Parents play a big role in the healthy development of their children's teeth and overall oral health. One of the best ways to keep your child's smile healthy for life is to start good oral health habits early. This article shows you how to look after your child's primary (baby) teeth and how to help your child properly care for his or her permanent (adult) teeth once they come in.
About primary teeth
Your child's primary teeth are important. They help your child eat and learn to speak properly. The health of your child's primary teeth can affect the health of the permanent teeth. Primary teeth hold the space for permanent teeth and help guide them into the correct position. They also contribute to healthy jaw development. Broken or infected teeth can affect your child's self-image.
Teething
Your baby begins teething when the first set of teeth erupts (breaks through) from the gums. Teething usually begins around 6 months of age; however, it can start any time between 3 months and 12 months of age. Some babies drool for weeks before their first tooth comes in. For others, teeth seem to come in without much fuss.
A total of 20 primary teeth come in, usually by the time your child is about 2 or 3 years of age. However, each child develops at his or her own pace. The chart on the following page shows you when baby teeth erupt in most children. If you have questions about the development of your child's teeth, speak with your dentist.
Eruption chart of primary teeth
Upper teeth When teeth erupt
Central incisors 7-12 months.
Lateral incisors 9-13 months.
Canines (cuspids) 16-22 months.
First molars 13-19 months.
Second molars 25-33 months.
Lower teeth
Second molars 20-31 months.
First molars 12-18 months.
Canines (cuspids) 16-23 months.
Lateral incisors 7-16 months.
Central incisors 6-10 months.
Teething pain
Some babies have no discomfort from teething. However, if your child seems to be in pain, it is likely because of the soreness, swelling and tenderness around the gums of the erupting tooth. Your child may be cranky, may drool more and chew on things. These symptoms may begin about 3 to 5 days before the tooth erupts and should stop as soon as the tooth breaks the gum. To help relieve the pain:
Gently rub the gums with a clean finger for about 2 minutes at a time.
Gently rub the gums with a cool teething ring.
Provide safe objects, like a clean teething ring, for your child to chew on.
Wipe your baby's face with a clean damp cloth to remove the drool and prevent rashes.
If your child is still uncomfortable, your dentist can suggest an over-the-counter medicine to ease the pain. Here's what you should NOT do:
Do NOT use a painkiller that can be rubbed on the gums, unless you have spoken to your dentist or doctor about it. Swallowing it could harm your child.
Do NOT offer your baby a teething biscuit as it may contain sugar.
NEVER ignore a fever. Erupting teeth do not make babies sick or give them a fever. If your child has a fever, check with your child's doctor.
Early childhood tooth decay
Early childhood tooth decay is a serious disease found in the teeth of infants and toddlers from as young as 1 year of age. It usually happens when your child falls asleep with infant formula, cow's milk or juice still in the mouth. All liquids except water contain sugars, which can be damaging to your child's teeth if left in the mouth for a long time. While your child sleeps, the liquid pools around the teeth and the bacteria (germs) in your child's mouth mix with the sugars in the liquid. This mixture makes a mild acid that attacks the hard outer layer of the teeth (called the enamel). Over time this may cause teeth to weaken and can cause cavities (holes) on the front teeth.
Signs of early childhood tooth decay
As soon as your child has primary teeth, gently lift the lips once a month and check the teeth for early signs of tooth decay. Look for:
Dull or chalking white spots or lines on teeth. These spots or lines may also be on the part of the tooth next to the gums.
Brown spots along the gum line of your child's teeth.
Dark teeth.
If your child cries when eating cold, sweet or hard food, that may be another sign of tooth decay. If you see any of these signs, take your child to the dentist right away. Early childhood tooth decay must be treated right away. If not, your child may suffer pain caused by an infection. In the long run, your child may also face other problems such as a speech impediment, crooked or crowded teeth and poor oral health.
Stopping early childhood tooth decay
Early childhood tooth decay is preventable. Here are ways to stop it:
Never put your child to bed with a bottle or sippy cup of milk, formula, juice or any liquid other than water.
When bottle-feeding, remove the nipple when your child has finished feeding and while your child is still awake. If your child falls asleep, remove the nipple from the mouth and wipe the teeth with a cloth to remove the remaining milk from the teeth.
Between meals, give your infant or toddler water to drink.
Start bottle weaning and introduce drinking from a cup by 1 year of age.
Clean your child's gums and teeth every day. Wipe the gums with a clean cloth. Brush the teeth with a soft-bristled toothbrush.
