Your Child's Teeth.....................

 

The following chart shows when primary teeth (also called baby teeth or deciduous teeth) erupt and shed. Please note that eruption times can vary from child to child.

As seen from the chart, the first teeth begin to break through the gums at about 6 months of age. Usually, the first two teeth to erupt are the two bottom central incisors (the two bottom front teeth). Next, the top four front teeth emerge. After that, other teeth slowly begin to fill in, usually in pairs – one each side of the upper or lower jaw – until all 20 teeth (10 in the upper jaw and 10 in the lower jaw) have come in by the time the child is 2 Ѕ to 3 years old. The complete set of primary teeth is in the mouth from the age of 2 Ѕ to 3 years of age to 6 to 7 years of age.

 

Primary Teeth Development Chart
- Upper Teeth When tooth emerges When tooth falls out
- Central incisor 8 to 12 months 6 to 7 years
- Lateral incisor 9 to 13 months 7 to 8 years
- Canine (cuspid) 16 to 22 months 10 to 12 years
- First molar 13 to 19 months 9 to 11 years
- Second molar 25 to 33 months 10 to 12 years

Lower Teeth
- Second molar 23 to 31 months 10 to 12 years
- First molar 14 to 18 months 9 to 11 years
- Canine (cuspid) 17 to 23 months 9 to 12 years
- Lateral incisor 10 to 16 months 7 to 8 years
- Central incisor 6 to 10 months 6 to 7 years

Other primary tooth eruption facts:
• A general rule of thumb is that for every 6 months of life, approximately 4 teeth will erupt.

• Girls generally precede boys in tooth eruption

• Lower teeth usually erupt before upper teeth

• Teeth in both jaws usually erupt in pairs – one on the right and one on the left

• Primary teeth are smaller in size and whiter in color than the permanent teeth that will follow

• By the time a child is 2 to 3 years of age, all primary teeth should have erupted
Shortly after age 4, the jaw and facial bones of the child begin to grow, creating spaces between the primary teeth. This is a perfectly natural growth process that provides the necessary space for the larger permanent teeth to emerge. Between the ages of 6 and 12, a mixture of both primary teeth and permanent teeth reside in the mouth.

Why Is it Important to Care for Baby Teeth?

 

While it's true that primary teeth are only in the mouth a short period of time, they play a vital role.

• They reserve space for their permanent counterparts.
• They give the face its normal appearance.
• They aid in the development of clear speech.
• They help attain good nutrition (missing or decayed teeth make it difficult to chew causing children to reject foods).
• They help give a healthy start to the permanent teeth (decay and infection in baby teeth can cause dark spots on the permanent teeth developing beneath it).
To understand the problems that decaying baby teeth can cause in permanent teeth, see Oral Health Problems in Children.

Caring for Your Baby's Teeth

 

Baby teeth are important because they allow an infant to eat a good diet, allow for proper jaw growth, give the face its form and appearance, assist in the formation of proper speech, and most important, act as "space savers" for adult teeth. Tooth decay in babies can lead to pain, infection, malnutrition, poor weight gain, and premature loss of teeth – which can affect the development of permanent teeth.

In addition, oral health problems in an infant's mouth, such as bleeding gums and cavities, increase the chance for these problems in permanent teeth. Good oral health habits – started at an early age at home – increase the chance for a healthy mouth during your child's young life and carry on through adulthood.

When to Start Caring for Your Baby's Teeth

 

It's a good idea to get in the habit of cleaning your baby's gums even before teeth emerge.
To clean your baby's mouth:
1. Lay your baby in your lap with his or her head close to your chest.
2. Gently, but firmly, rub a clean and damp piece of gauze or washcloth along both the upper and lower gums.
3. Clean the gums at least two times a day – after breakfast and after the last feeding of the day. Even better – clean your baby's gums after every feeding.
What Is Teething?
Teething refers to the time when baby teeth (also called deciduous teeth or primary teeth) appear. Generally, teething first occurs between 6 months and 24 months of age. While this process is uneventful in some children; for others, it causes quite a bit of discomfort and irritability.

What Are Symptoms of Teething?

Symptoms include:
• Increased irritability
• Placing objects or fingers in the mouth and biting down on them
• Increased saliva or drooling
• Loss of appetite or becoming choosy about foods
• Tender and swollen gums
• Rash on cheeks or redness in the area of the cheeks near the affected gums
• Restlessness
• Ear pulling, which may be a sign of teething or possibly an ear infection (make an appointment to have your child seen by your doctor or pediatrician)
Teething does not result in fever, vomiting, or diarrhea. If your child experiences these problems, contact your doctor.

