Caring for Your Children’s Teeth

Prof. KING, Nigel Martyn

Honorary Consultant in Paediatric Dentistry

Specialist in Paediatric Dentistry

Primary teeth (baby teeth) start erupting at approximately 6 months of age and this set of 20 teeth has normally erupted by 2 years of age. There can be a variation of up to 12 months but if your child’s teeth have still not all erupted by the age of 3 years, a professional opinion should be sought, i.e. you should take your child to see a specialist paediatric dentist. 

Major Problems with Children’s Teeth

1. Black Stain

The mouth has a large number of bacteria, maybe as many as 210 different types. They do not cause any major health problems under normal circumstances.  However, sometimes the balance of the number of bacteria varies and in some children this can cause a black stain that in itself is not harmful, but is unsightly. 

Children with this problem need to see a specialist paediatric dentist because this stain cannot be removed with a toothbrush and toothpaste alone. Special instruments and techniques are required.

2. Dental Caries (Tooth Decay/Cavities)

A number of other bacteria, when exposed to food and beverages with high sugar contents, generate an acid that causes the teeth to decay, causing cavities. Thus, failure to maintain bacteria-free teeth by brushing twice daily along with the consumption of a high sugar content diet can lead to dental caries (decay). These cavities progress towards the living part of the tooth, causing pain, which may prevent the child from sleeping and directly and indirectly adversely influence their ability to concentrate school lessons. They cannot enjoy eating a mixed diet, particularly one that includes meat if the teeth are broken down and painful. 

The progression of the decay process can lead to an infection that may present as gum swelling that is painful, particularly when pressure is applied to the tooth. If left untreated this infection may lead to swelling of the face and even closure of the eye.  This represents a systemic spread of the infection and requires immediate professional care.

Treatment of a decayed primary tooth may take the form of a restoration/filling or placing an artificial crown after removal of the decayed tooth structure and restore the natural shape and function of the tooth. Furthermore, this maintains the appropriate amount of space for the permanent successor tooth. 

If the decay has destroyed most of the tooth or has led to an infection, then the tooth may need to be extracted. This in turn leads to a loss of space and may cause crowding of the permanent teeth when they erupt.

3. Broken Teeth

A primary tooth or teeth may get damaged if a child falls over, trips at home or bumps into something. Underneath every primary tooth is a permanent tooth, of which growth is most likely to be affected by such damage. Therefore, it is important to have a paediatric dentist look into the problem at the first opportunity. Sometimes the tooth concerned may simply be loose, or it has been totally knocked out or pushed in, in which case the permanent tooth underneath is also likely to be damaged given its proximity. While the damage to the damaged primary tooth is treatable, parents are advised to discuss with the paediatric dentist and get prepared for the possible consequences to the permanent teeth, e.g. being malformed when it erupts.

4. Other Common Complaints

Two problems that commonly occur between 5 and 7 years of age are as follows:

- Extra Teeth

Approximately 10% of children have an extra tooth or teeth, most commonly in the front of the upper jaw, that may erupt, have a strange or pointed shape or may not erupt into the mouth but be growing towards the nose. In both cases they may cause the permanent teeth to not erupt on time or to be displaced to an abnormal location. These extra teeth, also known as supernumerary teeth may also be cylindrical in shape.

If unerupted, these teeth can be detected based on clinical signs and an X-ray film.  Either a simple extraction or surgical extraction, usually at a young age, is beneficial for normal development of the neighbouring permanent teeth. Delaying the treatment may complicate the problem, for example, the adjacent permanent teeth may be displaced, and the treatment procedure is more complicated.

- Delayed Exfoliation

The other most common problem occurs at the front of the lower jaw where the baby teeth are not completely lost before the permanent successor erupts on the tongue side of the baby tooth. This is a sign that there will be crowding of the permanent teeth. 

Whilst the solution appears to be the extraction of the baby tooth, this is not a long-term solution and is likely to occur four times because there are four permanent incisors to erupt. Therefore, it is better for this process to be monitored by a specialist paediatric dentist until all four permanent incisors appear in the mouth because by then the best solution becomes more apparent.

By waiting, the trauma to the child of having to experience multiple tooth extractions can be reduced because a better assessment of the required treatment can be made and the number of teeth to be extracted may be less than if treatment begins too early. However, if this problem occurs in the upper jaw, then early treatment can avoid a problem in the relationship between the upper and lower teeth. Therefore, in this case, an early consultation with a specialist paediatric dentist should be sought.

Tooth Brushing: When to Start?

It can be appreciated that starting to brush a child’s teeth as soon as they erupt; that is at approximately 6 months of age, allows the bacteria that cause cavities to be removed. Brushing is not always easy in the beginning but persistence can develop it into a routine habit that will benefit the child in the long term.

However, an added benefit is that the parents will become aware of the condition, position and colour of their child’s teeth. Thus, parents can seek professional advice from a specialist paediatric dentist before any major problems occur.

Parents are advised to brush the teeth of infants and to supervise their tooth brushing when they get older. They should also use a toothpaste that contains fluoride.

Pacifiers: Good for Children?

Pacifiers are used by some parents to keep their child quiet and help them sleep.  The advantage of sucking a pacifier over sucking a finger or thumb is that it can be more easily stopped by simply removing it and throwing it away. 

Like most things, if used correctly, there is no harmful effect in the short-term other than the obvious one of creating dependence and placing the pacifier back in the child’s mouth after it has been dropped and so may be dirty. However, a much more harmful effect of a pacifier is when it is filled or coated with a sweetened beverage, honey or juice. This will certainly cause cavities in the teeth.

A further problem is when the pacifier is incorrectly placed in the mouth so that the flange that should on the outside is placed under the lip and subsequently causes damage to the gums and the inside of the lip.

Start Tooth Brushing and Seeing the Dentist as Early as Possible

Development of a brushing habit early in your child’s life provides opportunities to prevent a number of problems and develop awareness of the condition of your child’s oral health. This should be combined with early visits to a specialist paediatric dentist to make the child more comfortable in the dental environment and for early detection of potential problems.

Cooperation from children is essential during dental visits: so the earlier a child visits and gets used to the setting of a dental clinic, the earlier tooth-related problems, if any, can be identified and treated with a satisfactory outcome.