New parents watch with anticipation for the tiny white bud that signals the arrival of baby’s first tooth. So when teeth don’t appear, it’s normal to wonder if there is something wrong. Whereas for most kids with no teeth, this delay is not something to worry about, there may be underlying causes for this condition in some infants.


When Do Teeth Usually Appear?

Babies are born with most of their teeth already formed within their gums, and they usually begin to appear by the age of six months. The two lower front teeth emerge first, followed by the four upper front teeth, then the remaining two lower front teeth. The rest generally arrive two at a time – one on each side of the mouth – and by the age of three, nearly all children have a complete set of 20 primary teeth.

When Is a Delay Considered Abnormal?

Kids with no teeth by the age of 18 months should be taken to see a dentist, according to the American Academy of Pediatrics (AAP). Four to 15 months of age is the normal range for the appearance of the first tooth, and the other teeth usually follow in a regular schedule. Most children have four teeth by the time they are 11 months old, eight teeth at 15 months, 12 teeth at 19 months, 16 teeth at 23 months and 20 teeth at 27 months. Permanent teeth begin to appear around six years of age. Teeth that do not follow this normal eruption pattern aren’t necessarily a concern, but no teeth at all can indicate more advanced problems in a few cases.

What Causes It?

A number of things may be to blame when a child’s tooth eruption falls outside the normal schedule. Sometimes, late tooth eruption is simply a family trait. Preemie and low-birthweight babies may also experience delayed tooth eruption, and the teeth can have enamel defects that come with it. Research cited in the American Journal of Orthodontics and Dentofacial Orthopedics suggests some rare genetic abnormalities that cause poorly formed teeth and late tooth appearance as well, such as amelogenesis imperfecta and regional odontodysplasia. Nutritional deficiency and Vitamin D-resistant rickets can also cause a delay, though it may be a symptom of Down’s Syndrome, hypopituitarism or a similar developmental defect.

Is Delayed Tooth Eruption Harmful?

Delayed tooth eruption that is not part of a broader problem isn’t a serious concern, but it may create a higher risk of dental problems later in life. In fact, a study of children who were genetically predisposed to late tooth eruption found their chances of needing orthodontic treatment by 30 years old was 35 percent higher. In addition, keep in mind primary teeth play an important role in helping kids eat well, and are a guide for permanent teeth to serve the same purpose.


For most children with no teeth, a delay is simply an opportunity for parents to enjoy their gummy smile a little longer.

Nonetheless, the parents should arrange a dental visit for children whose teeth appear later than the regular schedule – especially if they’re worried the delay may indicate a more serious issue. Caring for your child’s teeth, however late they erupt, gives them the best start for long-lasting oral health.


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