Banning the bottle at bedtime
If you give your child a bottle at bedtime, stopping all at once will not be easy. To stop this habit, try putting water in the bottle. If this is turned down, try watering down your child's bottle over a week or 2, until there is only plain water left.
Soothers and thumb-sucking
Sucking is a normal, natural reflex for babies. It feeds, comforts and relaxes them. If your child needs to suck, introduce a soother (or pacifier). You can control when and how your child uses a soother. However, you can't control when your child's thumb will go into the mouth. Do not let your child use a soother all the time. Never dip a soother in sugar, honey or corn syrup, as this can cause cavities.
It is best to get your child to stop sucking before the permanent teeth come in. If your child keeps sucking a soother or his or her thumb after the permanent teeth have come in, it may cause problems with how the jaw and teeth grow. Let your child's dentist know if your child has a thumb-sucking habit.
Cleaning your infant's teeth and gums
Start cleaning your child's mouth even before the primary teeth have erupted. This will get you both into a good oral health routine and will give the teeth a clean mouth to erupt in. The goal is to wipe all parts of the gums and teeth. Here's how to do it:
Lay your baby in a comfortable place.
Make sure you can see into your baby's mouth.
Gently wipe the gums with your finger wrapped in a clean, damp cloth. If your baby has teeth, brush them with a soft-bristle, baby-size toothbrush.
Do not use toothpaste until your child has teeth.
Cleaning your toddler's teeth
As your child gets older, you may find that squirming during brushing is a problem. Here's how to clean a toddler's teeth:
Stand the child in front of you, facing toward the sink and mirror.
Tip your child's head back against your stomach. This lets you control your child's movements. It also lets you see both the upper and lower teeth.
Use a child-size toothbrush with a smear of fluoride toothpaste.
Brush with a gentle circular motion to clean all surfaces. This means the cheek side, the tongue side and the chewing surface of each tooth.
Make sure your child spits out all the toothpaste and rinses well.
Tips to help your toddler brush
It's normal for children to want to brush their own teeth. You can allow this, but check to make sure your child is doing a good job. Explain that you still want to help. A parent or adult must always carry out at least one tooth-brushing session a day. If your toddler isn't cooperating, try these tips:
Take turns brushing each other's teeth. Let your child brush your teeth with your toothbrush and show your child how much fun it is to have someone else brush your teeth. Then you tale a turn brushing your child's teeth with your child's toothbrush. Toothbrushes should not be shared.
Try using an egg timer. Set the timer and have your child brush for 30 seconds. Then you brush your child's teeth for 30 seconds. For a thorough cleaning, repeat this 4 times.
Set an example. Let your child see you brushing. Show off your clean teeth. Your excitement will make your child excited to brush.
About permanent or adult teeth
At around age 6 or 7, children start to shed (lose) their primary teeth. The roots slowly get shorter as the adult tooth moves up in the jaw and the primary tooth falls out. Children lose primary teeth until they are about 12 years old. It's okay for children to wiggle their primary teeth if they are loose. But it's NOT okay to use force to pull out a tooth that's not ready to come out. When a tooth comes out at the right time, there should be very little bleeding.
At this age, the first permanent or adult teeth start to erupt. These are the “first molars”, or the “6-year molars”. They come in at the back of the mouth, behind the last primary teeth. They do not replace any primary teeth. The charts on the following page show you when primary teeth shed and permanent teeth erupt in most cases. Remember, each child develops at his or her own pace. If you have questions about the development of your child's teeth, speak with your child's dentist.
Between 6 to 13 years of age, all the permanent teeth will erupt except the wisdom teeth. (known as third molars). Sometimes, a permanent tooth starts to erupt before the primary tooth has fallen out. Your dentist may advise removing the primary tooth to make sure there is space for the new permanent tooth to come in, or to avoid a permanent tooth from coming in to the wrong position.
Permanent teeth often look more yellow than primary teeth. This is normal. But it could also be caused by a medicine your child took, by an accident that hurt a primary tooth, or by too much fluoride. If you or your child are concerned, ask the dentist about this when you go for a checkup.
Tooth shedding and eruption charts
Primary teeth
Upper teeth When teeth fall out
Central incisors 6-8 yrs.
Lateral incisors 7-8 yrs.
Canines (cuspids) 10-12 yrs.
First molars 9-11 yrs.
Second molars 10-12 yrs.
Lower teeth
Second molars 10-12 yrs.
First molars 9-11 yrs.
Canines (cuspids) 9-12 yrs.
Lateral incisors 7-8 yrs.
Central incisors 6-8 yrs.
