Identifying Primary and Permanent Teeth

I work with Boy Scouts ranging in age from 11-18 years. Last year, a 12 year-old kid handed me a tooth that had just fallen out. I asked him if he knew whether it was a permanent tooth or a baby tooth. He said he didn't know. I figured it was a baby tooth since there was no unusual trauma to the face. How can you tell if a lost tooth is a permanent tooth?

Question:

I understand your dilemma, and your question is well stated. In the age group you describe, mostly the younger ones (11-13 years) will still be losing some primary teeth. These should be either primary canines (also known as cuspids or eye teeth) or primary molars. The easiest way to determine if the teeth are primary is by the root structure. When the permanent teeth are erupting, they reabsorb the roots of the primary teeth causing them to loosen and fall out. Generally, the primary teeth will have little or no root when they are lost.

The crowns of the teeth (the part visible above the gumline) can also give you a clue. Generally, primary teeth have a more bulbous (rounder) profile than permanent teeth. The primary canines are also relatively smaller than permanent canines. When primary molars are lost, they are replaced by the permanent premolars or bicuspids. The primary molars are usually slightly larger than the permanent premolars and have more cusps. The premolars generally have 2 cusps (with the exception of the lower second premolar, which has 3), while the primary molars can have 3-5 cusps. The primary molars can sometimes look like little flower buds. The primary molars are also much smaller than the permanent molars which erupt behind the primary molars. One other clue: primary teeth are almost always whiter than their permanent counterparts.

In some cases, you can see the permanent tooth already showing slightly through the gums. If there is a still a question as to which type of tooth this is, you might check in the mouth to see if another tooth is erupting. Also, when looking in the mouth, if you notice slightly bleeding gum tissue or maybe only a slight redness to the tissue, it is most likely a primary tooth. If you see a large hole and lots of blood, it is more likely a permanent tooth.

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