Infant and Children’s Oral Health: A mini-guide for Parents
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Babies are born with 20 primary (‘baby’) teeth that usually start to come through the gums by the age of 6 months, and all teeth have usually appeared by the age of 2 or 3 years. Therefore, it is essential that you care for your child’s teeth from an early age, well before the teeth arrive. You can start brushing your baby’s teeth as soon as they begin to come through. Use a baby toothbrush with a tiny smear of fluoride toothpaste.
Although your child will lose their baby teeth, they are needed to help guide the permanent teeth into the right place in the jaw when the time comes. So as soon as teeth appear, it is time to start cleaning.
With the appearance of teeth, the decay becomes a possibility.
You might be unaware that one of the most serious forms of tooth decay occurs in babies and young children who are given bottles containing sugary drinks such as milk and fresh fruit juice.
If left in contact with the teeth, sugary drinks of any sort will cause decay because the sugar is converted to acid that dissolves the tooth enamel.
About baby teeth
Babies are born with the following teeth:
- 4-second molars
- Four first molars
- Four canine teeth
- Four lateral incisors
- Four central incisors
There is one set on each side of the upper jaw and one on each side of the lower jaw.
The teeth in the centre of the bottom jaw often come through first, sometime between 4 months and ten months.
Each child is different, so don’t worry if your baby’s teeth appear earlier or later. Instead, talk to your dentist if you are worried.
Your child’s jaw will continue to grow, and permanent teeth will start to replace the baby teeth when the child is around age 6.
The outer covering of baby teeth is made of thinner enamel than the enamel of permanent teeth, making the baby teeth look whiter. Unfortunately, it also means they are more likely to get tooth decay.
Baby teeth also have shorter and different shaped roots from permanent teeth, making it easier for the roots to dissolve later and allowing permanent teeth to grow underneath them.
Babies can be pretty uncomfortable when they are teething. Try chilled (not frozen) teething rings, washcloths or dummies to ease the pain.
Tooth brushing tips for babies
- Use a tiny smear of toothpaste for babies and toddlers up to 3 years old and a pea-sized amount for children aged 3 to 6.
- Gradually start brushing your child’s teeth more thoroughly, covering all the surfaces of the teeth. Do it at least twice a day: just before bed and at another time that fits in with your routine.
- Not all children like having their teeth brushed, so you may have to keep trying. Make it into a game, or brush your teeth at the same time and then help your child finish their own.
- The easiest way to brush a baby’s teeth is to sit them on your knee, with their head resting against your chest. Then, with an older child, stand behind them and tilt their head backwards.
- Brush the teeth in small circles, covering all the surfaces, and encourage your child to spit the toothpaste out afterwards. There’s no need to rinse with water, as this will wash away the fluoride.
- Supervise brushing to make sure your child gets the right amount of toothpaste, and they’re not eating or licking toothpaste from the tube.
- Carry on helping your child brush their teeth until you’re sure they can do it well enough themselves. This will typically be until they are at least 7.
Baby teeth are important.
Baby teeth help your child to chew food easily and to pronounce words properly. They are also needed to hold a place in the jaw for the permanent teeth to come through later.
It is essential to keep baby teeth clean. This will protect against infection, cavities and pain. In addition, decayed baby teeth can damage the permanent teeth underneath.
When should dental care begin?
Most pediatric dentists will agree that regular dental care should begin by one year of age, with a dental check-up at least twice each year for most children. However, some children may need check-ups more often. This dental checklist for infants and toddlers is from the American Academy of Pediatric Dentistry (AAPD):
Birth to 6 months old
- Clean your baby’s mouth after feedings and at bedtime. Use water and a cloth or gauze, or use a soft infant toothbrush.
- Talk with your child’s healthcare provider about using fluoride supplements if you live in an area without fluoridated water.
- Also, ask about fluoride varnish that can be applied to the teeth.
- Create regular feeding habits (bottle-feeding and breastfeeding).
6 to 12 months old
- During this time, the first tooth should appear. Contact the pediatric dentist for an exam as soon as the first tooth comes in, but no later than your child’s first birthday.
