Dental Care

One of the memorable milestones in parenting is seeing the first white nubbin poking though a pink gum line, nearly always between six and ten months of age. This is the first of the primary (temporary) teeth, which allow children to chew and speak until the secondary, or permanent, teeth appear.

Between six and nine months of age (or in some infants as late as fifteen months), the lower central incisors (middle teeth), the upper central and lateral incisors (the teeth to the side of the middle teeth), and the lower lateral incisors will erupt – usually in that order. Between twelve and sixteen months, look for the first top and bottom molars (jaw teeth used for chewing), along with the lower cuspids (the pointed teeth on the sides). Between eighteen and thirty months, the primary teeth will be completed with the appearance of the upper cuspids and the upper and lower second molars. See Atlas of Body Systems insert for diagrams of the teeth and mouth.

Many children experience discomfort with the eruption of teeth. They drool more than usual and may try to gum the nearest firm object. Contrary to popular belief, teething does not generate a temperature over 100.4°F (rectally). (A baby or toddler with a higher fever should be assumed to have another problem.) Rubbing a finger against the gum through which the tooth is erupting sometimes helps; some infants prefer teething rings. Acetaminophen (Tylenol and others) can help, but topical preparations that are supposed to numb the gums usually do not provide dramatic relief because they don’t remain in place very long.

The general order and appearance of the permanent teeth are as follows:

  • ages 4 to 6: Primary teeth begin to fall out and be replaced by permanent teeth
  • ages 6 to 8: Arrival of upper first molars, lower central incisors, lower first molars, and upper and lower central incisors
  • ages 8 to 10: Lateral (side) incisors erupt on the top; lower cuspids appear
  • ages 10 to 13: Upper first and second bicuspids, lower first and second bicuspids, second molars appearing on the upper and lower gums
  • ages 17 to 22: Wisdom teeth
  • the timing of tooth eruption can vary greatly from child to child.

Dental Care in Young Children

Dental care at home can begin before the first teeth erupt. Infants begin collecting plaque on their gum pads even before the teeth break through them; this material can accumulate on the emerging dental surfaces. The gums can be gently cleaned of milk curds and other food debris using a clean washcloth moistened only with water. After the first teeth have erupted, a small soft tooth-brush may be used. Teeth should be brushed within five or ten minutes after a meal. You can use a very small (pea-sized or less) dab of fluoride toothpaste, but if a young child objects, this can be postponed until he is older. When he is using a fluoride toothpaste regularly, be sure that only a small amount is placed on the brush.(Fluoride helps strengthen the outer enamel, but there is enough in a strip of toothpaste covering the length of the bristles to cause eventual discoloration of a child’s teeth if he swallow’s the toothpaste regularly.)

Continue to supervise tooth brushing as your child matures: he starts, you finish. Many parents allow their toddlers to do the majority of the brushing, but if your child insists that he wants to “do it himself,” find creative ways to encourage him to let you help. You should continue this supervision through seven to ten years of age, until you are convinced that your child is adequately brushing all of his teeth.

Fluoride taken by mouth is important to the developing secret of strong teeth. To determine whether your child is receiving an adequate amount, find out how much is present in your water supply. If you are breast-feeding, you should discuss with your baby’s doctor whether or not fluoride supplementation is necessary. Children drinking tap water containing fluoride in a concentration of 0.6 parts per million (abbreviated ppm) do not need any supplementation. If you have a private well, call your local water or health department, which may offer free fluoride-level testing. For areas in which the water supply contains less fluoride, the American Academy of Pediatrics’ Committee on Nutrition recommends that fluoride be supplemented each day according to the following schedule:

First Trip to the Dentist

Most dentists who see children recommend that a first dental visit be shortly after the first birthday, but definitely by the age of three, followed by dental checkups and cleaning every six months. You may wish to utilize a diatric dentist, who will be well prepared to work with younger patients and will often have an office setting that is inviting and relaxing for children.

The welfare of the primary teeth should not be ignored merely because they will eventually be replaced by permanant teeth. If primary teeth become damaged or lost prematurely, the alignment of the permanent teeth could be adversely affected.