What Can I Do to Ease Teething Pain?

• Massage your child's gums with a clean finger or the back of a small cold spoon
• Allow your child to bite down on a chilled (but never frozen) teething ring. A frozen teething ring can damage the gums.
• Try an over-the-counter teething ointment to numb the gums. Ask your dentist or doctor for some product recommendations.
• Allow your child to suck on a cold, wet cloth
Teething biscuits or cookies and frozen bananas are not recommended. These objects promote tooth decay and may cause your child to choke.
What Should I Do if My Baby Was Born With Teeth?
Some infants are born with one or more teeth (called natal teeth) or may have teeth emerge within the first 30 days of life (called neonatal teeth).

These usually are either extra teeth or are remnants from neonatal development that do not need treatment. If they are, however, actual teeth, it's a good idea to maintain them. Your doctor, however, may recommend removing them if the teeth are loose and pose a danger of being inhaled by your baby. Early teeth may also interfere with feeding or irritate your baby's tongue.
Talk to your doctor to see what treatment is right for your baby

Brushing and Flossing Your Child's Teeth

Teeth should be cleaned as soon as they emerge. By starting early, your baby gets used to the daily routine. A soft washcloth wrapped around your finger can substitute for a brush when teeth first appear. Ask your dentist when you should switch to a toothbrush. Some dentists suggest waiting until four teeth in a row have come out; others recommend waiting until the child is 2 or 3 years old.
Click here for an animated demonstration on the proper way to brush.

Points to Consider
• Choose a small, child-sized, soft-bristled toothbrush. Soaking the brush in warm water for a few minutes before brushing can soften the bristles even more.

• Many dentists recommend using only plain water for brushing up to the age of 2. This is because young children swallow toothpaste and swallowing too much fluoride can lead to tooth discoloration in permanent teeth. Ask your dentist if toothpaste should be used. Also, check the manufacturer's label; some toothpastes are not recommended in children under age 6. If a toothpaste is to be used, squeeze out about a green pea-size amount of fluoride toothpaste onto the toothbrush.

• Brush your child's teeth twice a day – in the morning and just before bed. Spend 2 minutes brushing, concentrating a good portion of this time on the back molars. This is an area where cavities often first develop.

• Replace the toothbrush every 3 or 4 months, or sooner if it shows signs of wear. Never share toothbrushes between children.

• Start flossing your child's teeth once a day as soon as two teeth emerge that touch.

• Ask your dentist about your child's fluoride needs. If your drinking water is not fluoridated, fluoride supplements or fluoride treatments may be needed.

• Ask your dentist about dental sealants. These are thin, plastic protective barriers that fill in the chewing surfaces of the teeth, protecting them from tooth decay.

 

When Should Children Brush and Floss on Their Own?

 

Most children lack the coordination to brush or floss their teeth on their own until about the age of 6 or 7. Up until this time, remember that the best way to teach a child how to brush their teeth is to lead by example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

 

How Safe Is Fluoride for My Child?

Fluoride is safe for children. Fluoride is a natural mineral that protects and strengthens the teeth against the formation of cavities. Using it early in your child's life will provide extra protection for developing teeth. Find out if your tap water contains fluoride by calling your local water authority. If your tap water does not contain fluoride, ask your dentist if you should give your child a fluoride supplement.

 

Do Home Faucet Filters Remove Fluoride?

 

There is a wide variation in water filters. Some do filter out fluoride; others do not. Check with the manufacturer of the filter you have purchased or have the water tested by a laboratory that does this type of testing.

 

Does It Matter What Toothpaste My Child Uses?

Many children's toothpastes are flavored with child-pleasing tastes to further encourage brushing. Select your child's favorite. Also, look for toothpastes that carry the American Dental Association's Seal of Acceptance. This indicates that the toothpaste has met ADA criteria for safety and effectiveness. Finally, read the manufacturer's label. Some toothpastes are not recommended for children under a certain age.

 

Can My Child Use a Mouthwash?

Generally, mouthwashes are not recommended in children who are incapable of spitting and rinsing – skills that occur around the age of 6. It's important to note that mouthwashes are not a substitute for brushing. Mouthwashes do not help clean the teeth.

 

When Should My Child Start Seeing a Dentist?

It is generally recommended that an infant be seen by a dentist by the age of 1 or within 6 months after his or her first tooth comes in.

