Teething and Tooth Care

A baby’s teeth start to develop in the womb, however while a few babies are born with teeth and some do not begin to get their first tooth until after they are one, the average age for a child to cut their first tooth is around six months.  These first teeth are called ‘milk teeth’ or sometimes ‘deciduous teeth’.  Most children will have the complete set of 20 milk teeth by the time they are 2 and a half years old, although sometimes it can be later.  Milk teeth are extremely important in a baby’s development.  They allow the baby eat and chew properly and help with their speech development.  If milk teeth are looked after properly, they will normally start to fall out when a child is about 6 years old.  They are replaced with adult teeth.  Most children will have all 32 adult teeth by the age of 14 and some people may get up to four wisdom teeth in early adulthood.

Teething Pain
Some babies seem to suffer from teething pain more than others, and some babies are only affected by some of their teeth. Often a child may become irritable whilst teething.  The gum may look red and sore or the child may have a red, warm cheek, your baby may dribble a lot and like to chew on fingers or toys, and he may find it hard to sleep and  lose his appetite.  Sometimes a baby may get sore under their nappy while they are teething.  Although teething can affect each child in a different way, it is important to remember that a fever, vomiting or diarrhoea are never caused by the teething process, please check with your doctor or Health Visitor if concerned.

Types and order of milk teeth

The 20 milk teeth are made up of:
• Eight incisors: these are used for biting.  These are at the front of the mouth.
• Four canine teeth: these are sharp and used for cutting and tearing food.  These are between the incisors and the molars.
• Eight molars: these are used for grinding and chewing.  These are at the back of the mouth.

Teething Chart

The incisors tend to appear first, usually at approximately 6 months.  The central lower ones are usually first, then the upper two. These are closely followed by the upper side teeth and then the lower side teeth.  The upper molars tend to break through next between the ages of 12 and 16 months and these are followed by the lower molars.  The upper canines normally break through next, followed by the lower canines and finally the rear molars break through with the bottom ones first, between 24 and 36 months.

The milk teeth tend to normally fall out in the same order that they came through in the first place.  They become wobbly and fall out because the permanent teeth underneath cause the root of the milk tooth dissolve.

People used to think that because milk teeth were going to fall out; they were not very important and didn’t always give them the best care.  However, they do the important job of guiding the adult teeth so that they grow in the correct position.  Also, if any of the milk teeth are lost through decay, this can spread to the bone under the gum and erode the foundations needed for the adult teeth.

Helping with teething pain

Every child is different when teething and different things will help each child get through the process of teething.  You may find that you need to try things until you find one that works for your child.  Some ways of helping are:

• Cuddles and playing: Giving your baby one-to-one time and playing with them can take their mind off the pain or discomfort.  Your baby will often be comforted by being close to you and having a cuddle.

• Teething gels: these are available from your local chemist.  Sometimes they contain a very mild local anaesthetic which helps to numb any pain or discomfort which your child has.  They also contain antiseptic to help prevent any infection in your baby’s mouth. There are many teething gels on the market, however, it is important to ensure that you choose one suitable for your child’s age group.  Using a clean finger you simply rub onto your baby’s gums.  Always read and follow the instructions and ask your pharmacist or Health Visitor for advice if you have any questions or want to use teething gels on a baby under 4 months old.

• Pain Medicine: if your child is suffering from a high temperature or in a lot of pain due to teething you may wish to use a paracetamol or ibuprofen based children’s medicine.  It is important to check the age recommendations on the product and to read and follow all instructions.  You can ask the pharmacist for more advice if you are unsure on how to use this kind of medicine.

• Teething rings and toys: there are many different types and styles of these on the market.  They give your child something to chew on which may help ease their pain and also distract them from any pain.  Some teething rings can be cooled in the fridge before using to help numb and soothe your baby’s gums.  Make sure you follow all instructions carefully.  If you do not have a teething toy or ring, you could try giving your baby a cold, wet flannel.

