Teething is an essential milestone for a baby since teeth are vital for chewing solid food. While teething in babies follows a pattern, some babies may experience a delay in the eruption of their primary or milk teeth. There can be several causes behind delayed teething, ranging from benign causes to severe conditions that may require treatment.
Read on to learn about what causes delayed teething, its complications, and when to see a doctor.
Normal Teething Chart For Babies
It is essential to understand normal teething pattern sin babies to determine delayed teething. The first teeth to erupt in your baby’s mouth are the lower front teeth, and they do so around six months of age. The upper front teeth are the next, followed by other teeth that emerge within their respective age range (1).
| Lower Teeth | Upper Teeth |
|---|---|
| Central incisor: 6-10 months | Central incisor: 8-12 months |
| Lateral incisor: 10-16 months | Lateral incisor: 9-13 months |
| First molar: 14-18 months | First molar: 13-19 months |
| Canine: 17-23 months | Canine: 16-22 months |
| Second molar: 23-31 months | Second molar: 25-33 months |
What Is Delayed Teething?
Teething is defined as the process of primary teeth eruption from the gums (2). If the teeth do not erupt during the usual age range or there is a significant deviation from their expected time of eruption, then the baby is considered to be experiencing delayed teething (3).
Several signs and symptoms accompany the process of a tooth’s eruption. Babies with delayed tooth eruption also display delayed signs and symptoms of teething.
Should You Be Concerned If Your Baby Starts Teething Late?
According to the Australian Dental Association, some babies may begin teething at an early age of four months, while some may start teething as late as ten months (1). There is usually no need to be concerned if your baby experiences delayed teething.
Each baby achieves developmental milestones at a different age, and it is the same with teething. A baby can achieve teeth eruption at any age within the specified age range. Therefore, you may wait since the baby could eventually experience teething on attaining the upper limit of the age range.
When To Consult A Doctor?
If your baby’s first teeth (lower central incisors) do not erupt even after the age of 12 months, see a pediatric dentist. Some babies are late bloomers and experience delayed teething for no specific reason. However, in some cases, delayed teething may occur due to underlying problems, which require diagnosis and treatment.
Other developmental milestones may not be related to teething; thus, do not wait for your baby to achieve teething with other milestones before taking them to a dentist (4).
What Causes Late Teething In Babies?
The following conditions may cause delayed teething in babies. Some of the reasons are pathological abnormalities and may require treatment to commence teething.
1. Hereditary factors
If you or your partner had similar late teething issues at the same age, it could likely be that your baby experiences similar issues.
2. Poor nutrition
Studies have shown that poor nutritional status or nutritional insufficiency can affect teeth eruption. The nutritional status of the body influences teeth in their pre-eruptive phase. Any deficiency in calcium and the vitamins D, C, B, and A can significantly impact your baby’s teething (5).
3. Thyroid disorders
Babies with thyroid disorders, especially hypothyroidism, could have delayed teeth eruption. If they have any existing teeth, they may also have other dental problems, such as enamel hypoplasia, open-bites, or cross-bites (6).
4. Fibrosis
Fibrosis is a condition characterized by thick gums that impede or prevent the teeth from erupting. This could cause a delay in teeth eruption in some babies.
5. Hormonal issues
Problems in the secretion of the growth hormone, a hormone released by the pituitary gland, may significantly affect the development of facial structures, including the eruption of teeth. Hypopituitarism is one of the conditions that can cause the pituitary gland to secrete low levels of the growth hormone, leading to delayed teething, among other problems (7).
6. Systemic diseases and medication
Many systemic disorders, such as iron-deficiency anemia and sickle-cell anemia, may delay teething (8). Certain long-term medications may also interfere with tooth eruption.
7. Injuries
Any trauma to the jaw could affect the tooth buds and delay teething. Injuries may also lead to fibrosis, which also causes delayed teething.
8. Impacted teeth
Milk teeth may also become impacted like permanent teeth. An impacted milk tooth may fail to erupt and stay lodged within the jaw or gums. A baby with impacted teeth is likely to experience other signs and symptoms, such as gum redness, gum swelling, and pain.
9. Absent or missing teeth
In rare cases, a baby may have a missing tooth, which could be mistaken for delayed teething (9).
10. Genetic disorders
Genetic conditions, such as amelogenesis imperfect a and dentinogenesis imperfect a, may affect the baby’s teeth and gums, increasing the risk of delayed teething. Premature babies may also be at risk of experiencing delayed teething due to genetic reasons.
Certain genetic disorders could affect the musculoskeletal growth of the body, affecting even the eruption of the teeth. Some genetic disorders associated with delayed teething are Down syndrome, Turner syndrome, Gardner syndrome, Hutchinson-Gilbert syndrome (Progeria), and Bloch–Sulzberger syndrome (10). A baby with these disorders is likely to experience other significant symptoms as well.
Complications Of Delayed Teething
Complications of delayed teething may depend on the underlying reason. Delayed teething due to no apparent reasons or due to benign reasons may not lead to complications.
In some cases, delayed teething may cause the following complications.
- Jaw bone deformity and asymmetrical face: Misalignment of jaws due to delayed teething may lead to long-term issues, such as an asymmetrical face. This complication may usually arise in babies who experience delayed teething due to severe problems, such as genetic disorders.
- Delay in chewing food: A delay in the emergence of primary teeth could delay the age at which you add solid food to your baby’s diet. It could cause a delay in learning how to chew solid food. Inability to eat solid food may increase the risk of other issues, such as malnutrition.
- Formation of cysts: Impacted or embedded teeth increase the risk of developing a cyst around them. It could cause intense pain and may require surgical intervention.
- Crooked permanent teeth: Primary teeth work as placeholders for permanent teeth. Any issues in primary teeth could also impact permanent teeth. The untimely eruption of primary teeth may interfere with the eruption of permanent teeth, affecting their alignment or causing them to become impacted.
The baby’s first tooth eruption is a matter of celebration, even though they might have to deal with their teething symptoms. There is usually no need to panic, and the first teeth erupt by the age of ten months in most babies. If your baby does not display teething even after completing their first birthday, consult a pediatric dentist for evaluation and treatment.
References:
2. Teething; Stanford Children’s Health
3. LokeshSuri, EleniGagari, and HeleniVastardis, Delayed tooth eruption: Pathogenesis, diagnosis, and treatment; American Journal of Orthodontics and DentofacialOrthopedics
4. NehaVerma et al., Effect of Developmental Milestones on Patterns of Teeth Eruption; International Journal of Scientific Study
5. AparnaSheetal et al., Malnutrition and its Oral Outcome – A Review; Journal of Clinical & Diagnostic Research; NCBI
6. S Vucic et al., Thyroid Function during Early Life and Dental Development; NCBI
7 GauravAtreja et al., Oral manifestations in growth hormone disorders; Indian Journal of Endocrinology and Metabolism; NCBI
8. Caroline Maria Igrejas Lopes et al., Enamel defects and tooth eruption disturbances in children with sickle cell anemia; NCBI
9. Teething: Common Concerns; C.S. Mott Children’s Hospital
10. Choukroune, Tooth eruption disorders associated with systemic and genetic diseases; Journal of Dentofacial Anomalies and Orthodontics