Nutrition and Your Child's Teeth

What your child eats affects his or her teeth. Too many carbohydrates, both sugars (for example, from cake, cookies, candies, milk, and other sugary foods and beverages) and starches (for example, pretzels and potato chips) can cause tooth decay. How long carbohydrates remain on the teeth is the main culprit that leads to tooth decay.

The best thing you can do as a parent is to teach your child to make healthy food choices. Here are some tooth-friendly foods to serve your children along with some other tips:

• Fruits and vegetables: Offer fruits and vegetables as a snack instead of carbohydrates. Fruits and vegetables that contain a high volume of water, such as pears, melons, celery, and cucumbers are best. Limit banana and raisin consumption as these contain concentrated sugar or if you serve these fruits, try to brush your child's teeth immediately after they are eaten.

• Cheese. Serve cheese with lunch or as a snack, especially cheddar, Monterey Jack, Swiss and other aged cheeses which help to trigger the flow of saliva. Saliva helps to wash food particles away from teeth.

• Avoid sticky, chewy foods. Raisins, dried figs, granola bars, oatmeal or peanut butter cookies, jelly beans, caramel, honey, molasses and syrup stick to teeth making it difficult for saliva to wash the sugar away. If your child consumes these types of products, have them brush their teeth immediately after eating.

• Serve sugary treats with meals, not as snacks. If you plan to give your child any sweets, give them as desserts immediately following the meal. There's usually an increased amount of saliva in the mouth around mealtime, making it easier to wash food away from teeth. The mealtime beverage also helps to wash away food particles on teeth.

• Get your children in the habit of eating as few snacks as possible. The frequency of snacking is far more important than the quantity consumed. Time between meals allows saliva to wash away food particles that bacteria would otherwise feast on. Frequent snacking, without brushing immediately afterwards, provides constant fuel to feed bacteria, which leads to plaque development and tooth decay. Try to limit snacks as much as possible and to no more than one or two a day. Brush teeth immediately after consuming the snack if possible.

• Avoid sugary foods that linger on the teeth. Lollipops, hard candies, cough drops and mints all contribute to tooth decay because they continuously coat the teeth with sugar.

• Buy foods that are sugar-free or unsweetened.

• Never put your baby to bed with a bottle filled with milk, formula, juice, or soda. If your baby needs a bottle at bedtime, fill it with plain water.

• Offer your child plain water instead of juice or soda. Juices, sodas and even milk contain sugar. Water does not harm the teeth and aids in washing away any food particles that may be clinging to teeth.

• Include good sources of calcium in your child's diet to build strong teeth. Good sources include milk, broccoli and yogurt.

Other Tips:
• If your child chews gum, encourage him or her to choose xylitol-sweetened or sugar-free gum. Xylitol has been shown to reduce the amount of bacteria in the mouth and the chewing action helps increase the flow of saliva.

• Use fluoride-containing toothpastes and brush and floss your child's teeth daily. The best way to prevent tooth decay is to use fluoride-containing toothpaste every day. (Fluoride toothpaste should only be used in children old enough to spit out the remaining toothpaste.) The fluoride seeps inside the tooth to reverse early decay. Brush your child's teeth at least twice a day and after each meal or snack if possible. If brushing between meals is not possible, at least rinse the mouth with water several times. Floss your child's teeth at least once a day to help remove particles between teeth and below the gum line.

• Brush your child's teeth after giving him or her medicine. Medicines such as cough syrups contain sugar that bacteria in the mouth use to make acids. These acids can eat away at the enamel -- the protective top layer of the tooth.

• Visit the dentist regularly. It is generally recommended that you take your child to the dentist starting at age 1 or within 6 months of the first tooth breaking through the gums. Getting regular dental check ups will also help catch any developing dental problems early.

Oral Health Problems in Children

There are a number of problems that affect the oral health of children, including tooth decay, thumb sucking, tongue thrusting, lip sucking, and early tooth loss. Even though baby teeth are eventually replaced with permanent teeth, keeping baby teeth healthy is important to a child's overall heath and well-being.

Baby Bottle Tooth Decay
Baby bottle tooth decay (also called early childhood caries, nursing caries, and nursing bottle syndrome) occurs when a baby's teeth are in frequent contact with sugars from liquid carbohydrates, such as fruit juices, milk, formula, fruit juice diluted with water, sugar water or any other sweet drink. Human breast milk can cause tooth decay as well. As these liquids break down in the mouth into simple sugars and are allowed to sit in the mouth, bacteria start feeding on the sugars, causing tooth decay.