Permanent teeth
Upper teeth When teeth come in
Central incisors 7-8 yrs.
Lateral incisors 8-9 yrs.
Canines (cuspids) 11-12 yrs.
First premolar* 10-11 yrs.
Second premolar* 10-12 yrs.
First molars 6-7 yrs.
Second molars 12-13 yrs.
Third molars 17-21 yrs.
(Wisdom teeth)
Lower teeth
Third molars 17-21 yrs.
(Wisdom teeth)
Second molars 11-13 yrs.
First molars 6-7 yrs.
Second premolar* 11-12 yrs.
First premolar* 10-12 yrs.
Canines (cuspids) 9-12 yrs.
Lateral incisors 7-8 yrs.
Central incisors 6-7 yrs.
*Premolars are also known as bicuspids
Teaching school-aged children how to brush
Brushing before bed is an important step in your child's oral health routine. If you don't get rid of the germs (bacteria) and sugars that cause cavities, they have all night to attack the teeth. Usually children are ready to do a good job brushing on their own when they reach 5 to 7 years of age. Here's what to show your child:
Always have your child wash his or her hands before brushing.
Have your child brush at a 45-degree angle to the teeth. Starting with the bristles at the base of the tooth where the gums meet and teeth meet, have your child move the brush to the top of the tooth, using a gentle circular motion.
Teach your child not to scrub. Your child can hurt the gums by brushing too hard.
Have your child clean every surface of every tooth. This means the cheek side, the tongue side and the chewing surface of each tooth. For the inside of the front teeth, your child can use the “toe” of the brush.
At this age, your child may not reach right to the back of the mouth to clean the molars. You should check.
Teach your child to slow down. A good brushing should take 2 to 3 minutes.
Have your child brush the tongue.
Have your child spit out the toothpaste and rinse.
Toothbrushes and toothpaste
The best kind of brush is soft, with rounded bristles. It should be the right size for your child's mouth. You will need to buy a new toothbrush at least every 3 to 4 months. Children can be hard on toothbrushes. If the bristles get bent or worn down, they will not do a good job, and may hurt your child's gums.
Make sure the toothpaste has fluoride. For children over 3 years of age, use only a bit of toothpaste, about the size of a garden pea. For children under 3, use a smear of toothpaste to minimize swallowing.
Teaching school-aged children how to floss
The ideal age to teach children how to floss is when they are 7 to 8 years of age. Here's how:
Always have your child wash his or her hands before flossing.
Take a piece of floss about as long as your child's arm. Show your child how to wrap it around the middle fingers, leaving a few inches between your child's hands.
Show your child how to hold the floss tightly between the thumbs and index fingers.
Using the thumbs and index fingers, have your child gently guide the floss between the teeth to the gum line. Teach your child to wrap the floss into a “C” shape around the base of the tooth.
Have your child wipe the tooth from the bottom to top 2 or 3 times using a gentle rubbing motion. Teach your child to to push too hard to get the floss between the teeth. This can snap the floss into the gums and hurt them.
Teach your child to floss both sides of each tooth. Don't forget the backs of the last molars.
Show your child how to move to a new part of the floss for each new tooth.
When you floss, bacteria from your mouth can spread to your hands, so have your child wash his or her hands after flossing.
Trouble flossing?
If your child is having problems handling the floss, a loop of floss may be easier. Take about 12 inches (30 cm) of floss and tie a knot to make a circle or a loop that the child can hold between the thumbs and index fingers. Use the same method for flossing as described above. Your child can also use floss sticks, or floss holders, which may be easier to use when he or she first learns to floss. Your child's dentist may have other suggestions as well.
Healthy gums
Although tooth decay is the main oral health problem affecting children, they can also get gum disease. Daily brushing and flossing can stop gum disease. If your child's gums bleed, don't stop brushing. If the gums are always swollen, sore or bleeding, take your child to the dentist.
Good food, healthy teeth
Healthy food is good for our general health and our oral health. The nutrients that come from healthy foods help your child to fight cavities and keep gums healthy.
Sugars in food
Sugars are one of the main causes of cavities in children's teeth and are found in many foods. Foods high in sugar include soft drinks, chocolate bars, pastries and baked goods. Ingredients such as corn syrup, dextrose, fructose-glucose, honey, maple syrup, molasses and sucrose are all different types of sugars.
When your child eats or drinks foods that contain sugars, the bacteria in the mouth mix with the sugars to make a mild acid. This acid attacks the hard outer layer of the tooth (called the enamel) and can eventually cause a cavity (hole) in the tooth. The damage that sugars do depends on how much and how often they are eaten, when they are eaten and how long they stay in your child's mouth. The longer and more often sugars touch your child's teeth, the more damage they can do.