• Chewing: A baby will often chew on their toys, fingers or anything that they can when they are teething.  If you baby is over six months old you could give them healthy snacks to chew on.  Raw fruit and vegetables are ideal for use in teething: for example, pieces of carrot or apple. Frozen fruit or ice cubes in a mesh feeder can also be beneficial as can a breadstick or the crust of a slice of bread.  Many supermarkets sell rusks or biscuits that are targeted for teething, however, be very aware of their sugar content as even if your child has no or very few teeth, too much sugar can cause tooth decay.  Never leave your child unsupervised when they are eating or chewing on food.

• Replacing fluid: If your baby is dribbling a lot, you may need to make sure that you keep offering drinks.  A cool drink may also help to soothe the gum.  Sugar-free drinks are the best.  You could also try smooth fruit purees.

• Helping with Dribbling: Many babies begin dribbling a long time before a new tooth is visible.  It is important that you wipe the dribble off their face and chin as this will stop them from developing a rash.  You may also find using ‘dribble’ type bibs useful.

Looking after your child’s teeth
It is important to begin cleaning your baby’s teeth as soon as the first one appears.  However, even before this time, you can clean your baby’s gums and keep them healthy by using a very soft brush or even a clean finger to massage the gums.

Make sure you buy a soft toothbrush suitable for the age of your baby.  Use baby toothpaste that contains fluoride and place a smear of toothpaste onto the brush.  Do not worry if your baby does not allow you to brush much at this stage, it will not take long for both you and you baby to get used to tooth-brushing and it will become an enjoyable time for you both.  Make sure that your baby also sees you cleaning your own teeth.

Get into the routine of cleaning your baby’s teeth twice a day.  Make sure that one of these times is just before bedtime. It is important that YOU brush your child’s teeth until you are certain that they are able to do it well and thoroughly by themselves. This can be as late as 8 years old. If your child dislikes teeth cleaning, try to make it fun by playing games such as ‘copy me’ where you  clean your teeth for a bit and then your child’s and take it in turns.

As you and your child get used to tooth-brushing, you will find your own best and comfortable positions.  However, to start with you may wish to sit your child on your knee with their head resting back against your chest.  Brush the teeth in small circles covering all areas.  Encourage your child to ‘spit’ afterwards.  Do not rinse your child’s mouth with water.

First trip to the dentist
NHS dental treatment is free for children.  Contact your dentist surgery for advice on when your child should attend for their firstDentistappointment; this age will vary between dentists surgeries but for many it is around the age of 18 months to 2 years.  Before this time, it is important that you child goes with you and watches you attend your regular check-ups and appointments with the dentist.  This will allow your child to get used to the sights, smells and general going-ons at the dentists.  If you do not have a dentist, ask your Health visitor or local clinic for advice.

You can help prepare your child for their first visit to the dentist by sharing books together about the dentist surgery.  Visit your local library or bookshop and ask for suggestions.  You could also ‘play’ dentists by taking it in turns to look in each other’s mouths and practise opening wide and saying ‘ah’ or bringing your teeth together by saying ‘ee’.

During the appointment, the dentist will probably ask you to sit on the chair and hold your baby on your lap.  The dentist will ask to look at the teeth and if your child allows, they will count the teeth and check for cavities.  It has been known for children as young as 2 to have cavities and to need fillings.  The dentist should discuss with you what should happen in the coming months, which teeth should come through next and types of toothbrush and toothpaste to use; he may also demonstrate correct tooth-brushing techniques and may discuss the use of fluoride.

On leaving the dentist appointment, you should be aware of the follow-up care provided by the dentist and may even have your appointment for 4-6 months’ time.  Most dentists will also reward your child with a sticker for being ‘good’.

What is Fluoride?
Fluoride is the active ingredient in toothpaste; it helps to prevent tooth decay.  However, although it should be used twice daily: too much of it can be harmful.

•    It is recommended that under 3s use a fluoride toothpaste that contains about 1000 parts per million (ppm) of fluoride.
•    When your child is 3 or over they can generally use any toothpaste as long as it contains no more than 1500ppm of fluoride.

As always, check the packaging and read and follow all instructions.

In some areas of the country, fluoride gets added to the water.  However, if you use the recommended small amounts and encourage your child to spit after tooth-brushing, normal and lower fluoride toothpastes are still safe to use.  Speak to your dentist if you are concerned.

