The average age for the first tooth to erupt, a lower incisor, is at about 6 months, but 2 months on either side of this is quite normal. Different children react in different ways to teething, bear in mind that it is a normal physiological process, and any discomfort is quite transient. Teething gel will probably help if needed.
The usual sequence is lower incisors, upper incisors, canines, first molars and finally second molars at about two and a half years. There will be variations on this, of course, being quite inconsequential.
Toothbrushing is very important for removing food debris and dental plaque and delivering fluoride twice daily to your child’s teeth. Modern toothbrush design provides sizes specific to every stage of dental development for children. Some children accept it willingly, and others put up quite a struggle! Just bear in mind that you are not actually hurting your child while cleaning the teeth, and do not forget the back teeth; the cheek side of the upper molars and the tongue side of the lower molars are the areas most often missed.
Any of the well-known brands of toothbrush and toothpaste are acceptable. When used in the amounts recommended by dentists, fluoride is an extremely safe way of protecting your child’s teeth against the ravages of dental decay. The toothpaste formulations for infants and young children have lower concentrations of fluoride. We advise that only a small pea-size amount is used twice daily, after breakfast and then last thing at night, after the last food or drink is taken.
Bleeding gums are usually an indication of inflammation caused by inadequate toothbrushing. A visit to the dentist or dental hygienist for help with brushing techniques should help get the gums back to health.
Sometimes, non-nutritive sucking i.e., dummy or thumb, can procline the upper incisors, and make them stick out. The teeth may also stick out because the lower jaw is set further back than the upper jaw. The teeth may procline from both causes. If the habit stops before the age of about 6 years, then the teeth usually return to where they would have been had the child never had the habit. The short answer, then, is no, a dummy is not bad for the teeth. However, tooth decay could be the outcome if it is dipped in something sweet, such as honey.
All foods or drinks that contain refined sugars or starches have the potential to cause tooth decay. Some are worse than others, for example, because they are ‘stickier’ and stay in contact with the tooth surface longer. Fizzy carbonated drinks have high acid content, and these can lead to acid erosion of the enamel surface; enamel cannot be regenerated by the body.
A simple rule of thumb is that the amount of sugar consumed is not as important as the frequency. If your child only has any food or drink containing sugar with their main meals, and none at all between meals, for most children, that will be a good safeguard against tooth decay.
Toddlers often fall while they are developing their sense of balance, and chipped front teeth frequently result. The outcome depends on many factors, such as the amount of tooth lost and how hard the impact was. It is always a good idea to have the trauma checked by your dentist because if the baby tooth develops an abscess, it may have implications for the integrity of the adult tooth that follows.
X-rays can be an essential part of diagnosis for dentists, and while we are always conscious of radiation hygiene, there are occasions when they need to be taken. Modern X-ray machines deliver a very small amount of radiation and are a safe procedure for children.
The first visit to the dentist for a child used to be at the age of 3 years when they could reasonably be expected to sit in the dental chair and accept the experience. Unfortunately, many 3-year-olds have six or more cavities due to feeding or toothbrushing inadequacies. For that reason, paediatric dentists recommend the first visit at about twelve months; the child stays on the mother’s lap, often with its head on the dentist’s lap. Most children of that age will cry out of anxiety, but it is a quick examination, and the dentist can either give a clean bill of health and suggest the next check at about 30 months or else suggest ways of dealing with any decay or soft tissue problems he has detected.
Dr John Roberts qualified in 1971 at the University of Bristol. After a period in general dental practice in England and South Africa, he undertook specialist postgraduate training in Paediatric Dentistry at the Eastman Dental Centre, New York, before working at Weymouth Street in 1978. He held the post of Senior Clinical Lecturer at Guy’s Hospital Dental School, teaching at postgraduate level, and has lectured regularly in Britain, Europe and North America. Dr Roberts was a member of the Executive Committee of the European Academy of Paediatric Dentistry.
As well as publishing regularly in professional journals, he is the co-author of a standard textbook of paediatric dentistry. Dr Roberts is registered as a Specialist in Paediatric Dentistry with the General Dental Council.