A baby tooth staying in place for a long time without becoming loose
- Crossbite in the front or back teeth
- The jaw shifting to one side when closing
- Markedly protruding front teeth
- Sleeping with the mouth open, mouth breathing
The link between decay and crowding
The spaces between crowded teeth are harder to clean, which raises the risk of decay. On the other hand, baby teeth lost early to decay can lead to loss of space and crowding. Preventing decay and monitoring crowding therefore go hand in hand.
When to see an orthodontist
A first orthodontic check-up is recommended at around age 7. At this check-up the orthodontist assesses:
- whether there is enough room in the jaws for the permanent teeth,
- the bite relationship,
- whether any teeth are impacted or missing (with an X-ray if needed).
For most children, monitoring is all that is recommended; where needed, early treatment options such as palatal expansion, a space maintainer or Invisalign First may be considered.
What you can do at home
- Teach your child to use floss or a small interdental brush in crowded areas.
- Check the evening brushing.
- Support your child in giving up habits such as thumb sucking.
For more information, see our crowded teeth treatment and early orthodontic treatment pages.
