Dentists and especially paediatric dentists frequently refer to the “tooth fairy” when discussing the loss of primary teeth with their young patients and parents. However, like many legends there is debate as to whether this is fact or fiction. Is the tooth fairy simply a fantasy figure of early childhood? Folklore states that when a child loses a baby tooth and they place it under their pillow at bedtime the tooth fairy will come when the child is asleep and replace the tooth with a small amount of money. As paediatric dentistry specialists I’m certain that we have all discussed the tooth fairy many times with our patients and their parents. Is this custom confined to a few western countries or is it perhaps more widespread?

In earlier centuries in Europe, it was a tradition to bury baby teeth that fell out, and the parents left a gift or some money from the tooth fairy under the child’s pillow when the child had lost their sixth tooth. Nowadays some parents also sprinkle glitter on the floor to represent the trail that the tooth fairy took in the child’s bedroom. In northern Europe the tooth fairy is recorded in the writings of the Eddas, the earliest records of Norse traditions. In other countries around the world the legend of the tooth fairy is described differently. In Madrid in 1894, for example, originated Ratoncito Perez (Little Mouse Perez), a figure that has become popular in Spanish-speaking cultures. In Chile, Mexico and Peru he is called “El Raton de los Dientes” (the Tooth Mouse), while in Argentina, Columbia, Uruguay and Venezuela he is known as “El Raton Perez”. In Italy the tooth fairy is sometimes replaced by a small mouse, and in France and Francophone areas he is called “la petite souris” (the little mouse). In some Asian countries, when a child loses a tooth this is thrown into the air and while doing so the child asks for it to be replaced with the tooth of a mouse. This tradition is based on the fact that rodents’ teeth grow continuously during their entire lives.

There are few details of the tooth fairy’s appearance. Approximately 75 % of people believe the tooth fairy to be female. Descriptions include the Tinkerbell-type fairy with wings, wand etc., but some describe the tooth fairy as a man, a bunny rabbit or a mouse. Other descriptions are of a child with wings, a pixie, a ballerina, a mother-figure, a dragon, and a dental hygienist. Belief in the tooth fairy is viewed as part of the trusting nature of young children. Many parents are unsure whether they should promote the legend of the tooth fairy. Most children report positively when referring to the tooth fairy.

Does the tooth fairy leave a higher amount of money as a reward for healthy teeth? Some use the tooth fairy to promote good dental health, telling children that they will get more money from the tooth fairy for sound teeth than for decayed teeth. The question of how much is left is always of interest, and the amount has steadily increased over the years. The sum varies by country, socio-economic status of the parents, and how much the child reports their friends receive. A recent survey from the USA reported that American children currently (2013) receive an average of $3.70 (€2.80) per tooth. Nowadays most people have smartphones, and there is a tooth fairy app available for iPhones. This Tooth Fairy Calculator helps parents struggling to determine the going rate of a tooth by showing what the tooth fairy is leaving under the pillows of other children. By entering information including gender, education, age, family size, marital status and household income, parents can see how much the tooth fairy left in other households.

The tooth fairy in her/his many guises throughout the world will remain one of the favourite legends with young children and of course their parents. In 2010 a film called “Tooth Fairy”, starring Dwayne Johnson and Julie Andrews, was released as a family comedy. Perhaps in the future dentists will better use the tooth fairy to promote the oral health of children’s teeth.