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Your Child's Mouth

The Primary Teeth
Caring for Primary Teeth
Early Childhood Caries
The Permanent Teeth
Caring for Permanent Teeth
Diet and Your Child's Teeth

The Primary Teeth

When infants are born, almost all of their primary (baby) teeth already have formed. These teeth are still hidden in the gums. They usually begin to erupt or cut through the gums at about 6 months of age. Some babies get teeth earlier, and some get them later. That's OK. Your 1-year-old may have a different number of teeth than your neighbor's 1-year-old.

Usually, the two front bottom teeth come in first. Next are the four front top teeth and two more bottom teeth. From here, teeth slowly begin to fill the mouth. Teeth usually come in two at a time, one on either side of the jaw. Your child should have all 20 primary teeth by the time he or she turns 3 years old.

Baby teeth usually have spaces between them. These spaces help make sure there is enough room for the permanent teeth. In fact, lack of space between the baby teeth can sometimes mean that adult teeth will be "crowded" or not have enough space to come in.

Caring for Primary Teeth

Take good care of your child's baby teeth. They do eventually fall out. But until they do, your child's baby teeth play an important role by helping your child bite and chew food, and speak clearly. Baby teeth also save space for the permanent teeth, and help guide them into place.

Even before your child gets his or her first tooth, you should wipe your child's gums with a clean damp gauze or washcloth. Once your child's teeth come in, brush them twice a day. Use a soft toothbrush with polished nylon bristles. You can make the bristles even softer by soaking them in warm water for a few minutes.

Begin using fluoridated toothpaste to brush your child's teeth when the child is 2 years old. Be careful to use only a small dab of toothpaste (about the size of your child's pinky fingernail). Young children tend to swallow toothpaste when brushing rather than spit it out. Though it's uncommon, this can sometimes lead to fluorosis and cosmetic problems in the permanent teeth.

As soon as two teeth touch each other, floss between them once a day. You can use regular floss or special plastic floss holders.

Talk to your doctor or dentist about fluoride. If your child drinks water that isn't fluoridated, he or she may need fluoride treatments or supplements.

At some point, your child will want to use the toothbrush. It's OK to give him or her a turn. But afterward you should always brush your child's teeth a second time. Most children won't be able to brush their teeth well on their own until they are about 8 years old.

Children who are at high risk for cavities can get sealants placed on their teeth. Dental sealants are plastic coverings that are placed over the grooves of teeth to protect them from decay.

Early Childhood Caries

Early childhood caries, or ECC, is a serious form of cavities. It can quickly destroy your child's teeth. In the past it has been called baby bottle tooth decay, nursing caries or nursing bottle syndrome. ECC often occurs when your baby's teeth are exposed to sugars for long periods throughout the day. Baby bottles or sippy cups with fruit juice or milk both contain sugars. When these liquids are in the mouth, bacteria start eating the sugars and then produce acids. These acids cause decay if they remain on teeth long enough.

Early childhood caries can occur if your child:

  • Is put to bed with a bottle filled with any liquid other than plain water
  • Drinks from a bottle filled with sugary liquids or milk during the day
  • Receives a pacifier dipped in sugar, honey or a sweet liquid

Normal breastfeeding has not been shown to cause dental cavities. However, breastfeeding for long periods of time can still put your child at higher risk for dental decay.

Remember, it's not just what your baby is drinking, it's also how often. The more time that liquids (other than water) are in a baby's mouth, the higher the risk. This is why it is dangerous to let your baby go to sleep with a bottle or use a bottle as a pacifier during the day.

Tooth decay can occur much more easily if there are large numbers of cavity-causing bacteria living in your child's mouth. One of the most dangerous types of cavity-causing bacteria is Streptococcus mutans. In the mouths of children with no or little tooth decay, S. mutans makes up less than 1% of the mouth's bacteria. But in children with ECC, it makes up more than half the bacteria.

S. mutans is common. It is passed from parent to child, usually when a child is between 6 and 31 months old. Keeping your own mouth healthy and free of cavities can help your child's mouth stay healthier, too.

The top front teeth usually are the first ones affected by ECC. Often, the cavities start on the backs of the teeth. The top teeth farther back in the mouth are affected next. Finally, the bottom back teeth get cavities. The lower front teeth usually do not get cavities. These teeth are covered by the tongue, which keeps liquids away. These teeth also are close to large salivary glands, so they are bathed in saliva. Saliva helps wash away sugars and bacteria.

