Children 0-3 years of age

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 to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 6-8 months.

The simple answer is that teeth should be cleaned as soon as they first appear. Parents should not limit the cleaning only to teeth. The gums also need to be cleaned.

Before teeth erupt, parents can use a clean, small gauze pad or a clean dry wash cloth. The teeth and gums are wiped to remove liquid and food debris. This can be done before bedtime. As soon as the child gets the first tooth, a small, soft toothbrush can be used to clean the all surfaces of the teeth, paying special attention to the grooves on the chewing surfaces of the molars as well as the gums and tongue.

For those babies not being breast fed, there is general agreement that around one year of age is a good time to wean baby from the bottle. Paediatric dentists like to see children give up bottles as soon as possible. That is because they see an alarming number of toddlers with Early Childhood Caries. This type of decay, which begins on the front teeth, is only seen in toddlers. It results from prolonged use of a milk or sweetened liquid bottle that is put into bed with the baby. Same thing can happen when the baby drinks sweet liquids from a sippy cup.

Early examination procedures have been recommended strongly in the past decade to help reduce the number of infants and children who suffer from preventable tooth decay.
Ideally, we like to see children have their first dental check up by their first birthday. Why? Seeing the child early gives the dentist the opportunity to examine the mouth and confirm normal oral development. Most importantly, the teeth can be examined for cleanliness. It gives the dentist the opportunity to provide advice on prevention and make the best care plan for your child. It also gives parents the chance to discuss feeding practices, teething and mouth habits.

For years many thought that teething caused fever and general sickness. Teething has been blamed for many things! Research into the problems of teething has shown that some children become irritable, have increased drooling and sometimes a facial rash. However, for most children the effect of teething is teeth! It is a normal part of development. If your child has a high temperature that worries you, it is unlikely to be caused by teething and you should consult your physician.

Many remedies have been suggested over the years. There are non-medical things that can help. Teething rings have been found to be helpful for some babies. The biting pressure seems to relieve some discomfort especially if the teething ring is chilled. We generally do not recommend pain relief tablets. The treatment can be managed by local measures. For example, special local anaesthetic medicines are available to be placed on sore gum areas. Only use medicines intended for this purpose should be used.

About 1 in 10 children experience tooth decay before they are two years old. The most common cause is when a baby is placed in the crib at night with a bottle of milk or sweetened liquid. The contents of the bottle cling to the teeth all night. Tooth decay begins! The same effect can occur with a sweetened pacifier. In rare circumstances, babies who are breast fed throughout the night over a long time are also at risk. The decay experienced by these toddlers has a typical pattern. It usually is evident near the gum line of the upper front teeth. Because of the age of these children, treatment becomes a major problem sometimes requiring general anaesthesia. Parents need to be alert and keep the teeth healthy. Occasionally when illness or some other disturbance affects growing teeth, the quality of the enamel is poor. These teeth can decay early and more easily. A dental examination around one year of age helps identify these problems.

For years the importance of baby teeth was underrated. Once their importance was recognized, adult teeth improved. There are the obvious reasons why baby teeth are important – chewing, speaking, and appearance. Baby teeth do more. They conserve the space in the jaws for permanent teeth. If baby teeth are removed ahead of their natural time to fall out, space for the second teeth may be lost.

Children 3-6 years of age

We would all like the dental visit to be a good experience. There is little point in saving the tooth and losing the child! Research tells us that anxious parents can pass their anxieties to their children. So, try and be relaxed and positive. Treat the visit as a routine part of life and health care.Your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less information concerning the visit, the better, since it will only make your child anxious.

Please do not be upset if your child cries. Children are often afraid of anything new and strange, and crying is the normal reaction to that fear. Please permit us the time to develop rapport with your child. After the first visit, encourage his or her independence and allow us the privilege of bringing your child from the reception room to the dental chair alone. Most school age children do better alone with the pediatric dentist, hygienist and assistant than with a parent present.

It is best if you avoid using using words around your child that might cause unnecessary fear, such as “needle”, “pull”, “drill” or “hurt”. The office makes a practice of using words that convey the same message, but are pleasant and not frightening to the child. We strive to make each and every visit to our office a fun one!

