The initial growth period for primary (baby) teeth begins in the second trimester of pregnancy (around 16-20 weeks). During this time, it is especially important for expectant mothers to eat a healthy, nutritious diet, since nutrients are needed for bone and soft tissue development.
Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old. Altogether, a set of twenty primary teeth will emerge by the age of three.
The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges). This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.
Which teeth emerge first?
In general, teeth emerge in pairs, starting at the front of the infant’s mouth. Between the ages of six and ten months, the two lower central incisors break through. Remember that cavities can develop between two adjacent teeth, so flossing should begin at this point.
Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months. Teething can be quite an uncomfortable process for the infant. Clean teething rings and cold damp cloths can help ease the irritation and discomfort.
Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors. Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches. Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”
Eight more teeth break through between the ages of thirteen and twenty-three months. On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor. Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.
Finally, a second set of molars emerges on each arch – usually beginning on the lower arch. Most children have a complete set of twenty primary teeth before the age of thirty-three months. The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.
How can I reduce the risk of early caries (cavities)?
Primary teeth preserve space for permanent teeth and guide their later alignment. In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food. For these reasons, it is critically important to learn how to care for the child’s emerging teeth.
Here are some helpful tips:
If you have questions or concerns about the emergence of your child’s teeth, please contact our practice.
The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth or no later than the child’s first birthday.
Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years. Tooth decay and early cavities can be exceptionally painful if they are not tended to immediately, and can also set the scene for poor oral health in later childhood.
The pediatric dentist is a specialist in child psychology and child behavior and should be viewed as an important source of information, help, and guidance. Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.
What potential dental problems can babies experience?
A baby is at risk for tooth decay as soon as the first tooth emerges. During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm and will also demonstrate how infant teeth should be brushed and flossed.
In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities). To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.
Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake. Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood. Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.
What happens during the first visit?
Pediatric dentists have fun-filled, stimulating dental offices. All dental personnel are fully trained to communicate with infants and young children.
During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth. The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times. If the infant’s teeth appear stained, the dentist may clean them. Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.
What questions may the pediatric dentist ask during the first visit?
The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.
Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:
If you have further questions or concerns about the timing or nature of your child’s first oral checkup, please contact our office.
Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task. Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.
Why brush primary teeth?
The importance of maintaining the health of primary (baby) teeth is often understated. Primary teeth are essential for speech production, chewing, and jaw development. They also facilitate the proper alignment and spacing of permanent adult teeth. Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.
What differences are there among toothpaste brands?
Though all toothpastes are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.
The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring. Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis. Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.
Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth. In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which cause painful mouth ulcers in some children.
So which toothpaste brand should I choose?
The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child. Home oral care should begin before the emergence of the first tooth. A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.
Prior to the age of two, the child will have many teeth, and brushing should begin. Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day. Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.
Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride. The ADA logo is clear and present on toothpaste packaging, so be sure to check for it. Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing. Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty. If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.
Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.
If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.
Tooth decay has become increasingly prevalent in preschoolers. Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.
Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay. Sealants can bolster the mouth’s natural defenses, and keep smiles healthy when they are used in combination with other preventative measures like biannual checkups and an excellent daily home care routine.
How do sealants protect children’s teeth?
In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids. These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean. Molars mark the site of four out of five instances of tooth decay. Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars. These areas are extremely difficult to access with a regular toothbrush.
If the pediatric dentist evaluates a child to be at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth). The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.
Dental sealants do not enhance the health of the teeth directly and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care. However, sealants are usually less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.
How are sealants applied?
Though there are many different types of dental sealant, most are comprised of liquid plastic. Initially, the pediatric dentist must thoroughly clean and prepare the molars before painting sealant on the targeted teeth. Some sealants are bright pink when wet and clear when dry. This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.
When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand). This specialized light hardens the sealant and cures the plastic. The final result is a clear (or whitish) layer of thin, hard, durable sealant.
It should be noted that the “sealing” procedure is easily completed in one office visit and is entirely painless.
When should sealants be applied?
Sealants are usually applied when the primary (baby) molars first emerge. Depending on the oral habits of the child, the sealants can last for the life of the primary tooth or might need replacing several times. Essentially, sealant durability depends on the oral habits of the individual child.
Pediatric dentists recommend that permanent molars be sealed as soon as they emerge. In some cases, sealant can be applied before the permanent molar is full grown.
The health of the sealant must be monitored at biannual appointments. If the seal begins to lift off, food particles can become trapped against the tooth enamel, actually causing tooth decay.
If you have questions or concerns about dental sealants, please contact our office.
For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life. Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.
According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old. Thumb sucking can be a harder habit to break and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.
How can thumb sucking and pacifier use damage children’s teeth?
Pacifier and thumb sucking damage can be quite insidious. Both can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time. Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:
Jaw misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold. Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.
Tooth decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance. Oral bacteria feed on sugar and emit harmful acids. The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.
Roof narrowing – The structures in the mouth are extremely pliable during childhood. Prolonged, repeated exposure to thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device). This can cause later problems with developing teeth.
Slanting teeth – Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results. In addition, thumb sucking and pacifier use in later childhood increases the need for extensive orthodontic treatments.
Mouth sores – Passive sucking is much less harmful than aggressive sucking. Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.
If you do intend to purchase a pacifier:
How can I encourage my child to stop thumb or pacifier sucking?
In most cases, children naturally relinquish the pacifier or thumb over time. As children grow, they develop new ways to self-soothe, relax, and entertain themselves. When thumb sucking or pacifier use persists past the age of five, a gentle intervention may be required.
Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use:
If the above suggestions do not seem to be working, your pediatric dentist can provide more guidance. Remember: the breaking of a habit takes time, patience, and plenty of encouragement!
Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities. Fitting snugly over the upper teeth, guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile. In addition, guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.
The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental guards during any sporting or recreational activity. Most store-bought guards cost fewer than ten dollars, making them a perfect investment for every parent.
How can mouth guards protect my child?
The majority of sporting organizations now require participants to routinely wear guards. Though guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain). In this way, guards help minimize the risk of traumatic brain injury, which is especially important for younger children.
Guards also reduce the prevalence of the following injuries:
What type of mouth guard should I purchase for my child?
Though there are literally thousands of guard brands, most brands fall into three major categories: stock mouth guards, boil and bite guards, and customized mouth guards.
Some points to consider when choosing a guard include:
In light of these points, here is an overview of the advantages and disadvantages of each type of guard:
Stock mouth guards – These guards can be bought directly off the shelf and immediately fitted into the child’s mouth. The fit is universal (one-size-fits-all), meaning that that the guard doesn’t adjust. Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores. Pediatric dentists favor this type of guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.
Boil and bite mouth guards – These guards are usually made from thermoplastic and are easily located at most sporting goods stores. First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold. Boil and bite guards are slightly more expensive than stock guards but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.
Customized mouth guards – These guards offer the greatest degree of protection, and are custom-made by the dentist. First, the dentist makes an impression of the child’s teeth using special material, and then the guard is constructed over the mold. Customized guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.
If you have questions or concerns about choosing a guard for your child, please contact your pediatric dentist.
Childhood cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world. There are two main causes of cavities: poor dental hygiene and sugary diets.
Cavities can be incredibly painful and often lead to tooth decay and childhood periodontitis if left untreated. Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually are all crucial factors for both cavity prevention and excellent oral health.
What causes cavities?
Cavities form when children’s teeth are exposed to sugary foods on a regular basis. Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating. A sticky film (plaque) then forms on the tooth enamel. The oral bacteria within the plaque continually ingest sugar particles and emit acid. Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay. If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.
Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected. It is essential that children brush and floss twice per day (ideally more), and visit the dentist for biannual cleanings. Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.
How will I know if my child has a cavity?
Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all. Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye. Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.
Some of the major symptoms of cavities include:
If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist. Failure to do so will make the problem worse, leave the child in pain, and possibly jeopardize a tooth that could have been treated.
How can I prevent cavities at home?
Biannual visits with the pediatric dentist are only part of the battle against cavities. Here are some helpful guidelines to prevent cavities:
If you have questions or concerns about how to prevent cavities, please contact our practice.
The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.
These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.
The pediatric dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.
What is the purpose of dental checkups?
First, the pediatric dentist aims to provide a “good dental home” for the child. If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.
Second, the pediatric dentist keeps meticulous records of the child’s ongoing dental health and jaw development. In general, painful dental conditions do not arise overnight. If the pediatric dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.
Third, the pediatric dentist is able to educate parents and children during the visit. Sometimes the pediatric dentist wants to introduce one or several factors to enhance tooth health – for example, sealants, fluoride supplements, or xylitol. Other times, the pediatric dentist asks parents to change the child’s dietary or oral behavior – for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.
Finally, dental X-rays are often the only way to identify tiny cavities in primary (baby) teeth. Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease. Dental X-rays are only used when the pediatric dentist suspects cavities or orthodontic irregularities.
Are checkups necessary if my child has healthy teeth?
The condition of a child’s teeth can change fairly rapidly. Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment.
In addition to visual examinations, the pediatric dentist provides thorough dental cleanings during each visit. These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places. Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy.
The pediatric dentist is also able to monitor the child’s fluoride levels during routine visits. Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning. Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks. Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply).
Finally, the pediatric dentist may apply dental sealants to the child’s back teeth (molars). This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.
If you have questions or concerns about when to schedule your child’s dental checkups please contact your pediatric dentist.
The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.
Generally, the first primary tooth breaks through the gums between the ages of six months and one year. By the age of three years old most children have a “full” set of twenty primary teeth. The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges. Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.
Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits, and the proper spacing and alignment of adult teeth. Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.
In what order do primary teeth emerge?
As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.
Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth, then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.
Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months). Canine teeth can be found next to the lateral incisors and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth and are lost between the ages of 10 and 12 years old.
What else is known about primary teeth?
Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both sexes.
Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once. Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone. Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.
If you have questions or concerns about primary teeth, please contact our practice.
According to AAPD (American Academy of Pediatric Dentistry) guidelines, infants should initially visit the pediatric dentist around the time of their first birthday. First visits can be stressful for parents, especially for parents who have dental phobias themselves.
It is imperative for parents to continually communicate positive messages about dental visits (especially the first one), and to help the child feel as happy as possible about visiting the dentist.
How can I prepare for my child’s first dental visit?
Pediatric dentists are required to undergo extensive training in child psychology. Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools. Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.
There are several things parents can do to make the first visit enjoyable. Some helpful tips are listed below:
Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined. Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.
Leave other children at home – Other children can distract the parent and cause the infant to fuss. Leaving other children at home (when possible) makes the first visit less stressful for all concerned.
Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language like “drills,” “needles,” “injections,” and “bleeding.” It is imperative for parents to use positive language when speaking about dental treatment with their child.
Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way. Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”
Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect. Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:
What will happen during the first visit?
There are several goals for the first dental visit. First, your pediatric dentist and the child need to get properly acquainted. Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history. Third, the dentist needs to evaluate the health of the existing teeth and gums. Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.
The following sequence of events is typical of an initial “well baby checkup”:
If you have questions or concerns about your child’s first dental visit, please contact our office.