If left untreated, decayed teeth can cause pain and make it difficult to chew and eat. Also, baby teeth serve as "space savers" for adult teeth. If baby teeth are damaged or destroyed, they can't help guide permanent teeth into their proper position, possibly resulting in crowded or crooked permanent teeth. Badly decayed baby teeth could lead to an abscessed tooth, with the possibility of infection spreading elsewhere.

How Do I Prevent Baby Bottle Tooth Decay?

Some tips to prevent baby bottle tooth decay include:

1. During the day, to calm or comfort your baby, don't give a bottle filled with sugary liquids or milk; instead, give plain water or substitute a pacifier.

2. At anytime, don't dip your baby's pacifier in sugar, honey, or any sugary liquid.

3. At bedtime, don't put your baby to bed with a bottle filled with sugary liquids (watered-down fruit juice or milk still increases the risk of decay). Give plain water.

4. Don't allow your baby to nurse continuously throughout the night while sleeping, since human breast milk can cause decay. Use a pacifier or give a bottle filled with plain water instead.

5. Don't add sugar to your child's food
6. Use a wet cloth or gauze to wipe your child's teeth and gums after each feeding. This helps remove any bacteria-forming plaque and excess sugar that have built up on the teeth and gums.

7. Ask your dentist about your baby's fluoride needs. If your drinking water is not fluoridated, fluoride supplements or fluoride treatments may be needed.

8. Teach your baby to drink from a cup by his or her first birthday. Moving to a "sippy cup" reduces the teeth's exposure to sugars; however, constant sipping from the cup can still result in decay unless it is filled with water.

Thumb Sucking

Generally, it's normal and healthy for infants to suck their thumbs, fingers, pacifiers or toys. Object sucking gives children a sense of emotional security and comfort. However, if thumb sucking continues beyond the age of 5 – when the permanent teeth begin to come in – dental problems may occur. Depending on the frequency, intensity, and duration of the sucking, the teeth can be pushed out of alignment, causing them to protrude and create an overbite. The child may also have difficulty with the correct pronunciation of words. In addition, the upper and lower jaws can become misaligned and the roof of the mouth might become malformed.

 

Tips to Help Your Child Stop Thumb Sucking

First, remember that thumb sucking is normal and should not be a concern of parents unless the habit continues as the permanent teeth begin to emerge.

The child must make the decision on their own to stop sucking their thumb or fingers before the habit will cease. To help toward this goal, parents and family members can offer encouragement and positive reinforcement. Because thumb sucking is a security mechanism, negative reinforcement (such as scolding, nagging, or punishments) are generally ineffective – making children defensive and driving them back to the habit. Instead, give praise or rewards for time successfully avoiding the habit. Gradually increase the time needed without sucking to achieve the reward. The younger the child, the more frequent the rewards will need to be given. For children who want to stop, cover the finger or thumb with a band-aid as a reminder. Take the thumb or finger out of the mouth after the child falls asleep.

To help older children break the habit, parents should try to determine why their child is doing it – find out what stresses your child faces and try to correct the situation. Once the problem is gone, the child often finds it is easier to give up sucking. If this doesn't work, there are dental appliances a child can wear in the mouth to prevent sucking. These appliances are cemented to the upper teeth, sit on the roof of the mouth and make thumb sucking harder and therefore less pleasurable.

 

Tongue Thrusting

Tongue thrusting is the habit of sealing the mouth for swallowing by thrusting the top of the tongue forward against the lips.
Just like thumb sucking, tongue thrusting exerts pressure against the front teeth, pushing them out of alignment – which causes them to protrude, creating an overbite and possibly interfering with proper speech development.
If you notice symptoms of tongue thrusting, consult a speech pathologist. This person can develop a treatment plan that helps your child to increase the strength of the chewing muscles and to develop a new swallowing pattern.

 

Lip Sucking
Lip sucking involves repeatedly holding the lower lip beneath the upper front teeth. Sucking of the lower lip may occur by itself or in combination with thumb sucking. This practice results in an overbite and the same kinds of problems as discussed with thumb sucking and tongue thrusting. Stopping the habit involves the same steps as described for stopping thumb sucking.

