What Causes Late Teething in Babies And When To See A Doctor?

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The process of eruption of milk teeth is called teething. While the teething process follows a set pattern, it is not uncommon to see late teething in babies. The exact cause behind it is usually not always known. Nevertheless, most late teething cases are benign and do not need any intervention. Your pediatric dentist can help you rule out any other conditions that may require treatment.

Read this post to learn more about the causes and complications of late teething and when to see a doctor for it.

Normal Teething Chart For Babies

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It is essential to understand normal teething patterns in babies to determine delayed teething. The first teeth to erupt in your baby’s mouth are the lower front teeth, and they do so around six months of age. The upper front teeth are the next, followed by other teeth that emerge within their respective age range (1).

What Is Delayed Teething?

Teething is defined as the process of primary teeth eruption from the gums (2). If the teeth do not erupt during the usual age range or there is a significant deviation from their expected time of eruption, then the baby is considered to be experiencing delayed teething (3).

Several signs and symptoms accompany the process of a tooth’s eruption. Babies with delayed tooth eruption also display delayed teething symptoms.

Should You Be Concerned If Your Baby Starts Teething Late?

According to the Australian Dental Association, some babies may begin teething at an early age of four months, while some may start teething as late as ten months (1). There is usually no need to be concerned if your baby experiences delayed dental development.

Each baby achieves developmental milestones at a different age, and it is the same with teething. A baby can achieve teeth eruption at any age within the specified age range. Therefore, you may wait since the baby could eventually experience teething on attaining the upper limit of the age range.

When To Consult A Doctor?

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If your baby’s first teeth (lower central incisors) do not erupt even after the age of 12 months, see a pediatric dentist. Some babies are late bloomers and experience delayed teething for no specific reason. However, in some cases, delayed teething may occur due to underlying problems, which require diagnosis and treatment.

Other developmental milestones may not be related to teething; thus, do not wait for your baby to achieve dental milestones with others before taking them to a dentist (4).

What Causes Late Teething In Babies?

The following conditions may cause delayed teething in babies. Some of the reasons are pathological abnormalitiesⁱXAbnormality in structural or functional aspects of the body’s tissues or organs. and may require treatment to commence teething.

1. Hereditary factors

If you or your partner had similar late teething issues at the same age, it could likely be that your baby experiences similar issues.

2. Poor nutrition

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Studies have shown that low birth weight or poor nutritional status or nutritional insufficiency can affect teeth eruption. According to the Centers for Disease Control and Prevention, the percentage of babies born with low birth weight in the United States is 8.52%. The nutritional status of the body influences teeth in their pre-eruptive phase. Any deficiency in calcium and the vitamins D, C, B, and A can significantly impact your baby’s teething (5).

3. Thyroid disorders

Babies with thyroid disorders, especially hypothyroidismⁱXA condition caused due to thyroid gland's inability to produce sufficient amounts of thyroid hormone. , could have delayed teeth eruption. If they have any existing teeth, they may also have other dental problems, such as enamel hypoplasiaⁱXTooth abnormality that leads to reduced enamel (covering of the tooth crown) production. , open-bitesⁱXA dental condition where the top and bottom teeth do not meet when the mouth is closed. , or cross-bites (6).

4. Fibrosis

Fibrosis is a condition characterized by thick gums that impede or prevent the teeth from erupting. This could cause a delay in teeth eruption in some babies.

5. Hormonal issues

Problems in the secretion of the growth hormone, a hormone released by the pituitary gland, may significantly affect the development of facial structures, including the eruption of teeth. Hypopituitarism is one of the conditions that can cause the pituitary gland to secrete low levels of the growth hormone, leading to delayed teething, among other problems (7).

6. Systemic diseases and medication

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Many systemic disorders, such as iron-deficiency anemia and sickle-cell anemiaⁱXA genetic disorder characterized by abnormally shaped red bed cells and low levels of hemoglobin. , may delay teething (8). Certain long-term medications may also interfere with tooth eruption.

7. Injuries

Any trauma to the jaw could affect the tooth buds and delay teething. Injuries may also lead to fibrosis, which also causes delayed teething.

8. Impacted teeth

Milk teeth may also become impacted like permanent teeth. An impacted milk tooth may fail to erupt and stay lodged within the jaw or gums. A baby with impacted teeth is likely to experience other signs and symptoms, such as gum redness, gum swelling, and pain.

9. Absent or missing teeth

In rare cases, a baby may have a missing tooth, which could be mistaken for delayed teething (9).