- Brush teeth after each feeding and at bedtime with a small, soft-bristled brush. Use a very small amount of fluoride toothpaste, about the size of a grain of rice.
- As your child starts to walk, stay alert for possible dental or facial injuries.
- The American Academy of Pediatrics advises breastmilk for at least six months. After that, the AAPD recommends breastfeeding for at least one year. At about one year old, continue to breastfeed or begin weaning as you and your baby are ready. But also start giving your baby whole milk. The fat in whole milk is needed for brain development.
1 to 3 years old
- Follow the schedule of dental exams and cleanings, as advised by your child’s pediatric dentist. Generally, dental exams and cleanings are recommended every six months for children and adults.
- At about age 3, as your child learns to rinse and spit, brushing with a pea-sized portion of fluoridated toothpaste is best.
- Make the experience enjoyable for your child by using games or songs. This can help make the twice-daily activity pleasant for both of you.
Facts about baby teeth
Correct care of a child’s baby teeth (primary teeth) is critical. This is because these teeth hold space for future adult (permanent) teeth.
- If a baby’s tooth decays or is removed too early, the space for the permanent teeth is lost. It can only be regained through orthodontic treatment.
- Infected baby teeth can cause permanent teeth to develop incorrectly. This can lead to stains, pits, and weaker teeth.
- Baby teeth are important in speech development.
- Baby teeth aid in chewing food correctly, promoting healthy nutrition.
Most children begin losing their baby teeth around age 5 or 6. Children often lose their front teeth first. They continue to lose baby teeth until age 12 or 13. This is when all permanent teeth finally come through, except for the third molars (wisdom teeth). These molars begin to appear around age 17 to 21.
How to care for baby teeth
Baby teeth can start to decay as soon as they appear in the mouth. In addition, frequent exposure to sugary liquids can destroy the teeth.
You should wipe your baby’s gums with a wet facecloth or a clean gauze pad after each feed. You can brush your baby’s first tooth as soon as it appears with a soft toothbrush and a little water.
Older children should be supervised while they are cleaning their teeth. Children over 18 months can use a pea-sized amount of children’s low-fluoride toothpaste and, if possible should be taught not to swallow it. They should rinse with water after brushing.
To reduce the risk of tooth decay:
- Never allow your baby to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquid.
- Don’t dip a dummy in sugar or honey.
- Clean the dummy before you give it to your baby.
- Visit your dentist in about 12 months.
If you are worried about your baby’s tooth development, consult a pediatric dentist.
Tips on how to prevent tooth decay for your infant and toddler
- Wipe your baby’s gums with a wet facecloth or a clean gauze pad after each feed. You can brush your baby’s first tooth as soon as it appears with a soft toothbrush and a little water.
- A pea-sized amount of low fluoride toothpaste can be used from the age of 18 months. If a small amount of toothpaste is swallowed by your child, this is not a concern. Toddler’s teeth need cleaning twice a day — in the morning and before bed.
- Once your child has two teeth that touch, usually by age 24 to 30 months, begin using dental floss before brushing.
- Never allow your child to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquid (which are all sugary).
- If you use a dummy, make sure that it is clean and not dip it into a sugar-containing liquid.
- Start taking your child to the dentist six months after their first tooth appears or when they reach 12 months of age — whichever comes first.
- Feed your child a balanced diet from the five major food groups — vegetables, fruit, grains, meat and dairy food. Limit snack foods that are high in sugar.
- Encourage your child to drink water when thirsty and limit fruit juice and soft drinks to special occasions.
Start teaching your child healthy dental habits when they are very young. It may prevent dental problems in the future.
Diet and dental care for children
The AAPD advises the following to be sure your child eats correctly to maintain a healthy body and teeth:
- Ask your pediatric dentist to help you assess your child’s diet.
- Shop smart. Don’t usually stock your pantry with sugary or starchy snacks. Instead, buy “fun foods” just for special times.
- Limit the number of snack times. Choose healthy snacks.
