Smile Milestones: How to Navigate Your Child’s Early Dental Development

By Dr. Haripriya Nair, BDS

Your child’s first teeth are more than just tiny pearls — they lay the foundation for a healthy lifelong smile.

From the moment a child is born, every milestone becomes a cause for celebration. Parents eagerly anticipate each ''first'': the first smile, the first word, the first steps.

By two to three months, babies begin cooing and gurgling in response to their environment. At three months, many can roll over onto their tummies, and by six to seven months, they’re able to sit up, with or without support. Crawling soon follows, leading to those first wobbly steps around 10 to 12 months. Around the age of one, many babies start saying simple words like “mama” or “dada” and respond to gestures, such as nodding or waving. Any delays in these expected milestones often send anxious parents into research mode, sometimes with more confusion than clarity.

While physical and speech milestones are widely recognized, dental milestones often go unnoticed, despite being just as important.

Now, when you’re a doctor (or a dentist, to be precise, since there’s still some confusion among people about whether dentists are real doctors), weddings and family gatherings often turn into opportunities for relatives to seek free consultations.

The worst part? Some may have already seen another dentist and are well aware of their treatment plan, but they still seek confirmation from the “in-house” dentist during such occasions. A second opinion that costs no more than a polite “Hi” or “Hello,” instead of making a proper appointment.

During one such conversation with a 28-year-old woman about “a hole in her tooth,” something else caught my attention. Her 1.5-year-old daughter was happily playing in her arms and had no visible milk teeth. When I asked about it, the mother casually explained, “It’s because her head is firm, so the tooth buds are taking time to erupt.”

I’ve always known there are misconceptions about milk teeth among the general public. After all, they’re just temporary, and new teeth will come in later, so why worry? That’s the mindset many parents have. But I believe it’s high time we start educating parents about the importance of dental health in children and how early oral care can impact their overall well-being. To understand this better, we first need to explore the milestones in a child’s dental development.

Early Surprises:

If these terms are new to you, don’t worry: you’re not alone. In rare cases, a tooth may be present at birth, which is called a natal tooth, while some erupt within the first 30 days of life, which is called a neonatal tooth. These are not part of the normal teething timeline and are usually premature eruptions of the milk teeth, most often the lower front incisors.

Natal teeth are more common than neonatal teeth, but both are relatively rare. Though these terms look quite simple, they come with a few challenges such as pain during suckling and refusal to feed⁽¹⁾. In some cases, natal or neonatal teeth are loose due to underdeveloped roots, posing a risk of aspiration if they dislodge. They may also interfere with breastfeeding, cause ulceration on the baby’s tongue (Riga-Fede disease), or create discomfort for the nursing parent. Clinically, they appear in various shapes and sizes and at times may also resemble a normal tooth. It is always advisable to consult a pediatric dentist and get an X-ray done if needed. Some teeth may need monitoring, while others may require removal if they pose a safety concern.

Teething and the Emergence of Milk Teeth

Teething typically begins between 4 to 7 months of age, marked by the appearance of the first tooth, the lower front incisors. During this time, some babies may experience sore, tender gums. Parents might also notice increased drooling, irritability, and a slightly elevated body temperature (which is not the same as a true fever). Babies instinctively begin to chew on objects to soothe their gums (a normal part of the process).

To help ease their discomfort, parents can gently rub the baby's gums with clean, damp gauze. Teething rings and toys can also provide relief, but it's important to choose safe, non-toxic options. Homemade ice popsicles made from water or pureed fruit can be soothing as well.

By the age of 2 to 3 years, most children will have a complete set of 20 primary (milk) teeth. If this doesn’t occur, it’s advisable to schedule a dental check-up to ensure everything is developing as expected. Delayed eruption can be due to multiple reasons including genetics or heredity, or even medical conditions or developmental issues. There are even studies that suggest low birth weight can also affect tooth eruption⁽²⁾.

Supernumerary teeth:

A supernumerary tooth is an extra tooth that appears in addition to the normal 20 milk teeth or 32 permanent teeth. The exact cause of this condition isn’t fully understood. One theory suggests that the developing tooth splits into two, while another suggests that the tissue that forms teeth becomes overly active and creates an extra tooth. Genetics also seem to play a role.