10. Genetic disorders

Genetic conditions, such as amelogenesis imperfectaⁱXA rare genetic and developmental disorder indicated by abnormal enamel formation. and dentinogenesis imperfectaⁱXA rare genetic disease characterized by discoloration of teeth. , may affect the baby’s teeth and gums, increasing the risk of delayed teething. Premature babies may also be at risk of experiencing delayed dental development due to genetic reasons.

As a mother, Ananya Sri shares in her blog her premature-born son’s delayed teething journey. She says, “Anyway, it has been 1 year and 3 months since our son was born and still no sign of a tooth. “Finally, something that we should have done a long-long time ago, we decided to ask my very renowned dentist aunty from Hong Kong. She informed us that the calcification of teeth happens in the third trimester of fetal development and since Aarav was 2 months early, it means it is obvious that there will be a delay. She also warned us not to give too much calcium which we had halved over time to 5 ml daily because excessive calcium can lead to kidney stones. And then after months of rubbing my clean fingers on his gum to look for sharpness / hardness, my sister, Saumya finally spotted 3 mini teeth in Aarav’s gums (i)!!”

Certain genetic disorders could affect the musculoskeletal growth of the body, affecting even the eruption of the teeth. Some genetic disorders associated with delayed teething are Down syndrome, Turner syndrome, Gardner syndrome, Hutchinson-Gilbert syndrome (Progeria)ⁱXA rare genetic condition marked by accelerated aging. , and Bloch–Sulzberger syndromeⁱXAn uncommon genetic disorder affecting several organs, including the eyes, skin, teeth, and central nervous system.  (10). A baby with these disorders is likely to experience other significant symptoms as well.

Quick fact

Cleidocranial dysplasia is a condition that affects the bone and teeth development. It may cause late teething (12).

Complications Of Delayed Teething

Complications of delayed teething may depend on the underlying reason. Delayed teething due to no apparent reasons or due to benign reasons may not lead to complications.

In some cases, delayed teething may cause the following complications.

1. Jaw bone deformity and asymmetrical face: Delayed teething also causes a delay in permanent teeth eruption. This leads to misalignment of jaws leading to long-term issues, such as an asymmetrical face. This complication may usually arise in babies who experience delayed teething due to severe problems, such as genetic disorders.

2. Delay in chewing food: A delay in the emergence of primary teeth could delay the age at which you add solid food to your baby’s diet. It could cause a delay in learning how to chew solid food. Inability to eat solid food may increase the risk of other issues, such as malnutrition.

3. Formation of cysts: Impacted or embedded teeth increase the risk of developing a cyst around them. It could cause intense pain and may require surgical intervention.

4. Crowded permanent teeth: Primary teeth work as placeholders for permanent teeth. Any issues in primary teeth could also impact permanent teeth. The untimely eruption of primary teeth may interfere with the eruption of permanent teeth, affecting their alignment or causing them to become impacted.

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Point to consider

Teeth play an important part in speech (13). Late teething may cause delayed development of speech.
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Infographic: Common Misconceptions About Delayed Teething

Late teething is common in some babies and is not always a reason to worry. In such cases, it is crucial not to believe in non-scientific misconceptions, as this infographic mentions. Seek a pediatrician or pediatric dentist’s advice to understand the underlying reasons and solutions for delayed teething.

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Dr. Tazeen RaeesMDS

Dr. Tazeen Raees holds a master’s degree in Prosthodontics and Implantology and is working as a chief prosthodontics mentor at APJ Abdul Kalam Education Centre, Indian Dental Association, Mumbai. She has over six years of experience. Dr. Raees has various national and international publications to her credit and is strongly inclined towards research activities. She attended an exclusive observership program...more

Dr. Meenakshi MaruwadaBDS, PGCAD

Dr. Meenakshi is a dentist and a passionate writer with over eight years of experience in dentistry and four years in writing. She started her career as a dentist with a dental chain in Mumbai and soon rose to lead the clinic as a Head Dentist. She then switched to working for two start-ups in healthcare, before beginning her own...more

Rohit GarooBSc, MBA

Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University. Also, he holds a certificate in Developmental Psychology from The University of Queensland and loves to expand his knowledge through certifications in various...more

Anindita GhatakB.Tech

Anindita Ghatak holds a B.Tech degree in Biotechnology from Amity University, Kolkata. During the course of her studies, she has worked on different research projects in the fields of Microbiology and Bioinformatics. Anindita has over three years of experience writing medical articles for journals. Her interest in writing on different health-related topics and their accessibility to people have led her...more