Disclaimer – Remember what you read on this site or any site is not a substitute for advice given by your dentist. Content here is generalized, your situation may require indvidualized solution that only a licensed professional providing direct care can provide. Consult your child’s dentist before taking any action.
American Academy of Pediatric Dentist provides a comprehensive educational resource for parents. They are the “Big authority on Little Teeth” so we decided to give them their due and put the link here. For your convenience, we have included some excerpts with or without modification below. Please visit AAPD website.
Baby Oral care
When Will My Baby Start Getting Teeth?
Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general the first baby teeth are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See “Eruption of Your Child’s Teeth” for more details.
Eruption Of Your Child’s Teeth
Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).
Baby’s First Tooth
When that first tooth makes an entrance, it’s time to upgrade to a baby toothbrush. During this time, your child’s gums may feel tender and sore. To help alleviate this discomfort, we recommend that you soothe the gums by rubbing a clean finger or a cool, wet cloth across them. You may also choose to make use of a teething ring. When your child has finished teething, you can expect a total of 20 primary teeth.
Baby teeth aren’t permanent. Why do they need special care?
Although they don’t last as long as permanent teeth, your child’s first teeth play an important role in his development. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13. Baby teeth help your little one in development of speech, smile, and chew properly. They also hold space in the jaw for permanent teeth. If a child loses a tooth too early (due to damage or decay) nearby teeth may encroach on that space, which can result in crooked or misplaced permanent teeth. Also, your child’s general health is affected by the oral health of the teeth and gums.
What’s the best way to clean my baby’s teeth? Caring for Gums
Your child’s first primary or baby teeth will begin to erupt between the ages of six and 12 months, and will continue to erupt until about age three. Even before your baby’s first tooth appears, the gums can benefit from your careful attention. We recommend you clean his gums after feedings with a damp, soft washcloth. After breast- or bottle-feeding, wrap one finger with a clean, damp washcloth or piece of gauze and gently rub it across your baby’s gum tissue. This practice both clears your little one’s mouth of any fragments of food and begins the process for building good daily oral care habits.
Choosing Baby Toothbrush
Choose a toothbrush with soft bristles and a small head. You most likely can find a toothbrush designed for infants at your local drugstore. There are usually two options: a long-handled toothbrush that you and your baby can hold at the same time, and a finger-puppet-like brush that fits over the tip of your pointer finger. In each case, the bristles are soft and few.
At this stage, toothpaste isn’t necessary; just dip the brush in water before brushing. If your little one doesn’t react well to the introduction of a toothbrush, don’t give up. Switch back to a damp washcloth for a few months and try the toothbrush again. During the teething process, your child will want to chew on just about anything, and a baby toothbrush with a teether can become a favorite toy during this period.
Brushing with Toothpaste
When a few more teeth appear, you can start using toothpaste with your child’s brush. However, for the first two years, be sure to choose toothpaste that does not contain fluoride, unless advised to do so by your dentist, because too much fluoride can be dangerous for youngsters. At this stage, use only a tiny amount of toothpaste. From the beginning, have your little one practice spitting the toothpaste out after brushing to prepare for fluoride toothpaste, which should not be swallowed at any age. Parent brushing a child’s teeth until age 6-7yr will train the child to brush appropriately.
Your child’s primary teeth are shed at various times throughout childhood. Permanent teeth begin erupting at age six, and continue until age 21. Adults have 28 permanent teeth (32, including wisdom teeth).
Bleeding after a baby tooth falls out
Fold and pack a clean gauze and place over bleeding area. Have the child bite the gauze for 15 minutes. If bleeding persists, call Dentist.
Baby Bottle Tooth Decay (Early Childhood Caries) Avoiding Cavities
One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.
Make sure your baby never goes to bed with a bottle; sugary liquids in prolonged contact with teeth are a guarantee for early-childhood decay, also called baby-bottle caries.Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.Don’t give your baby any sort of sweetened liquids such as flavored drinks or soda. Even the sugars present in fruit juice, formula, and milk (this goes for breast milk as well) can cause decay, so regular teeth and gum cleaning is vital.