Even many healthy foods such as milk, juice, bread, cereal and pasta contain some sugars and they can be just as damaging as foods high in sugar if left in the mouth for a long time. Here are some examples of how oral health problems can happen:
If your child drinks freely throughout the day from a bottle or sippy cup filled with any drink other than water, your child's teeth are being coated in sugars over and over again. Over time, this will cause teeth to weaken and can cause cavities. Between meals, water is the best drink.
If starchy foods like teething biscuits, crackers or bread stay in your child's mouth for a long time, or if your child snacks on these foods often throughout the day, the sugars in these foods will make the acid that can cause cavities.
The good news is that the saliva in our mouths can help to protect our teeth from this damaging acid. During a meal, our mouths produce a great deal of saliva. This saliva protects our teeth by neutralizing the acids produced by sugars. But between meals, our mouths do not produce as much saliva and the sugar stays on our teeth longer. So eating between meals without brushing can be damaging to your child's teeth and can cause oral health problems.
Acids in foods
The acid found in some foods and drinks can also be harmful to your child's teeth. When we consume foods or drinks high in acid, the acids may play a part in causing dental erosion. Dental erosion is when the hard part of your tooth wears away from direct contact with acid. Foods and drinks high in acid include carbonated soft drinks, sport drinks, citrus fruits and vinegary foods such as pickles. To protect your child's teeth from dental erosion, choose drinks that are low in acid. Teach your child not to swish or hold drinks high in acid in the mouth for a long time.
Smart snacking for kids
While snacking can cause oral health problems, growing children need healthy snacks to keep them going between meals. Here are some snack tips to help keep your child's teeth healthy:
Limit the number of times a day your child eats or drinks sugars.
Avoid sugary treats that stay in the mouth for a long time like hard candy or lollipops.
Stay away from soft, sticky sweets that get stuck in your child's teeth.
Sweets are best served at the end of mealtime while there is still plenty of saliva in your child's mouth to wash away the sugars.
Drinks like juice and milk are best served during or at the end of mealtime. Water is the best drink to have between meals.
Between meals, serve snacks that will not harm your child's teeth, like vegetables, cheese, nuts and seeds.
When possible, have your child brush right after eating. Always have your child brush before going to bed.
Dental safety
Preventing dental injuries is an important part of keeping your child's smile healthy for life. By taking simple precautions, you can help your child avoid most common dental injuries.
Always use infant car seats and seat belts when you drive.
Babies will chew on almost anything. Keep babies away from hard thing that could hurt their teeth or gums.
Children fall a lot when they are learning to walk. Teeth can break, crack, get knocked out or become loose. See your dentist if any of these happens no matter how minor the injury may seem. Long-term consequences such as brown spots on adult teeth can occur as a result of a seemingly minor injury to the primary teeth.
If your child is active in sports, encourage the use of a mouthguard to prevent dental injuries. Ask your dentist about the types of mouthguards available and their cost.
Accidents do happen, and knowing what to do can mean the difference between saving and losing a tooth. Here's what to do for some of the most common dental injuries:
Knocked-out tooth
If your child's tooth is completely knocked out, rinse it quickly with water, but DO NOT scrub it, and try to put it back into the socket (opening). Be careful to hold the tooth by the crown (top), not the root, so you do not damage the ligaments when putting it back into the socket.
If you cannot put the tooth back into its socket, or if there's a chance that the tooth might be swallowed, put it in a container of cold milk and take it with you to your child's dentist, or to the nearest dentist, RIGHT AWAY. If you see bleeding from the opening, rinse the mouth out with water. Place a wad of tissue or gauze on the socket and bite down on it. The pressure applied will usually stop the bleeding. If you can get help within 10 minutes, there is a fair chance that the tooth will take root again.
Chipped or broken tooth
Broken teeth can almost always be saved. Call your child's dentist, explain what happened and ask to see him or her right away. If possible, bring in any piece of the chipped or broken tooth to your dentist. If it's a small break, your dentist may use a white filling to fix the tooth. If the break is serious, a root canal may be needed.
Badly bitten tongue or lip
Apply pressure to the part of your child's mouth that is bleeding. Use a clean cloth to do this. If your child's lip is swollen, use an ice pack to keep the swelling down. If the bleeding does not stop, go to a hospital emergency room right away.