Some children find it hard to spit the toothpaste out and end up swallowing the toothpaste.  If you cannot stop your child from swallowing the toothpaste, change to toothpaste that contains less than 550ppm of fluoride.  This is because swallowing large amounts of toothpaste (fluoride) can damage your teeth.  You could also try switching to a less ‘tasty’ toothpaste so that your child does not get confused into thinking it is a food or a sweet treat.

Losing teeth
TeethAt around the age of 6 or 7, your child will begin to lose their milk teeth.  This is nothing to worry about as milk teeth are designed to be replaced by adult teeth which are stronger, larger and permanent.  Milk teeth are only designed to last around 5-6 years but adult teeth are designed to last forever.  This is why it is vital to practise good oral health throughout childhood so that your child can look after their vital adult teeth.

Milk teeth tend to fall out in the same order that they grow.  The incisors fall out first, followed the first molars, the canines and then the second molars.

However, it is possible to lose your milk teeth earlier.  Some children lose a milk tooth through an accident such as a fall.  Unfortunately, some children may need to have a milk tooth extracted due to poor oral health and severe decay.  If a milk tooth falls out or is removed early, the adult tooth will not come through immediately as the adult tooth is unlikely to be in position at this time.  This will mean that the child may be toothless and this may cause problems in their speech and language development and also in their feeding and eating.

Before you child loses a tooth; it is likely that it will become ‘wobbly’.  This is because the permanent tooth causes the root of the milk tooth to slowly dissolve, causing the milk tooth to wobble.  Eventually, the wobbly milk tooth will fall out and the adult tooth will take its place.  Although a child may not like the sensation of having a wobbly tooth, the losing of the actual tooth should not be painful.

It is possible that some children may be scared of losing their tooth or they may think that they are losing it because it was ‘dirty’.  Make sure that your child is aware of what will happen to their teeth; tell them that it is part of growing up and nothing to worry about.  It may help to read books about losing teeth.

If your child does not lose their milk tooth naturally and it falls out early as a result of a fall or accident, it is important that you visit your dentist as soon as possible to ensure that the tooth is fully out and has not caused any problems.

It is up to you what you do with the milk tooth.  Most parents encourage the child to place their tooth under their pillow for the tooth fairy to collect and dispose of.  It is custom for the tooth fairy to reward the child for their tooth with a small gift or coin.  However, some parents may want to keep the tooth themselves and turn it into a keepsake or jewellery.  You may wish to discuss with friends and relatives what happens in their houses.

Orthodontics and the teenager

Orthodontics literally means ‘to straighten teeth’ this is normally done by an Orthodontist who usually works within your dentist surgeryBraces5although in some cases may be based at your local hospital.  They use mechanical devices, usually a brace to correct the position of teeth.

In a recent study, it was found that nearly a third of all 12 year olds in England would benefit from an Orthodontic procedure.  If a child has crooked or misaligned teeth, it is likely that your dentist will refer you to an Orthodontist.

It is possible that if you needed orthodontic treatment as a child, then so will your child, however this is not always the case.  In many cases, a child may have problems with their teeth or jaw for no obvious reason and sometimes it may be as a result of an accident.  It is also possible that children who insist on thumb-sucking past young childhood will need orthodontic treatment.  It is important not to assume a child is uncared for because they have crooked teeth, there is no link to suggest this.

Taken from www.nhs.uk, this list shows the main reasons why a child requires orthodontic treatment:

• Protruding upper front teeth – one of the most common reasons for needing orthodontic treatment, particularly as the teeth may be more prone to damage during falls or contact sports.
• Crowding – people with narrow jaws often lack enough space for their teeth, resulting in crowding.
• Impacted teeth – the adult teeth come through in the wrong position.
• Asymmetrical teeth – in some people, the centre of their upper and lower teeth do not match, giving their teeth an asymmetrical or crooked appearance.
• Deep bite – the upper teeth cover the lower teeth too much.
• Reverse bite – the upper teeth bite inside the lower teeth.
• Open bite – the upper and lower front teeth do not meet when the mouth is closed; an open bite often occurs as a result of prolonged thumb sucking.

