At what age do children typically lose their primary teeth and which tooth is usually lost first?

Normal Primary Tooth Loss in Children

Children typically begin losing their primary teeth around age 6 years, with the lower central incisors (bottom front teeth) being the first to exfoliate, followed closely by the upper central incisors. 1

Typical Age Range for Primary Tooth Loss

The maxillary (upper) central incisors are present in the mouth from approximately 12 months to 6 years of age, with exfoliation typically occurring between 5 to 7 years of age. 1 This represents the normal physiologic process of primary tooth shedding as permanent teeth develop and erupt.

Which Tooth is Lost First

The lower central incisors are generally the first primary teeth to be lost, though the upper central incisors follow shortly thereafter in the typical sequence of exfoliation. 1 The maxillary (upper) central incisors are consistently identified as among the most prominent teeth in the primary dentition and are typically present until the mixed dentition phase begins around age 6 years. 1

Timeline of Mixed Dentition

• From ages 6 through 12 years, children are in the mixed dentition phase, during which they exchange primary teeth for permanent teeth. 1
• By age 8 or 9 years, most of the incisors are permanent teeth, with a mixture of primary canines and molars remaining until approximately age 12 years. 1
• By age 13 years, most children have exfoliated all primary teeth and have 28 permanent teeth. 1

Clinical Pearls for Distinguishing Primary from Permanent Teeth

Parents often struggle to distinguish between primary and permanent teeth—only 33% of parents correctly identified the permanent first molar as a permanent tooth, with 59.3% incorrectly believing it was a primary tooth. 2 This highlights the importance of patient education, as the permanent first molar erupts around age 6 years behind the primary molars and is frequently mistaken for a primary tooth. 2

The permanent first molar erupts without replacing a primary tooth, making it particularly vulnerable to early caries if parents are unaware it is a permanent tooth requiring lifelong preservation. 2