Permanent dentition in children – when do these teeth come and how should they be cared for?

From primary dentition to mixed dentition and permanent teeth

Permanent dentition in children

The first tooth that starts to wiggle, is a major event – not only for your child, but also for you as a parent. This usually begins in children from the age of 6. This is the phase in which the baby teeth are gradually replaced by permanent teeth. This quite natural process brings some changes and many parents want to make it as positive and painless as possible for their children.

This article explains exactly what happens during the second dentition, in which phase it takes place and what you should pay attention to when caring for the teeth of the so-called mixed dentition. Being well informed and knowing what happens next, helps you to explain the dentition process to your child and make it as carefree as possible.

  1. When does the tooth-change take place in children?
  2. Wiggly tooth and new teeth: How do I explain it to my child?
  3. Oral care of primary and mixed dentition
  4. More tips for dealing with the mixed dentition

When does the tooth-change take place in children?

Children usually have their first loose tooth when they start school, i.e. at around six or seven. For some children, the second dentition starts as early as four or as late as eight. You don’t need to be concerned if it happens a little earlier or a little later.

Typically, the change of dentition occurs in three phases that span several years. During this time, the dentition consists of both baby teeth and permanent teeth, the so-called early (phase 1) and later (phase 2) mixed dentition.

Did you know?
Children have 20 baby teeth. In the second dentition phase, they are replaced by one permanent tooth each plus eight additional so-called molars and pre-molars. In early adulthood, after up to four wisdom teeth break through, the dentition comprising of 32 teeth, is then complete.

A child’s second dentition phase 1 from the age of 6

First phase (from about 6): Incisors and large molars

Normally the front teeth start to wiggle, both in the upper and lower jaw. When a child laughs, the familiar gap between the teeth can then be seen in the front.  After a while this gap is filled by the permanent incisors.

During this phase, the first molars – the so-called six-year molars – appear in the upper and lower jaws. They are referred to here as “breaking through”. These permanent molars do not replace baby teeth, but line up at the end of the dental arch. Even though the new molars still look very large in comparison, their breakthrough is often hardly noticed. They stabilize the remaining teeth as well as the biting position.

A child’s second dentition phase 2 from the age of 9

Second phase (from about 9 to 12): Canines and molars

In the second phase, the small molars as well as the canines are replaced with permanent teeth. Usually these baby teeth start to wiggle at the age of about 9, but sometimes a little earlier.

In addition, the so-called large molars break through at the end of the jaw. They are also called 12-year molars. Now with 28 teeth, the dentition is complete.

Second dentition phase 3 wisdom teeth

Third phase (from about 18 to 25): Wisdom teeth

It takes several years for the wisdom teeth, or third molars to break through. Some people do not get their one to four wisdom teeth until they are 25 or older, while for others they are not even set in the jaw at all. It is often necessary to have the wisdom teeth removed because they may be crowding the other teeth, growing crookedly, or displacing other teeth. Talk to your dentist or orthodontist about this issue early on. This will clarify whether removal might be necessary for your child.

Second dentition table

The table provides a rough guide of the typical course of second dentition.

Age Which tooth breaks through?''
6 First large molars (six-year molars)''
7 Middle incisors''
8 Central incisors''
9 Canine teeth in the lower jaw''
9 to 11 First small molars''
11 Canine teeth in the upper jaw''
12 Second large molars (12-year molars)''
15 All permanent teeth are completely visible''
18 to 25 or possibly later Wisdom teeth

Wiggly tooth and new teeth: How do I explain it to my child?

Child Tooth gap Mother

How exactly does this second dentition work? What is not commonly known: Even before birth, permanent teeth mature “hidden” in the child’s jaw. Here they can mature and develop for a long time until they gradually grow out. During this process, the root of the baby teeth is first dissolved before they fall out and the permanent teeth break through into the oral cavity. This is the reason why teeth start to wiggle and usually fall out painlessly and without an existing tooth root. After the loose tooth falls out, the permanent tooth takes its place.

The very first loose tooth is very special for your child. You can make the second dentition process positive, for example with the story of the tooth fairy, or with a few gift ideas.

  • A pretty little wooden tooth box to collect all the little baby teeth
  • A new toothbrush and toothpaste to celebrate the first tooth that fell out
  • A tooth-shaped money box to put the money from the tooth fairy in (instead of under the pillow)
  • A picture book, for example, about the tooth mouse, the second dentition or brushing teeth

These options provide a good framework for explaining the second dentition to your child. It also helps motivate children to brush their teeth and takes away their fear of going to the dentist.