Orthodontic treatment is available free of charge on the NHS to people under the age of 18 and to those who have a clear clinical need for treatment.

A child will only receive orthodontic treatment when ALL of their adult teeth have grown.  For many this will be around the age of 13 but for some can be as late as 15 or 16.

What will happen?
If your dentist feels that your child requires orthodontic treatment, they will refer you to an orthodontist who will carry out an assessment of your child’s teeth.  This will include examining, x-rays and making plaster models of your child’s teeth.  Once this has been done, the orthodontist will decide and discuss with you the type of treatment and appliances that your child will need and undergo.

There are four different types of orthodontic appliances sometimes known as braces, these are:

• Removable Appliances
• Functional Appliances
• Fixed appliances
• Headgear

Removable Appliances: these are used when the problem is minor, for example slightly crooked teeth.  The brace can be removed but should only be removed for cleaning and during certain activities.

Functional appliances: these are used if the child has a problem with their jaw position.  These are also normally removable.

Fixed appliances: A fixed brace is the most common type of treatment.  They are used when several teeth require correcting and where problems are wanted to be prevented in the future.  You will need to stop eating certain foods such as toffee and fizzy drinks to avoid damaging the brace or your teeth.

Headgear: Although this is not an actual type of brace, it is sometimes used with a brace to correct the position of the back teeth.  Most people will only need to use headgear for a few hours a day and possibly while they are asleep at night.  You cannot eat or drink whilst wearing headgear.

With all Orthodontic appliances or braces, it is vital that you follow all instructions and guidelines.

Towards the end of your child’s orthodontic treatment, they may be given a retainer to wear.  This is usually a plastic removable device that holds the newly fixed teeth in place while the gum and bone around the teeth ‘gets used’ to the new position.  Most need to be removed for eating and cleaning.

Orthodontic treatment usually takes between 18-24 months.  Throughout treatment, it is vital that you continue with good tooth-brushing techniques and follow any dietary advice that you are given.

Teenagers and mouth care
Your child’s oral health hygiene and tooth-brushing skills should continue into their teenage ages and then into adulthood.  This is why it is so vital that you teach them in the beginning.  It is important that your teenager:
• Continues to brush their teeth twice a day using fluoride toothpaste.
• Flosses daily in order to remove the plaque.
• Limits sugary foods and drink
• Continue to visit the dentist for regular check-ups.

Many teenagers need to go through orthodontic treatment, if your teenager is worried about the process; make sure you talk to them and get them to talk to their friends about it and also to your dentist.

Many teenagers participate in a sport of some kind.  It may be necessary for your teenager to wear a mouth guard to protect their teeth.  A mouth guard protects their teeth against breaking or causing damage to the lips or jaw during physical sports.  Speak to your dentist if you feel that your teenager needs a mouth guard.

Some teenagers may choose to smoke.  It is important that you explain the negative aspects of smoking to your teenager.  Smoking causes many health problems but it also stains teeth and gums.  It also stains the tartar that can build up on you teeth and can also cause bad breath.  Smoking also increases the chances of you getting Oral Cancer and gum disease.  However, if you cannot stop your teenager from smoking, make sure that their dentist is aware that they smoke.

At the moment, it is very popular for teenagers to get oral piercings.  However, oral piercing can cause many complications including infections, bleeding and nerve damage.  It is also possible for your teenager to choke on studs, barbells or hoops that come loose, and for the metal jewellery to crack or chip their teeth or cause damage to their gums.  If your teenager still wants an oral piercing, arrange for them to speak with their dentist to discuss their options.

A few teenagers may suffer from an eating disorder such as bulimia or anorexia.  Both of these disorders involve excessive vomiting and can directly affect the appearance of the teeth and can also cause the tooth enamel to erode.  A dentist may be able to help correct the enamel and appearance of the teeth, however if you are worried about your teenager, visit your doctor and ask for help and advice.

Many teenagers become very self-conscious and having a clean mouth with fresh breath and a nice smile will help your teenager stay confident and happy.

Source: Teething chart from Ontario Ministry of Health and Long-Term Care

by Jenny, mum to William and James

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