Supernumerary teeth are more often seen in permanent teeth than in milk teeth. The most common type is the mesiodens, found between the two front upper teeth, usually behind them toward the roof of the mouth. Other common types include extra molars (sometimes called “fourth molars”) and extra premolars in the lower jaw.

Doctors may recommend removing a supernumerary tooth if it causes problems like interference with eruption of normal teeth, prevention of orthodontic tooth movement, or leading to infections or other issues. If it is not causing any immediate problems and is hard to reach, it might just be monitored for the time being.

Mixed Dentition Phase

Around the age of 6, the first permanent teeth begin to erupt, usually starting with the lower molars, followed by the upper molars and the lower incisors and upper incisors and then canines, premolars, and second molars. This period is referred to as the "mixed dentition" phase because both milk teeth and permanent teeth coexist in the mouth.

As permanent teeth erupt, they cause the roots of the corresponding milk teeth to resorb, eventually leading to the milk tooth falling out. However, this process doesn’t always go as planned. Sometimes, the permanent tooth may emerge before the milk tooth has fallen, often erupting in an unusual position. A visit to the dentist will help assess whether any intervention is needed.

Time for Braces?

By the age of 12 to 14, most children will have lost all their milk teeth, and their permanent set will be in place. This is typically the ideal age to evaluate the need for orthodontic treatment. Since children are still growing during adolescence, braces can more effectively guide teeth into proper alignment than in adulthood.

Studies show that early orthodontic intervention using myofunctional appliances and growth modulators has a positive impact in correcting misalignments and improving facial symmetry more effectively than later treatment. Early evaluation can also help address any bite issues or spacing concerns before they become more complex.

Once the permanent teeth have settled, the next challenge often involves the wisdom teeth.

Wisdom Teeth: The Final Set

Wisdom teeth, or third molars, commonly called wisdom teeth, usually erupt after the age of 17–18 years. However, for some, they never erupt or partially come out through the gums, causing impaction. Unlike other teeth, wisdom teeth often come in at odd angles or remain impacted (trapped under the gum or bone). This can lead to pain, crowding, or even infection. The story of the wisdom tooth goes like this: our ancestors had larger jaws and more teeth because they fed on raw, uncooked food that was tough to chew. However, with evolution and the advent of cooking, our food became much softer, leading to smaller jaw sizes, leaving little to no space for the third molars to erupt⁽⁴⁾. In many cases, with repeated infection or food lodgment, dentists recommend their removal, as they are not essential for chewing and may compromise the alignment of the other teeth.

Conclusion

References:

1. Mhaske, Shubhangi, Monal B. Yuwanati, Ashok Mhaske, Raju Ragavendra, Kavitha Kamath, & Swati Saawarn. “Natal and Neonatal Teeth: An Overview of the Literature.” ISRN Pediatrics (2013): Article 956269. https://doi.org/10.1155/2013/956269.

2. Sajjadian, Negar, et al. “Relationship between Birth Weight and Time of First Deciduous Tooth Eruption in 143 Consecutively Born Infants.” Pediatrics & Neonatology 51, no. 4 (August 2010): 235–37. https://doi.org/10.1016/S1875‑9572(10)60044‑7.

3. Sandhu, Avreet, Brinda A. Sakaria, Sejal D. Patel, Gaurav Ahuja, Neeldipsinh Jadeja, Aaryan Mehta, & Dinta Kakkad. “The Impact of Early Orthodontic Intervention on Dental and Skeletal Development in Children with Mixed Dentition.” Journal of Pharmacy & Bioallied Sciences 16, no. Suppl 1 (2024): S818–S820. https://pubmed.ncbi.nlm.nih.gov/38595457/.

4. “Wisdom Teeth: What You Need to Know.” Health.com. Accessed June 13, 2025. https://www.health.com/wisdom-teeth-7501625.

5. “Supernumerary Tooth.” ScienceDirect. https://www.sciencedirect.com/topics/medicine-and-dentistry/supernumerary-tooth.

MSM/TLT/SE