First Visit to the Dentist
According to the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by his/her 1st birthday. Dr. Baliga recommend’s that you bring your baby in for a visit within six months of the first tooth’s eruption – usually around his or her first birthday. Since decay can occur in even the smallest of teeth, the earlier your baby visits us, the more likely he or she is to avoid problems. We’ll look for any signs of early problems with your baby’s oral heath, and check in with you about the best way to care for your little one’s teeth. Remember that preparing for each dental visit with a positive attitude goes a long way toward making your child comfortable with regular checkups. Your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
Setting a Good Example
As part of the natural learning process, little ones are expert mimics, and you can take advantage of this talent. Brush and floss daily while your child is watching, and he or she will intuit at an early age the importance of your good habits. As soon as your child shows interest, offer a toothbrush of his or her own and encourage your toddler to “brush” with you. (You’ll find toothbrushes with chunky, short handles that are easy to grip.) Most children don’t have the dexterity necessary to thoroughly clean their own teeth until they’re about six or seven, so you’ll have to do that part of the job. Try different tactics to make brushing fun: flavored toothpaste, a toothbrush with a favorite character on it, or singing songs about brushing. The primary goal is to instill healthy oral habits at an early age to set your child up for a lifetime of healthy, cavity-free teeth!
Adopting Healthy Oral Hygiene Habits
Brushing can be fun, and your child should brush as soon as the first tooth arrives. When a baby’s tooth erupts, parents should brush the tooth with a soft-bristled toothbrush and a pea-sized amount of toothpaste. For children younger than two, do not use fluoride toothpaste unless advised to do so by your dentist or other healthcare professional. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly.
Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.
Flossing is also a part of good oral hygiene habits, and your doctor will discuss with you the right time to start flossing. If you notice signs of decay, contact your dentist immediately. Flossing removes plaque between the teeth where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You should floss the child’s teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth.
How often should my child visit the dentist?
We recommend fluoride treatments twice a year along with cleanings to keep teeth their strongest.
Tooth sealants are also recommended because they “seal” the deep grooves in your child’s teeth, preventing decay from forming in these hard-to-reach areas. Sealants last for several years, but will be monitored at your child’s regular checkups.
Dental preventive care Tips
What causes cavities?
Certain types of bacteria live in our mouths. When these bacteria come into contact with sugary foods left behind on our teeth after eating, acids are produced. These acids attack the enamel on the exterior of the teeth, eventually eating through the enamel and creating holes in the teeth, which we call cavities.
How can I help my child avoid cavities?
Be sure that your child brushes his teeth at least twice a day with fluoride toothpaste. Flossing daily is also important, because flossing can reach spots between the teeth that brushing can’t. Check with your pediatric dentist about a fluoride supplement which helps tooth enamel become harder and more resistant to decay. Avoid sugary foods and drinks, limit snacking, and maintain a healthy diet. And finally, make regular appointments so that we can check the health of your child’s teeth and provide professional cleanings.
Listerine and generic equivalents used twice daily help reduce gingivitis when accompanied by proper brushing and flossing. Chlorhexidine containing rinses may be prescribed by your dentist. These mouthwashes are more effective than Listerine but are available by prescription only.
Chewing sugarless gum has been shown to reduce cavities. Look for gums sweetened with xylitol, which has been shown to reduce cavities much more than those using other sweeteners. Gum chewing stimulates saliva flow which buffers acids and aids in the immunity of the mouth. Xylitol helps reduce the activity of decay causing bacteria.
Reduce Frequency of Sugar Intake
The amount of sugars eaten throughout the day is not as important as the frequency of intake. This includes both simple sugars and starches. The mouth has a natural buffering capacity in the saliva which neutralizes the bacterial acids, thus minimizing decalcification of enamel. Frequent sugar doses overloads this ability.
Good Diet = Healthy Teeth
Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children’s teeth.
Brush and Floss
No one likes the twice annual lecture from their dentist or hygienist regarding the ills of poor oral hygiene, particularly flossing. We really are not as plaque obsessed as we seem. The reason to remove plaque thoroughly from all surfaces at least once a day are fairly simple. Both decay and periodontal diseases are infections caused by a number of specific bacteria which live in the plaque deposits. Once removed it takes about twenty four hours for the bacteria to grow to pathologic (disease causing) levels. Brushing only allows these germs to thrive between the teeth, so flossing daily is imperative. The simple act of proper daily hygiene will prevent the majority of dental troubles in most people.
Does my child need dental sealants?
Sealants cover the pits and fissures in teeth that are difficult to brush and therefore susceptible to decay. We recommend sealants as a safe, simple way to help your child avoid cavities, especially for molars, which are hardest to reach.
Using Fluoride to Protect Your Teeth
You brush your teeth twice a day, floss regularly and visit the dentist every six months, but did you know that rinsing with fluoride — a mineral that helps prevent cavities and tooth decay — also helps keep your teeth healthy and strong?
Fluoride is effective in preventing cavities and tooth decay by coating your teeth and preventing plaque from building up and hardening on the tooth’s surface.
