When Children Typically Lose Their First Tooth
Children typically begin losing their first primary tooth around age 6 years, with the lower central incisors being the first to exfoliate. 1
Normal Timeline and Sequence
Age of first tooth loss:
- The lower central incisors are generally the first primary teeth to be lost, typically around age 6 years 1
- The upper central incisors follow shortly thereafter in the typical sequence of exfoliation 1
- More specifically, maxillary central incisors exfoliate between 5 to 7 years of age 1
The mixed dentition phase:
- From ages 6 through 12 years, children exchange primary teeth for permanent teeth 1
- By age 8 or 9 years, most 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
Important Clinical Context
Distinguishing primary from permanent teeth:
- In general, children younger than 5 years are in the primary dentition 2
- Parents often cannot distinguish between primary and permanent teeth—only 33% of parents correctly identified the permanent first molar as a permanent tooth 3
- This lack of parental knowledge is important because management of dental trauma differs significantly between primary and permanent teeth 2
Common Pitfalls
Early pathologic tooth loss should not be confused with normal exfoliation:
- Early loss of primary teeth (before the normal exfoliation age) occurs in 16.5% of children, most commonly affecting lower primary first molars 4
- Premature loss due to caries, pain, or infection can lead to space loss and orthodontic complications 5, 6
- Children often present for their first dental visit too late (around age 7 years) when problems have already developed, rather than the recommended 12 months of age 7