Your child's first teeth will begin coming in between two and sixteen months (usually around six months). The bottom two front teeth are the first to come in.  This will usually be followed by the four upper teeth in the next couple of weeks. Many parents worry if a child gets a tooth earlier or later than “the norm”.  Every child gets their teeth at different times than others.  Everyone doesn’t get the same tooth on the exact same day and the exact hour as everyone else.  In other words, 99.9% of the time you don’t have to worry about it.  Odds are that if you received your teeth later in life that your child will too.  This goes the same for losing them too.  Genetics plays a role in this.

Your child will eventually get 20 baby teeth by the age of 3 years.  Children get four new teeth about every four months. Children begin losing their baby teeth when they are around the age of 6-7 years old.  The last teeth to be lost are the 2^nd baby molars at around 11-13 years old.

Permanent teeth begin to erupt at around 6-7 years of age and continues until your child gets his third molars (or wisdom teeth) when he is about 17-22 years old.

Answers to Common Questions of Parents About Children's Teeth:

How many teeth do kids get?
They typically get 20 "baby teeth”.

When do the first baby teeth come in?
You can expect them around four to six months old.

 When should I start brushing my child's teeth?
 As soon as they are born you should take a damp small cloth or gauze and wipe their teeth or gums to help them get in the habit.

What is  the best way to teach our child how to brush?
A great way to teach your child is by explaining why we brush our teeth and show them how you brush your teeth.  Then, you need to help them think of all the areas of the tooth they need to brush.  Holding the brush while they try it and you brush while they feel how you are doing it works well.  And never forget…Don’t forget to brush the tongue!

 
When should a child come see a dentist?
A good age to take a child to their 1^st dental appointment is around 2 ½ to 3 years old (unless you see a problem, then bring them in earlier).

Are sealants really worth it?
Definitely.  The back teeth especially, have little pits and grooves in the teeth that are a serious problem for cleaning. Bacteria can easily trap in these grooves and cause problems. If a sealant is properly placed, then it will prevent a cavity forming on the top of the tooth.  While there isn't a guarantee that decay won't get in, there is a 60-80% track record for five years on teeth that are protected with sealants, that they won't get a cavity. This is very significant as we are seeing more and more children growing up without cavities that have received sealants.  Not all teeth need sealants, especially if the top of the tooth is very flat or smooth and doesn't have the grooves that can contribute to the decay process starting.

 
What's the Proper Way to Brush My Child’s Teeth?
It's a good idea to supervise your child's brushing until the age of six, following the guidelines below:

What should I do if my child knocks out a tooth?
Depends if it is a “baby” or “adult” tooth.  If a baby tooth is knocked out in the front of the mouth nothing is usually done.  If the baby tooth comes out in the back of the mouth, sometimes a space maintainer is necessary to hold the space open for the adult tooth to come in its spot in a few months to years.  If it is an adult tooth it is another story.  If the tooth is completely knocked out, we like to have the tooth back in the socket within 30 minutes if it is going to have a good chance of living.  It will need a root canal and possibly a crown in the near future.  If you can’t get it back in the socket, keep it in MILK to keep it in the pH level equal to saliva. Don't rinse the tooth off or scrub it. Leave the tissue on the tooth and let the dentist decide what needs to stay or come off.
 

When Should My Child Begin Flossing?
You should floss for your children beginning at age four. At this age the teeth are usually touching and no spaces are between them.  By the time they reach age eight, most kids can begin flossing for themselves.

Is Teething Painful?

Yes. When babies are teething, usually between the ages of four months and 2½ years, they often have sore and tender gums. Teething can show up in a child in various ways.  A few are listed below:

Teething does not cause a fever. If your child has an elevated temperature, it needs to be addressed as a separate medical concern. If your baby continues to be cranky and uncomfortable after you attempt to ease its teething pain, call your physician.

What to do?

Let your child chew on a cold, hard object, such as a teething ring. The coldness helps ease the discomfort and the hardness will speed up the eruption of the tooth.

Massaging your child's gums with a clean finger can help reduce pain and discomfort during teething.

Teething gels or ointments (ask your pharmacist for a brand name) are used to numb the gums and reduce the discomfort.

When should thumbsucking stop?

Children should have ceased thumbsucking by the time the permanent front teeth are ready to erupt. It is important for a child to stop sucking their thumb before the age of 6 years.  However, it is strongly suggested that this habit be broken before this age is reached to prevent future teeth problems for the child.

 Is it worth it filling a child's tooth, it's going to fall out anyway?
Children's teeth not only help them chew, but also, they act as space maintainers for the adult teeth. If a child looses a tooth early, there may not be room because of it, for the adult tooth to come in, because often they are larger than the baby teeth. We use a year or more as a guideline to fill a small cavity... if the tooth will be in for less than one year and it's a small cavity, then we might take a chance on it and let it go. We wouldn't want to leave in an abscessed tooth to create an infection for the child.

When should we be concerned about orthodontics for my child?
As soon as the child has their first "permanent" molar, typically after 6 years old, is when orthodontists will consider putting some type of braces or beginning some type of treatment. If there is a skeletal discrepancy, and the jaws don't line up, then it's easier to use the growth of the child to gently guide the position of the teeth and jaws while the child is young and the bone is less dense, so it moves easier. Some dentists will wait until age 12 or 13 if the child doesn't have any major problems, to "fine-tune" the bite, and make sure the teeth align themselves well for maximal chewing function.