Fluoride comes in two varieties, systemic and topical:
- Systemic fluoride is ingested, usually through a public water supply. While teeth are forming under the gums, the fluoride strengthens tooth enamel, making it stronger and more resistant to cavities.
- Fluoride can also be applied topically to help prevent caries (cavities) on teeth present in the mouth. It is delivered through toothpaste, mouthwash, and professional fluoride applications.
Receiving a fluoride treatment from your dentist
A fluoride treatment in your dentist’s office takes just a few minutes. After the treatment, patients may be asked not to rinse, eat, or drink for at least 30 minutes in order to allow the teeth to absorb the fluoride. Depending on your oral health or your doctor’s recommendation, you may be required to have a fluoride treatment every three, six, or 12 months. Your doctor may also prescribe an at-home fluoride product such as a mouthwash, gel, or antibacterial rinse.
How to choose the right fluoride treatment
When choosing your own at-home fluoride product (such as toothpaste or mouthwash), always check for the American Dental Association’s (ADA) seal of acceptance. Products marked with the ADA seal of approval have been carefully examined by the ADA, and approved based on safety and effectiveness. Take care of your teeth and smile bright with dental fluoride treatments!
Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
- Too much fluoridated toothpaste at an early age.
- The inappropriate use of fluoride supplements.
- Hidden sources of fluoride in the child’s diet.
Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.
Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:
- Use baby tooth cleanser on the toothbrush of the very young child.
- Place only a pea sized drop of children’s toothpaste on the brush when brushing.
- Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
- Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
- Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).
Dental Radiographs (X-Rays)
Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed. Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.
The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.
Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. High-speed film and proper shielding assure that your child receives a minimal amount of radiation exposure.
In most cases, the answer is no. However, it’s important to pay attention to your child’s habits in case his or her behavior has the potential to affect overall oral health.
What is normal thumb-sucking behavior?
Most children begin sucking their thumbs or fingers from a very young age; many even start inside the womb. Sucking is a natural reflex for an infant and it serves an important purpose. Sucking often provides a sense of security and contentment for a young one. It can also be relaxing, which is why many children suck their thumbs as they fall asleep.
According to the American Dental Association, most children stop thumb sucking on their own between the ages of two and four. They simply grow out of a habit that is no longer useful to them. However, some children continue sucking beyond the preschool years (although studies show that the older a child gets, the lower the chances are of continuing the habit). If your child is still sucking when his or her permanent teeth start to erupt, it may be time to take action to break the habit.
What signs should I watch for?
First, take note of how your child sucks his or her thumb. If the sucking is passive, with the thumb gently resting inside the mouth, it is less likely to cause damage. If, on the other hand, the thumb sucking is aggressive, placing pressure on the mouth or teeth, the habit may cause problems with tooth alignment and proper mouth growth. Extended sucking affects both the teeth and the shape of the face and may lead to a need for orthodontic treatment in the future.
If at any time you suspect your child’s thumb sucking may be affecting his or her oral health, please give us a call and schedule a visit. We can help you assess the situation.
How can I help my child quit thumb sucking?
Should you need to help your child end the habit, follow these guidelines:
- Always be supportive and positive. Instead of punishing your child for thumb sucking, give praise when he or she doesn’t.
- Put a band-aid on your child’s thumb or a sock over the hand at night. Let your little one know that this is not a punishment, but rather a way to help remember to avoid sucking.
- Start a progress chart and let your child put a sticker up every day that he or she doesn’t suck. If your child makes it through a week without sucking, he or she gets to choose a prize. When the whole month is full, reward your child with something great (a toy or new video game); by then the habit should be over. Making your child an active participant in his or her treatment will increase the willingness to break the habit.
- If you notice your child sucking when he or she is anxious, work on alleviating the anxiety rather than focusing on the thumb sucking.
- Take note of the times your child tends to suck (long car rides, while watching movies) and create diversions during these occasions.
- Explain clearly what might happen to the teeth if he or she keeps thumb sucking.
Whatever your method, always remember that your child needs your support and understanding during the process of breaking the habit of thumb sucking.
What is Pulp Therapy?
The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment”, “children’s root canal”, “pulpectomy” or “pulpotomy”. The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable material. Then a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.
Does Your Child Grind His Teeth At Night?
Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
Tongue Piercing – Is it Really Cool?
You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.
There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!
Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
Tobacco – Bad News in Any Form
Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.
- If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:
- A sore that won’t heal.
- White or red leathery patches on the lips, and on or under the tongue.
- Pain, tenderness or numbness anywhere in the mouth or lips.
- Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek
What is the Best Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.
Ask your pediatric dentist about custom and store-bought mouth protectors.