- Be a role model for your child. Eat healthy foods and limit sugary drinks and snacks.
- Provide a balanced diet, and save foods with sugar or starch for mealtimes.
- Don’t put your young child to bed with a bottle of milk, formula, or juice.
- If your child chews gum or sips soda, choose those without sugar.
Sugar and tooth decay
Sugar causes tooth decay. It’s not just about the amount of sugar in sweet food and drinks, but how long and how often the teeth contact sugar.
Lollipops and sweet drinks in a formula bottle are particularly damaging because they bathe the teeth in sugar for long periods. The acid in drinks like fruit juice and squash can harm teeth as well.
The sugars found naturally in whole fruit and milk are less likely to cause tooth decay, so you don’t need to cut down on these types of sugars.
How to cut down sugar in your child’s diet
These tips will help you reduce the amount of sugar in your child’s diet and prevent tooth decay:
- Avoid sugar-sweetened drinks – the best drinks for young children are their usual milk and water.
- It’s OK to use bottles for expressed breast milk, formula milk, or cooled boiled water. But using them for juices or sugary drinks can increase tooth decay.
- From 6 months old, you can offer babies drinks in a non-valved free-flowing cup.
- When your baby starts eating solid foods, encourage them to eat savoury food and drinks with no sugar. Check if there’s sugar in pre-prepared baby foods (including the savoury ones), rusks and baby drinks. Read more about food labels.
- If you choose to give your child sweet foods or fruit juice, only give them at mealtimes. Remember to dilute 1 part juice to 10 parts water. Your child should have no more than one drink of fruit juice (150ml) on any one day as part of their 5 A Day.
- Don’t give your child biscuits or sweets – ask family and friends to do the same. Offer things like stickers, hair slides, crayons, colouring books and bubbles instead. They may be more expensive than sweets, but they last longer.
- At bedtime or during the night, only give your child breast milk, formula or cooled boiled water.
- If your child needs medicine, ask your pharmacist or GP if there’s a sugar-free option.
- Check your whole family’s sugar intake – see how to cut down on sugar in your diet.
Sucrose, glucose, dextrose, maltose, fructose and hydrolysed starch are all sugars. Invert sugar or syrup, honey, raw sugar, brown sugar, cane sugar, muscovado sugar, and concentrated fruit juices are also sugars.
Should I give my baby a dummy?
It’s OK to give your baby a dummy but avoid using them after 12 months of age, and using dummies after this can encourage an open bite, which is when teeth move to make space for the dummy. They may also affect your child’s speech development.
Discourage your child from talking or making sounds with a dummy or their thumb in their mouth, and don’t dip dummies in anything sweet, such as sugar or jam.
Dental Anxiety in Children
It’s perfectly normal to have fears, especially for children. Some fears come stem from drastic changes, being separated from their parents, or even the scary monster in the closet. Although many kids will grow out of their fear as they mature, teaching them to cope while they’re young can sometimes be difficult.
One fairly common and difficult fear that some parents face is when their child is terrified of going to the dentist, also called dental phobia or anxiety.
Believe it or not, almost 20% of school-age children are afraid of visiting the dentist. Unfortunately, this issue makes things difficult for the parents and technicians trying to help the child. Even worse, the anxiety can be detrimental to the child’s oral health when it prevents them from receiving necessary dental care. So what can you do to get them past this anxiety? We have some suggestions that may help you out:
What you can do to help your child?
It can help tremendously when both the parents and their dentist communicate and work together to make a dental visit go more smoothly. Both persons play a vital role in soothing and transitioning a child into his or her dental procedures.
Before the Visit:
Tell your child in advance that they have a dental visit.
Children need predictability in their life in order to adjust and transition into unfamiliar situations. Waiting until the last moment to tell your child about their dental visit can worsen their anxiety. They will need as much time as possible in order to mentally prepare for their visit to the dentist. During that time, you can also begin to help them through their dental phobia. Let them express their fears to you as the day of their appointment draws closer.