Explain to your child that from now on he or she can use “toothpaste for the big ones” – like Junior Karex Toothpaste! This will give your child the feeling of being more grown up now and more motivated when it comes to brushing teeth – associating the second dentition with a positive feeling!

Oral care of primary and mixed dentition

Child’s mixed dentition teeth brushing

A caries-free primary dentition is a good foundation for lifelong healthy teeth. Therefore, for both primary and mixed dentition, you should pay attention to proper oral care for your child.

Brushing the primary dentition

At around two years of age, children are old enough to brush their own teeth with some assistance. It is not until around elementary school age that they will be able to brush their teeth without your assistance. A caries-free primary dentition is important to create a healthy basis for the subsequent permanent teeth. It is important to use the right tooth brushing technique and an age-appropriate toothpaste. 

A toothpaste for younger children should clean gently, as baby teeth are more sensitive and have thinner enamel. The Kinder Karex Toothpaste containing BioHAP, strengthens tooth enamel and protects against caries. Since BioHAP is safe if swallowed, it can be used from when the first tooth appears.

Oral care for the mixed dentition

Basically, permanent teeth are more resistant than baby teeth due to their enamel being about twice as thick. Permanent teeth also have a higher degree of mineralization than baby teeth and are therefore somewhat less susceptible to acid attacks than baby teeth.

In addition, permanent teeth are larger and grow in an initially small jaw. This means that the teeth in a mixed dentition are very close together in many places, which makes oral care more difficult. The so-called fissures, i.e. the indentations on the chewing surfaces of the molars, also present an additional challenge for the care of both the baby teeth and the permanent ones.

In order to prevent the risk of caries and thus serious consequences for long-term oral health, it is necessary to clean the teeth thoroughly and at the same time gently, without damaging the teeth or the gums. For the care and protection of the teeth during this special transitional period, a toothpaste especially for older children is recommended.

Our tip for toothpaste: Junior Karex Toothpaste containing BioHAP is specially formulated for children six years and older whose teeth are in the second dentition phase.

  • BioHAP (tooth related active ingredient hydroxyapatite) and other calcium sources, effectively protect baby teeth and permanent teeth against caries
  • Caries protection even for those wearing braces
  • Strengthens tooth enamel against acid attacks
  • Soothes and protects irritated gums
  • Does not contain fluoride, parabens or sodium lauryl sulfate
  • Use: from the age of 6, 2x daily

Don’t forget the gums
Inflamed gums are common especially when teeth are breaking through or when braces are worn. To soothe the irritated areas, Junior Karex Toothpaste contains the active ingredient allantoin, which has an additional soothing and protective effect for the gums.

Oral care for those wearing braces

During the phase of the second dentition, orthodontic treatment often becomes necessary. During this time, not only are the gums stressed through wearing braces, but the teeth with braces also need special care.

For example, especially in the case of fixed braces, plaque builds up around the braces and often cannot be completely removed. Junior Karex Toothpaste containing the active ingredient BioHAP and additional calcium sources, also protects these hard-to-reach areas from caries bacteria and harmful acids, thus preventing tooth decay. At the same time, the active ingredient allantoin in Junior Karex Toothpaste soothes reddened or inflamed gums caused by wearing braces.

More tips for dealing with the mixed dentition

Below are some tips that you should keep in mind concerning the second dentition phase. Don’t hesitate to share your experience with other parents who may have already gone through their offspring’s second dentition phase. Another helpful resource is your dentist, who will guide you through all stages of the second dentition.

  • Regular and thorough toothbrushing is the key to preventing caries. This applies to the primary dentition as well as to the mixed and complete dentition. The rule of thumb: twice a day for a minimum of two minutes!
  • Is it okay to wiggle a loose tooth? Yes! A child can feel free to wiggle the loose tooth with his or her hand or tongue. This will make it a little easier to loosen the baby tooth later.
  • Inflamed areas may occur where a tooth is in the second dentition phase.  Show your child how to gently brush them and keep an eye on the affected teeth. Should the inflammation get worse, visit your dentist.
  • Even though orthodontic treatment is not recommended for children until the age of twelve, it may be a good idea to see the orthodontist after the primary dentition – at about the age of eight. The orthodontist can check whether there is any crowding or malocclusion in the mixed dentition that could possibly impair the proper breaking through of further teeth. 
  • If the baby teeth are already misaligned, this does not necessarily mean that the permanent teeth will also grow crooked. To ensure that the following teeth have enough space in the tooth gap, it is important not to disturb the naturalprocess of the loose tooth by pulling it out early.

Oral care for young and older children

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