Dental Cavities (Tooth Decay)

According to the National Institute of Dental Research, half of all American children have had at least one cavity by the age of seven. By the age of 17, 80 percent have had at least one decayed, repaired, or missing tooth.

The development of a cavity requires the following ingredients:

  • cariogenic (cavity-producing) bacteria, which produce tooth-eroding acid
  • accumulation of plaque on the surface of one or more teeth, which provides a place for bacteria to grow
  • prolonged contact between the teeth and carbohydrate food materials (especially simple sugars found in sweets)
  • a susceptible tooth surface; while any surface can be the site of a cavity, pits and fissures in the teeth are particularly vulnerable

Much of the pain, inconvenience, and cost resulting from dental caries is preventable through a combination of everyday measures at home and regular screening and appropriate intervention at the dentist’s office:

  • Regular brushing at home and periodic cleaning by a dentist/dental hygienist to remove accumulated plaque.
  • Fluoride, whether as a supplement or as an ingredient in toothpaste, strengthens enamel and reduces bacterial activity.
  • Avoid contact of sugars with teeth for prolonged periods of time.
  • Along with cleaning, appropriate screening, X-rays, and any necessary repair work, your child’s dentist may recommend the use of sealants, thin plastic coverings for the molars that effectively prevent the formation of plaque and cavities.

Reducing Fuel for Tooth Decay

The sugary foods have traditionally been associated with dental cavities; the primary issue is how long these carbohydrates remain in contact with the teeth. Particularly troublesome situations to avoid include dental caries. These cavities of the upper front teeth develop when babies repeatedly fall asleep with a bottle of milk or juice in the mouth, allowing the liquid to the teeth. Once cavities appear, a pediatricsal specialist may be needed to correct the problem. The best may to prevent this condition is to resist the temptation to give a fussy baby a bottle in bed. If a baby has already become used to a bedtime bottle and the parents are not ready to deal with the unhappy response to an apt withdrawal, a little water in the bottle is safer than milk or juice. Even when a child is in an upright position, the simple carbohydrates in juices sucked tend to remain in contact with the teeth longer than when they are sipped from a cup. Therefore, hold juices until he can drink from a cup and attempt to stop them from drinking out of bottles altogether by the age of 15 months.

Unless a child brushes after every snack, these foods will remain intact with teeth for prolonged periods of time.

A variety of situations can lead to discoloration of the teeth:

  • Trauma to the pulp (soft tissue that tills the center of the tooth) may result in a grayish discoloration.
  • Ingestion of excessive fluoride may cause a whitish discoloration. Larger amounts may create a mottled or dotted appearance.
  • Tetracycline antibiotics and their derivatives (including minocycline and doxycycline) can cause brown staining of the teeth in children if given to them before the age of eight or if taken by their mothers during pregnancy.

Injuries to the Teeth

About 10 percent of children will experience significant dental trauma at some time before age 18, most commonly as a result of falls, bicycle and motor vehicle accidents, fights, and sporting events. Dental fractures, tooth loss (avulsion), and gum lacerations comprise the majority of injuries. Because these are often associated with other more serious injuries such as blows to the head), the significance of tooth injuries can be overlooked. Besides damage to the tooth itself, periodontal tissues can be damaged and need attention as well. To minimize the likelihood of dental injuries, each child who participates in contact sports should wear a mouth protector. Children with protruding teeth should have them properly aligned. Those with neuromuscular disorders should wear the appropriate headgear if their condition causes frequent falls. Using seat belts can also prevent dental injuries resulting from car accidents.


Occlusion of the teeth is the way they come together when the mouth is closed is important not only for cosmetic purposes but also for speech and eating. If your child has to overbite, the upper teeth protrude in front of the lower teeth, an underbite the lower teeth protrude in front of the upper teeth, or crossbite, the upper teeth over the bottom teeth on one side, and vice versa on the other. If the misalignment significantly impairs speech or appearance, ask your dentist to refer you to an orthodontist (a dentist who specializes in correcting the alignment of the teeth and the bite).

Since orthodontic practice now focuses on preventive care, many appliances can be used to mold the bones of the mouth while they are still forming. But even if your child has passed puberty and is well into his teens, corrective orthodontics can still be done effectively.