Going to the dentist
Along with providing your child with nutritional foods and helping to keep his or her teeth and gums clean, one of the most important things you can do to prevent oral health problems is to take your child to the dentist regularly.
Here are 3 good reasons to take your child to the dentist for regular checkups:
You can find out if the cleaning you do at home is working.
Your dentist can diagnose any problems early and treat them right away.
Your child can learn to be comfortable in the dental office.
Your child's first visit to the dentist should happen 6 months after the arrival of the first tooth or by 1 year of age. It's important for your child's first visit to be a positive experience. To prepare your child, explain what will happen at the dentist's office or read your child a children's library book on going to the dentist.
At the checkup, your child's dentist::
Will check for signs of tooth decay and cavities.
Will give you tips on cleaning your child's teeth.
Will have your child's teeth professionally cleaned.
May talk to you about good eating habits.
May talk to you about fluoride.
May take x-rays of your child's teeth.
May talk to you about dental sealants.
Preventing tooth decay
Tooth decay, also known as dental caries, is a serious disease that starts just below the surface of the tooth. In most cases, tooth decay can be prevented and even turned around in its early stages with good oral hygiene, a well-balanced diet and regular dental visits. When your child goes for a dental checkup, one of the things the dentist looks for is tooth decay. If signs of tooth decay are found, its is important to stop it from spreading. Depending on the stage of the disease, your child's dentist may try to heal it with fluoride applications. As well, the dentist may suggest making changes to your child's oral hygiene routine and may discuss changes to your child's diet. If left untreated, tooth decay can damage the structure of your child's tooth and eventually lead to a cavity (hole) in the tooth.
Cavities and fillings in primary teeth
During the checkup, the dentist may notice a cavity in one of your child's primary teeth. It is important to take care of the cavity as soon as possible to stop the spread of tooth decay.
A filling is an inexpensive and easy way to treat a cavity and stop tooth decay from spreading deeper into the tooth. If tooth decay is not treated, it may become more painful and more costly to fix later. During a filling, the dentist removes the decay and fills the hole with dental filling material.
If a cavity is not treated and tooth decay is allowed to spread, the tooth may need to be removed. Even though your child's primary teeth will eventually all fall out, it is important to keep them healthy until the permanent teeth come in. Here's why:
Some of them will be in your child's mouth until age 12.
They help your child eat and speak properly.
They affect the health of the permanent teeth.
They hold the space for the permanent teeth.
They guide the permanent teeth into the correct position.
They contribute to healthy jaw development.
If they are infected or chipped, this may affect your child's self-image.
Fluoride
Fluoride has had a profound effect on our children's oral health. Children raised in communities with fluoridated water have 20% to 40% fewer cavities, and the effects are lifelong.
Fluoride is a mineral found in nature. It makes the hard outer layer of teeth (called enamel) stronger. When the enamel is strong, teeth are less likely to get cavities. Children can get fluoride in 4 ways:
In drinking water.
In fluoride toothpaste.
In fluoride supplements from your child's dentist.
In fluoride treatments from your child's dentist.
Fluoride supplements
If there is no fluoride in the water where you live and the dentist thinks your child is likely to get cavities, he or she may suggest that your child take a fluoride supplement. These supplements come in the form of pills to chew or lozenges to suck. The amount your dentist suggests will depend on you child's age and how much fluoride (if any) is found naturally in your drinking water.
Fluoride treatment
For even more protection against cavities, the dentist may suggest a fluoride treatment for your child. This treatment comes in the form of a gel or a rinse and can be given to your child by the dentist or another member of the dental team.
X-rays
At your child's checkup, the dentist may want to take x-rays of your child's teeth. Dental x-rays, also known as dental radiographs, are pictures of the internal structure of teeth and bones. These pictures allow the dentist to see if your child has any problems below the surface of the teeth and gums. They will also show if your child's teeth are coming in the way they should.
Sealants
The dentist may suggest sealing your child's teeth to protect them from cavities. A sealant is a thin layer of plastic applied to the chewing surface of molars. The plastic seals the tooth and makes it less likely to trap food and germs.
Finding a dentist
Some dentist may choose not to treat children and can refer you to a pediatric dentist. A pediatric dentist is a dentist who has completed a university post-graduate specialty program focusing on the treatment needs for infants and children, including those with a special health care needs.
Oral health is an important part of your child's overall health and well-being. Cavity and mouth injury prevention start at home with good eating habits, daily brushing and flossing and a properly fitted mouthguard worn during sport activities. Good oral health habits and regular visits to the dentist will ensure your child has a healthy smile for life.