Early Tooth Loss
Premature loss of a child's primary teeth typically occurs due to tooth decay, injury, or lack of jaw space.
If teeth are lost before the permanent teeth emerge, the nearby teeth can tip or shift into the space now unoccupied. When a permanent tooth tries to emerge into its space, there may not be enough room. The new tooth may emerge tilted. Crooked or misaligned teeth can cause a range of problems from interfering with proper chewing to causing temporomandibular joint problems.

If your child loses a tooth prematurely, your dentist may recommend a space maintainer. A space maintainer is a plastic or metal device that holds open the space left by the missing tooth. Your dentist will remove the device once the permanent teeth begin to erupt.

Your Child's First Dental Appointment

It is generally recommended that an infant be seen by a dentist by the age of 1 or within 6 months after his or her first tooth comes in.

 

What Happens at the First Dental Visit?

The first dental visit is usually short and involves very little treatment. This visit gives your child an opportunity to meet the dentist in a non-threatening and friendly way. Some dentists may ask the parent to sit in the dental chair and hold their child during the examination. The parent may also be asked to wait in the reception area during part of the visit so that a relationship can be built between your child and your dentist.

During the examination, your dentist will check all of your child's existing teeth for decay, examine your child's bite, and look for any potential problems with the gums, jaw, and oral tissues. If indicated, the dentist will clean any teeth and assess the need for fluoride. He or she will also educate parents about oral health care basics for children and discuss dental developmental issues and answer any questions.

Topics your dentist may discuss with you might include:

1. Good oral hygiene practices for your child's teeth and gums and cavity prevention
2. Fluoride needs
3. Oral habits (thumb sucking, tongue thrusting, lip sucking)
4. Developmental milestones
5. Teething
6. Proper nutrition
7. Schedule of dental check up visits. Many dentists like to see children every 6 months to build up the child's comfort and confidence level in visiting the dentist, to monitor the development of the teeth, and promptly treat any developing problems.

You will be asked to complete medical and health information forms concerning the child during the first visit. Come prepared with the necessary information.

When Should Children Get Their First Dental X-Ray?

There is no hard-and-fast rule for when to start getting dental X-rays. Some children who may be at higher risk for dental problems (for example, those prone to baby bottle tooth decay or those with cleft lip/palate) should have X-rays taken earlier than others. Usually, most children will have had X-rays taken by the age of 5 or 6. As children begin to get their adult teeth around the age of 6, X-rays play an important role in helping your dentist. X-rays allow your dentist to see if all of the adult teeth are growing in the jaw, to look for bite problems and to determine if teeth are clean and healthy.

Easing Your Child's Fear of the Dentist

Parents and dentists each play an important role in making the first dental appointment a positive experience. Any anxiety displayed by parents will be "picked up" by the child. And, an unfriendly dentist can cause unnecessary fear in the child.

Parent's Role

To help the dental visit go more smoothly:

1. Tell your child about the visits but limit the amount of details given. Answer any questions with simple, to-the-point answers. Let the dentist answer more complex or detailed questions. Dentists are trained to describe things to children in a non-threatening way and in easy-to-understand language
2. Don't tell your child that something will hurt or be painful.
3. Don't tell your child about an unpleasant dental experience that you've had.
4. Stress to your child how important it is to maintain healthy teeth and gums and that the dentist is a friendly doctor whose job it is to help do this.
5. Don't promise a reward for going to the dentist
Keep in mind that it is perfectly normal for children to be fearful – some are afraid of being separated from their parents; others are afraid of the unknown; others are afraid of being injured. A dentist who treats children will know how to cope with your child's fears and anxiety and put them at ease.

Dentist's Role

Children's fears can be expressed in a number of ways. Some children may cry; others may throw temper tantrums. Dentists often will use techniques to ease children's fears, including some of the following:

1. The dentist should talk in a friendly voice that could become firmer if necessary.
2. Simple words should be used to describe the procedure. Sometimes dentists will demonstrate the procedure on a doll or another person before performing the procedure on the child.
3. Many times dentists will tell stories or engage the child in conversation as a means of drawing attention away from the procedure.
4. Dentists often will use body language, such as a simple smile or frown, to reinforce positive behavior and discourage negative behavior. Praise and compliments should be given to reinforce good behavior.
5. The dentist may use sedation to help the child relax and be more comfortable, if necessary. The two most common types of sedation that might be used in children are nitrous oxide ("laughing gas") or an oral sedative (such as Valium).

If your dentist does not take steps to ease your child's fears, consider finding another dentist. It is important that your child have a positive experience at the dentist during their early years so that he or she does not develop an ongoing fear of oral health