One of the more common emergencies I deal with involves the eruption of the permanent lower front teeth (incisors) right behind their baby version. Some call this Shark Teeth because the double row of teeth resembles a shark’s mouth but your little one is way cuter than a shark, so I call this ectopic eruption.
Ectopic eruption is the eruption of a permanent tooth off-mark. It’s never “normal” to have the baby tooth present at the same time as its permanent version. But when do you need to intervene, and when is it okay to keep an eye on it? We can give you 3 considerations when making a decision.
The eruption of the permanent tooth in the wrong place should be evaluated in conjunction with that child’s overall orthodontic situation. If a child is crowded (no room for those new teeth) and the other matching incisors is already erupted, we may be more inclined to remove the baby tooth sooner to help minimize disrupting the symmetry of eruption.
The lower front teeth are where ectopic eruption happens most often. But if a canine or upper incisor ends up erupting in La La land, we may be more pressed to get the baby tooth out of the way. That’s because ectopic canines usually come into gum tissue that is not ideal and may lead to recession, or upper incisors often come into a crossbite if they miss their mark.
Sometimes a tooth that has just peeked its head through the wrong place can get its act together and the baby tooth can quickly be “helped out” by the child and as the tooth erupts it will move forward efficiently. Other times, the permanent tooth is very erupted and the baby tooth is just too stubborn, or the parent is too busy to return to the clinic to check on that tooth, or the child is in pain and just will not go after the baby tooth. In the latter instances, the removal of that baby tooth is so easy for the child (when done right by a good dentist), it may be easier for the parent and child to deal with it on the spot.
So in short, there are no written rules for managing a double row of teeth and your pediatric dentist can be a good resource for individual recommendation. The more conservative parents can get the tooth looked at and monitor; while the more hands-on parents can discuss and request their pediatric dentist to gently help resolve the issue of the baby tooth that has overstayed its welcome.