Is Early Loss of Baby Teeth Linked to Early Puberty?

My daughter started losing her baby teeth at 3.5 years old. She’s now 6 and has lost at least 10, with two more loose. Her dentist is concerned that it’s hormonal and she could be at risk of early puberty, and suggested she see an endocrinologist. Any data to support the link? I searched and couldn’t find anything online, just a few myths that had been debunked. Thanks!
—Skeptical

As with many developmental milestones, there is a great degree of variation in what is normal when it comes to losing baby teeth — “primary tooth exfoliation,” as it is called in the medical literature. There are a number of factors that affect the timing of tooth exfoliation, the strongest of which is genetics. It is considered normal to lose a first baby tooth between the ages of 4 and 7. However, it is considered abnormal to begin losing primary teeth prior to age 4.

There is evidence that dental maturity is associated with skeletal maturity. The linked study looked at panoramic dental x-rays and compared them to a special type of hand x-ray called a bone age, which is a validated tool for assessing skeletal maturity. Girls with precocious puberty have increased skeletal maturity based on bone age. The authors found that the dental x-rays and specific markers of dental maturity were associated with greater skeletal maturity and with blood tests used to diagnose precocious puberty.

Additionally, early primary tooth exfoliation can be caused by some rarer hormonal problems — in particular, a genetic disorder called hypophosphatasia. Some forms of hypophosphatasia are caused by autosomal recessive mutations. If you remember back to high school Punnett squares, this means a child would need to get a mutated gene from each parent to be affected, so there may be no family history of the disorder.

The reason it is important to look for signs of both precocious puberty and hypophosphatasia is that identifying and treating kids early affects how they do later. You might go to the pediatric endocrinologist and be told there is nothing wrong at all, but if something is wrong, the earlier you intervene, the better.

Plus, there are very few pediatric endocrinologists, so the wait to see one can be months long. Much better to be waiting when your only concern is some early visits from the tooth fairy.

The takeaway: Losing baby teeth before age 4 is associated with precocious puberty in girls and some rare genetic disorders. Intervening early can be important in both cases, so it is reasonable to have a consultation with a specialist.