Many types of toothbrushes are on the market. Some manufacturers specialize in the development of children’s toothbrushes. 
Rather offering a brand name, we would like you to think about what you want in a toothbrush for a child 3-6 years old. Look for a brush with a short and bulky handle as this is easier for the young child to manage. Bristles should be soft to avoid injury

One of the most important things about a tooth cleaning schedule is developing good habits. Brushing should be done at least twice daily – morning and at bedtime. Of course, if it is done more often that is good. Brushing teeth after meals or sweet snacks is very beneficial. Cleaning is best done by children and parents.

A child’s history of tooth decay is a main factor in any decision. If a child requires filling of teeth repeatedly, the dentist may recommend x-rays every 6 months. 
There are other factors that may influence the decision to take x-rays. If a child has a lot of fillings, the dentist may need to x-ray to be certain there is no decay under fillings. If the teeth are close together or in a twisted arrangement, the dentist may feel that the teeth cannot be examined thoroughly without an x-ray. Family history may be an influence, especially if other children in the family have many cavities. Most dentists today take x-rays “on prescription”. That means they examine a mouth and the child’s history, then make the x-ray decision for the individual patient.

This is typical of what dentists call an “open bite”. This situation can be seen in younger children (2-5 years) and in some older ones too. There are several reasons that this may occur. One of the most common causes of an open bite is a habit. Sucking fingers or thumbs, placing the tongue between the teeth and holding objects between the teeth all are habits that can cause this problem. It also can be due to a growth problem but this is rare. 
There are choices for dealing with open bites due to habits. The condition can be left without treatment. There are several ways that a habit can be eliminated. When this is done, very often the teeth move back into a better position without further treatment. Your dental caregiver should be consulted if your child has any of these habits.

At 2 to 5 years of age we are not too aggressive. We suggest that an occasional reminder to remove the finger is reasonable. Not too often, however. Be positive. Encourage and reward the child for not sucking. Praise the child for their grown up behaviour. 
Most children stop these habits on their own, but if they are still sucking their thumbs or fingers past the age of three, a mouth appliance may be recommended by your pediatric dentist.

Black stain is a result of a combination of many things in the mouth related to saliva, bacteria and foods. Black stain on the surfaces of teeth is associated with very low decay rates. No one seems to understand this association and it has been a topic of research. 
Other kinds of stains also appear on the outside of teeth. Green, orange and gray stains are the most common. These stains may indicate poor hygiene and under them early signs of tooth decay may be found.

Dental flossing cleans between the teeth in areas that the toothbrush cannot reach. For some children, it is important addition to the cleaning routine. 
Baby or first teeth tend to be spaced or non spaced. If spaced, they do not require flossing as the toothbrush can reach the areas between teeth. If they are not spaced, children’s first teeth can be flossed especially between the molars. At this age children cannot be expected to floss themselves. Parents need to help them. We suggest that you speak to your dental health care giver -dentist, therapist or hygienist- for advice as to the need to floss.

When they have cavities (decay), baby teeth are filled. Fillings are placed in the teeth to repair them until they fall out normally. If teeth are removed early, space may be lost in the dental arch. The end result is that the second teeth may become crowded in a mouth that might have had a good, straight set of teeth. 
Another reason that baby teeth are filled is to prevent dental abscess and facial infection. Teeth left to decay can lead to unnecessary health problems. 
A third reason that baby teeth are filled is to reduce the bacteria (germs) in the mouth that cause tooth decay. These bacteria multiply in areas of decay. Eventually, the decay spreads to other teeth and even to the permanent teeth when they come into the mouth.

Yes, it may be a problem later on especially if back teeth are lost early. It usually is not a problem for the front teeth. Baby or primary teeth are a specific size and occupy a certain amount of space in the jaw. If baby tooth is removed, the nearby teeth may drift into the space that has been created by the lost tooth. This means there will be insufficient space in the future for the secondary or permanent tooth that will replace the lost tooth. The end result is that the way the teeth bite together may be affected. 

Some children grind their teeth at night. It is a habit called bruxism. It is not unusual in the early years, especially in periods when the children are growing new teeth. We know that this really worries parents but it rarely requires treatment. The grinding habit is usually minor and only in rare occasions it will cause the teeth to wear teeth significantly. Regular visits to the dentist will allow to evaluate the wear and establish preventive measures to limit damage to the teeth.

Many children have unfortunate accidents and can damage their mouths and teeth. A wide range of injuries can occur. Sometimes the damage to the primary teeth are of little concern and sometime they are severe and teeth can be moved about or knocked out. The more serious injuries can cause damage to the permanent teeth that are still forming in the jaws. The amount and type of damage depends on the age of the child as this reflects the stage of development of the underlying second tooth. The amount of injury will not be seen until the permanent tooth comes into the mouth. A consultation with the dentist as soon as the injury happens is always recommended as evaluation of the damage (usually with x rays) and necessary measures to limit the problems can be implemented.