Answer their questions with straightforward, to-the-point responses. Be sure to limit the number of details given, and remind them that they can ask the dentist questions too. Dental professionals are trained to describe procedures to children in nonthreatening ways.
Communication with your child is key. Talk to them about the importance of maintaining healthy teeth and gums. Explain that the dentist is a friendly doctor who helps take care of their mouth, keeping them safe and healthy.
Inform your dentist beforehand. Making your dentist aware of your child’s dental phobia ahead of time will help them be prepared for the visit.
During the Visit:
Ask your dentist for advice, and follow their instructions. Dental professionals are trained in the ways of dental care and also dealing with a variety of patients. Ask them what you can do to put your child at ease, and follow their instructions during the visit.
Have your child’s favourite toy ready. A toy can be a helpful and calming distraction for your child during the visit. You can let them play while in the waiting room as they adjust to the new environment. Though not all toys are suitable for when they’re in the dental chair, your child may be allowed to have small simple toys during the procedure. (Just be sure to ask your dentist for permission.)
Stay calm, always. It can be difficult to stay calm while your child is having a tantrum or has anxiety at their dental appointment. Remind yourself to remain collected and to speak gently to your child. Having a soothing demeanour will make them feel safer and at ease.
Nothing is working! What do I do?
When nothing seems to be helping your child deal with their dental anxiety, there is another harmless option: Laughing gas. Using a safe and effective sedative will help keep your child calm during a dental procedure. Sedation dentistry is used for both kids and adults and is given as a controlled anti-anxiety medication. Most of the time, conscious sedation is enough to help the patient cope with the procedure. This kind of method allows the child to remain relaxed during the procedure. During this kind of sedation, they are still able to respond to verbal and physical stimuli. They can also breathe normally without any medical assistance. Afterwards, the child will probably have no recollection of the procedure and will function normally by the next day.
For their patients’ safety, dentists and their assistants are certified to administer such drugs and have a qualified staff member to monitor the vital signs of the patient during sedation. Different levels of sedation are achieved by different medications to bring on mild, moderate, or deep sedation. Medications such as Hydroxyzine or Midazolam can be taken orally for milder sedation. Intravenous (IV) drugs are used for deeper levels of sedation.
Sometimes it’s necessary to seek professional help for your child’s anxiety. Different therapeutic treatments like cognitive behavioural therapy or psychotherapy are worth trying. Doing so will allow your child to overcome their fears so they can receive proper dental treatment to keep their teeth and gums healthy.
Don’t tell your child about unpleasant dental experiences that you have had.
This may seem obvious, but even telling stories long before they ever see the dentist may promote dental phobia for your child. Stick to positive stories when describing what it’s like at the dentist’s office.
Avoid words like “hurt,” “shots,” or “painful.”
Even prefacing these words with “only a little” is not going to help your child with their dental phobia.
Find a child-friendly dental office.
If your child is really struggling to make it to dental appointments, it’s crucial that you find a dentist who has experience with young patients and their dental anxiety. If a dentist is not willing to take the steps to ease your child’s fear, you may have to consider finding a new dentist.
Don’t give up.
It can be understandably frustrating when your child refuses to go to the dentist, even for something as small as fluoride treatment. It’s going to take a lot of patience to deal with dental anxiety. Remember that keeping calm and nurturing is extremely helpful to a fearful child. These types of fears often only last as a phase; they will most likely grow out of it.
Helping your child overcome their fear of the dentist is beneficial for their mental and physical health. After all, giving your child the proper dental care they need is crucial for their well being.
- Raising Children Network (Dental care for newborns), Raising Children Network (Dental care for toddlers), Australian Dental Association (Children 0-11), The Sydney Children’s Hospitals Network (Teeth – Caring for your child’s teeth)
- Australian Dental Association (Teething chart, When the teeth come marching in), Australian Dental Association (Babies), WebMD (Your Teeth From Birth to Adulthood), Sydney Children’s Hospital Network (Teeth – Caring for your child’s teeth), Tresillian (Teething)
- University of Rochester, Medical Center Encyclopedia