Decayed teeth that are not fixed can cause pain and infection. Teeth that are very badly decayed may need to be removed. Tooth decay is a bacterial infection, and it can spread if it is not treated. Also, the permanent teeth under the gum can be affected if the decay is not treated.

Here are some tips on preventing early childhood caries:

  • Don't put your baby to bed with a bottle unless it is filled with plain water. Even watered-down fruit juice or milk can increase the risk of decay.
  • Talk with your doctor about weaning your infant from the bottle when he or she is 12 to 14 months old.
  • During the day, don't use a bottle to comfort your baby unless it's filled with plain water.
  • Don't dip your baby's pacifier in sugar or sugary liquids
  • Don't add sugar to your child's food.
  • Clean your baby's teeth and gums with a damp cloth or a soft toothbrush after each feeding
  • Take your baby to the dentist as soon as the first tooth comes in.
  • Teach your baby to drink from a cup by his or her first birthday.
  • Make sure your baby is getting the right amount of fluoride. If your drinking water does not contain fluoride, ask your doctor or dentist about fluoride supplements.

The Permanent Teeth

Children typically start to lose their baby teeth and replace them with adult teeth when they are 6 or 7 years old. Some children start losing teeth earlier. Others start later. The order that your child's teeth come in is more important than when they start to come in.

Most often, the first permanent teeth to come in are the lower front four teeth. However, some children get their first permanent molars (sometimes called the 6-year molars) first.

The 6-year molars come in behind the primary teeth. They do not replace primary teeth. Around age 11 or 12, the second permanent molars (also called 12-year molars) come in behind the 6-year molars.

By the time your child is 13 years old, most of his permanent teeth will be in place. Wisdom teeth, or third molars, come in between ages 17 and 21. However, some people don't get any wisdom teeth, or don't get all four. More often, wisdom teeth develop, but there may not be room in the mouth for them.

Caring for Permanent Teeth

You should continue to help your children brush their teeth twice a day until they are 8 years old or can show that they can do a good job on their own. Brush after breakfast and before bed. Keep your children's teeth free of food particles, especially the molars. Molars have lots of little grooves and crevices. Food particles can hide there and act as food for bacteria.

Your dentist also can place sealants on your children's molars to protect them from decay. But it's still important to brush and floss.

When your child is still very young, you can cradle his head in one of your arms and use your other hand to brush. Once children have the coordination and dexterity, they can brush on their own. However, be sure to inspect after each brushing and go over spots your child may have missed.

A few other tips:

  • Use a soft nylon toothbrush with a pea-sized dab of fluoride toothpaste.
  • Teach your child to spit out the foamy saliva.
  • As soon as any two of your child's teeth touch each other, floss between them. After age 9, children can floss their own teeth. Flossing removes food from between the teeth where a toothbrush can't reach.
  • Talk to your child's dentist or doctor to be sure he or she is getting the right amount of fluoride.

Diet and Your Child's Teeth

While what your child eats is important for healthy teeth, how often a child eats is just as important. Frequent snacking can increase a child's risk for decay.

Cavities can develop when sugar-containing foods are allowed to stay in the mouth for a long time. Bacteria that live in the mouth feast on these bits of food. They create acid, which eats away at tooth enamel. Between meals or snacks, saliva washes away the acid. If your child is always eating, there may not be time for this acid to get washed away.

When most people think of sugar, they think of the white sugar that is found in candy and baked goods. But all foods that contain carbohydrates will ultimately break down into sugars. Bacteria don't care whether you eat a lollipop or a pretzel. It tastes the same to them!

Here are a few tips for snacking and mealtime:

  • Give your child healthy snack foods, such as fresh fruits, vegetables and cheeses.
  • Buy foods that are sugar-free or unsweetened.
  • Serve sugary or starchy foods as part of a meal rather than as a snack. Most children drink liquids during a meal. This will wash many bits of food off the teeth. Saliva also does a good job of clearing the teeth.
  • Avoid certain foods unless your child plans to brush right after he or she eats them. These foods get between teeth and are hard to remove from the grooves in the tooth surface. Some of these foods include:
    • Cookies
    • Dried figs
    • Granola bars
    • Jelly beans
    • Doughnuts
    • Potato chips
    • Pretzels
    • Puffed oat cereal
    • Raisins
  • Offer fewer snacks.
  • After your child snacks, make sure his or her teeth are brushed. If this isn't possible, have your child rinse with water several times.
  • Encourage your child to choose xylitol-sweetened or sugar-free gum.

©2002-2013 Aetna, Inc. All rights reserved.

01/12/2011

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