 
Are their certain foods my child shouldn’t eat?
In today’s society we are seeing children eating too much sugar and fat and they are drinking too much soda.  It is a fact that caffeine can stunt growth and is addictive.  However, more and more parents are allowing their children eat these things for the convenience factor.  Also be careful of sticky candies that last on the teeth for a while. Milk is good because it contains calcium for the development of the children's teeth.  When thirsty, drink water.  It’s one of the best things out there!

How important are wearing sports mouthguards?
The importance of mouthguards is becoming more noted in our children’s and even adult sports. A properly fitted guard will spread out the pressure amongst all the teeth and perhaps the palate or bony ridge and lessen the intensity of a traumatic blow. Any child that participates in soccer, football, basketball, wrestling, martial arts, or any other contact sport should consider getting a mouth piece made by a dentist that is well form fitting.  Not one that is just boiled in the water from the store.

What is bottle caries?

 If a child is nursing with a bottle containing sugar in it, the acids can cause serious decay on the baby teeth. One way to prevent this is problem is to not let your baby sit for long periods of time with sugar flavored drinks (juices, sodas, milk, etc.) in their bottle. You should clean their gums and/or teeth after eating. 

Is My Child Teething?

When should crooked teeth be straightened?

As soon as they're detected!  Lots of times fixing crooked teeth at a young age is recommended when teeth are overcrowded to prevent tooth problems in the future.  Some baby teeth may be removed ahead of their normal shedding time to allow nature to do a certain amount of tooth straightening. This is known as interceptive orthodontics.

Does my child need fluoride supplements?

In general, yes. All children need supplemental fluoride after they are six months old to help prevent cavities. For most children, they can get this fluoride from the water they drink if they are in an area where the city water supply has an adequate amount of fluoride in it (greater than 0.6 ppm), and they are drinking tap water.

Sources of water that generally don't have enough fluoride include well water and filtered or bottled water.  Also, commercially prepared pre-mixed infant formulas do not contain an adequate amount of fluoride.  Talk to your Pediatrician about taking a multivitamin that contains fluoride in it or obtain it from your dentist.

It is in general better to have your child drink water that is supplemented with fluoride instead of giving extra fluoride drops or supplements. Too much fluoride can cause fluorosis,

What is Fluorosis?

·   To ensure your child does not have any adverse effects from fluoride, you can follow some basic rules:

1. fluoridated products should not be swallowed!

2. Only a small amount of toothpaste, such as the size of a small pea is needed for a child

3. fluoridated products, especially mouthrinses should not be given to a child under 6 years of age, or to anyone who cannot rinse ( those you suspect are swallowing some of the product)

4. keep fluoridated products out of reach of children

5. parental supervision is needed for children when brushing or using any fluoridated substances

Fluoride

Dental decay is a very common disease in North America and throughout most of the world. One way to help prevent this disease from occurring is through the use of fluoride.

Fluoride helps to harden tooth enamel and make it more resistant to tooth decay. A small cavity can be stopped and even reversed by the remineralization process enhanced by fluoride.

Fluoride is usually delivered to the teeth in 2 ways; topically (directly on the teeth) and/or systemically (enters through the blood stream).
 
 

Systemic Fluoride

Systemic fluoride is delivered to the tooth surface via the bloodstream from a food source, water source, or dietary supplement like a pill, tablet, or drops. Fluoridated water is a very effective way to reduce dental decay.

Fluoridated water and dietary supplements can reduce up to 60 % of tooth decay.

Some water supplies already naturally contain fluoride, for others, fluoride is intentionally added to the water supply. Some communities have no fluoride in their water. Other communities are unaware of this option.  Check with you city officials or health department and they should be able to tell you the levels of fluoride in your water.

Children 15 years of age and younger will benefit the most from the systemic fluoride.  When the teeth are developing in the jawbone, the fluoride ion is then built into the enamel structure of the developing tooth, making the tooth bond more resistant to acids that attack the tooth.

Topical Fluoride

Topical fluorides are applied directly to the tooth structure to delay or slow down the tooth decay process.

Topical forms of fluoride include:

·   toothpaste - used daily, must have an ADA or CDA Seal of Acceptance on the label.

·   professional fluoride application - this is a gel that is applied for 1 to 4 minutes, usually in a tray at the end of a dental appointment. Not everyone is given a professional fluoride treatment.  It depends on your oral health needs.

·   fluoridated home mouthrinses – these can be purchased over-the-counter for children over 6 years of age, and adults who are susceptible to cavities.

·   home care fluoride gels - applied by trays or by brush, these gels are for those who are highly susceptible to cavities. These people would include:

-adults with a high incidence of root cavities

-those who experience an extremely dry mouth

-people who wear braces or orthodontic appliances

-those who have rampant or excessive cavities

Fluoride gels can be bought over-the-counter or by prescription.

Seek the advice of your dental hygienist or dentist for a daily home fluoride program that is individualized for your needs.

Fluoride Safety

·   Fluoride is very effective in controlling dental decay when used properly. If not used in the proper doses, fluoride toxicity and dental fluorosis can occur.

·   Fluoride toxicity is when large amounts of fluoride are ingested during a short period of time. This can be dangerous to your health.

Symptoms may include nausea, diarrhea, vomiting, abdominal pain, increased salivation or increased thirst.

These symptoms would begin 30 minutes after ingestion and can last up to 24 hours.

Depending on how much of a toxic overdose of fluoride is ingested, certain emergency procedures should be implemented. If you feel nausea, drink milk, or try to induce vomiting, and call your dental office or medical doctor. If these symptoms do not subside, or the conditions worsen ( hard to breath), call an emergency service to transport you to the hospital.

Helpful Books for teaching children about the dental office

http://www.dentalreview.com/childrens_books.htm

Pediatric Pamphlet at:  www.ada.org/public/topics/parents/tips.html