A space maintainer is an appliance that protects space in the jaw that is created when a tooth is lost prematurely. There are two general types of space maintainers. Fixed space maintainers are held to the teeth by a dental cement. Removable space maintainers can be taken out and cleaned. The design of a space maintainer depends upon the teeth missing, the teeth present and the child’s tooth development.

Children >6 years of age

The arrival of second teeth occurs at 6 years +/- 6 months. With the exception of the wisdom teeth, the last of the secondary teeth come in around 12 years of age. 
Tooth eruption can be variable. Girls tend to get teeth earlier than boys. Variation has been observed between racial groups. In our experience, it is not so much the timing that is important as the sequence of tooth eruption. When individual teeth are delayed, this could indicate local problems. A good reason to see your dentist regularly is to have development supervised.

It is time to do something! Most experts think that by 6 years of age, when the second teeth start to come in, is the proper age to treat the habit. 
We like to see the habit discontinued because it can push the new teeth into poor alignment. Finger sucking encourages the upper teeth to protrude. It also can be associated with poor speech, social stresses and other habits. These habits are treated with psychologically based programs and/or mouth appliances. Correction of the habit is sometimes not easy. Consult your dentist.

The common site for this occurrence is in the lower front tooth region. It happens in 30% of children. The appearance of two rows of teeth is due to the second teeth coming in behind the baby teeth. 
Your dentist should be consulted. An x-ray may be needed to determine how much of the root of the baby tooth remains. Sometimes the baby teeth need removal, but in many cases, they fall out after a few weeks.

A large space sometimes is noticed when the two upper front teeth come in. The easy answer is that this is a normal part of jaw development. As more teeth arrive, the space tends to close. When the croner teeth arrive near the teenage years, the space is usually closed. There can be other causes for space between front teeth and the area may need x-ray investigation by your dentist.

About 1 in 20 people have variations in the number of teeth. Some have extra teeth and some have missing teeth. Missing teeth are more common in the second set of teeth than in the baby set of teeth. Some people have numerous missing teeth. This is usually related to some type of condition. Some people only have one or two missing teeth. There may be no apparent reason for this occurrence or it may be something that other family members have as well.

When teeth first come into the mouth they are more at risk for tooth decay. The most common teeth sealed are the permanent molars. These molar teeth arrive about 6 years of age and often have deep grooves on the chewing surfaces. Tooth brushing cannot clean these grooves properly. Over the years it has been reported that many of these new molar teeth will get tooth decay. What the sealant does is stick to the tooth so that food cannot collect in the deep molar grooves. This prevents them decaying!

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Mouthguards help lessen injuries to mouth and teeth. They are used in many sports where there is a possibility of injury. Some of these are – football, netball, hockey, skateboarding and basketball. 
Mouthguards are best fitted from a mold of your child’s teeth or they can be purchased commercially. The custom fitted mouthguard is a superior fit. This makes it easier for the child to talk wearing the appliance and it offers better protection. However, for a child in the 6 to 9 age bracket, teeth are constantly falling out and being replaced. It may be more practical for this age group to purchase the commercial guards. The more expensive fitted guards can be purchased when all the permanent teeth are in place. Note that mouthguards can be made for children wearing braces.

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Flossing teeth is difficult. Children acquire these abilities at different rates. Studies with 7 to 8 year olds have shown that many of the children do not have the ability to self-floss at this time. Consequently, at about 8 to 10 years of age we suggest that children can be introduced to self-flossing. Begin by learning to floss the front teeth. Then, when they can do this well, begin to floss in the back of the mouth. It is important not to have a child floss before they are ready. It frustrates them and then their cooperation will be lost. 
It is important to floss correctly. Your dental team can help you learn.

This does not have to be the case. To have dental decay we need teeth, germs in the mouth and sweet foods. If germs collect in large numbers and sweet foods are eaten regularly and allowed to remain in the mouth without being brushed away, we have a recipe for tooth decay. We have had many patients under our supervision that arrived with terrible baby teeth but did not get decay in their permanent teeth. It took a lifestyle change. Diet, proper mouth care, and regular dental visits are all important. So, bad second teeth do not have to follow bad baby teeth.