Babies & Children's Teeth

The importance of diet

Avoiding giving a baby or a young child unnecessary sugars is a good way to establish healthy eating patterns to protect every child's teeth for life. Milk and water are the only drinks that should be put into a baby's bottle. Don't give a child sugary drinks in bottles or pacifiers (dummies) dipped in a sugary substance.

Babies should be introduced to a feeding cup as soon as possible. Fruit juice given to children should be diluted (1-part juice to 10-parts water) and given in a cup. Restrict juices to mealtimes only. If the child tends to snack between meals, remember that cheese is a very tooth friendly food – avoid sweets, cakes and biscuits.

The importance of cleaning teeth

Plaque will start to form on a child's teeth and gums as soon as the first tooth appears (erupts). So, it is very important to begin a suitable toothbrushing routine as soon as possible. The brushing routine that is established with a child at an early age should continue throughout their life.

Use a toothbrush that is appropriate for the child's age and stage of tooth development. A small-headed soft brush should be used as soon as the first tooth erupts. Character toothbrushes are an excellent way to make brushing fun for young children. A small smear of a children's fluoridated toothpaste should be used on the brush. As the child gets older a slightly larger brush with medium bristles may be used.

The importance of fluoride

Fluoride occurs naturally, at some level, in the water in most areas and helps to prevent tooth decay when at the optimum concentration. Fluoride is present in most toothpastes but special children's toothpastes are better for babies and infants because the amount of fluoride is controlled specifically for their needs. The amount of fluoride in any area’s water supply can be found out by contacting the Local Water Authority. Fluoride supplements come in tablet form and may be prescribed by the dentist if active decay is identified during routine dental examinations. A varnish can be applied by the dentist or hygienist in the surgery. Although fluoride is a valuable protective agent, like many things it is important to have just the right amount, not too much or too little. To avoid excess fluoride from toothpastes, children under six years should be supervised when toothbrushing and only use a small smear of toothpaste. Children over seven years can use the family fluoride toothpaste but only a pea sized amount on their brush.

Weaning & Teething

The timing of the eruption of the first teeth can vary widely from three months to as late as 11 or 12 months. This is perfectly normal but, if there are any concerns about the late eruption of teeth, this should be discussed with the dentist. The first teeth to appear are usually the central lower teeth (incisors).

Sugars should not be added to weaning foods. When buying prepared foods always read the labels to ensure that hidden sugars are not present.

Try to introduce babies to 'savoury' foods, such as pureed vegetables and fruit. During teething babies may look a bit flushed and dribble more than usual. Babies often find comfort from the use of teething rings. Teething does not usually cause symptoms such as high temperatures. However, when babies are distressed and have a slightly raised temperature, they often respond very quickly to a dose of paracetamol suspension.

Teething and Eruption Dates

The exact dates will vary from child to child, but the following guide will give some idea of what to expect. Permanent tooth development in girls maybe more advanced than in boys.

Primary, Baby or Deciduous Teeth
3-6 months	Central lower incisors erupt
9-12 months	All front incisors now present
12 months	First primary molars
18 months	Primary canines
2 years	Second primary molars

Adult or Permanent Teeth
About 6 years	Lower central incisors replaced. First lower permanent (adult) molar erupts (6-year molar). These appear behind the primary molars at the back of the mouth
9 years	Canines replaced
11/12 years	Permanent pre-molars replace primary molars
12 years	Second molars erupt
16 years +	Wisdom teeth erupt

Healthy Gums

With all children it is important to establish good oral hygiene practice as early as possible to prevent the development of common gum diseases (such as gingivitis) in later childhood and teenage years.

Visiting the Dentist

It is a good idea to get babies and young children used to the idea of having dental examinations by taking them along to the dentist when adults are having dental check-ups. Dental visits by infants should begin at 18 months if only to become familiar with the dentist and to have a ‘ride’ in the dental chair. Once confidence is gained by two years of age it will be possible to examine the deciduous teeth, which should all be present. While for the majority of children the teeth will develop normally, for some children there are variations in the number of teeth, their size, colour and shape. If you have any concerns about your child's teeth, you should consult your dentist as soon as possible.

Plain still water and milk are the best choices of drink for a child. Sweetened drinks should be avoided for as long as possible. They encourage a 'sweet tooth', leading to problems later on.

Sugar-free squashes, if totally sugar free, are the safest alternative to water or milk for the protection of children's teeth. They should be diluted as much as possible – there should only be a hint of colour in the water when the drink is made up. Some of these drinks contain artificial sweeteners, which should not be given to a young child (check with a dentist/health visitor).

The dilution of natural fruit juices with water minimises the risk of tooth damage. Dilute one-part juice/squash to ten parts water.

If children are genuinely thirsty, they will always drink water! It can be made more exciting to drink by giving it in a special cup, adding ice or using a straw.

Squashes, fizzy drinks (whether diet or regular), fruit drinks, cocoa and milkshakes all cause harm to teeth. The sugar in them causes decay while the acid in both normal and diet drinks dissolves the enamel on the teeth.

Comfort feeders and bottles containing sugary drinks given to young children for prolonged periods of time cause severe dental problems because they bathe the teeth in sugar. When using feeding bottles, hold the child until the feed is finished. Never leave a baby propped up with a bottle. Apart from the increased risk of damage to their teeth, the baby could choke.

Never leave a sweetened bottle or feeder cup by a child's bed overnight.

Milk or water is the only drink that should be given in a baby's bottle.

Sugared liquid medicines for children are very effective but, if taken regularly, they have a significant risk of causing dental decay. If possible, try giving them at mealtimes and not last thing at night. Better still, ask the GP or pharmacist for a sugar-free medicine.

The more often that a child has sugary drinks, the more likely they are to get dental decay. Therefore, it's best to give such drinks at mealtimes only.

When buying drinks look at the labels. Manufacturers often describe sugars as 'added' or 'natural'. Natural sugars are just as damaging to teeth as refined sugars.

Honey is a source of natural sugar but acts as a concentrated solution of glucose and fructose (these are both 'hidden sugars'). Sugars in fruit juices are also natural but are more rapidly absorbed than those in the whole fruit; also, natural fruit juices can be acidic.

REMEMBER:

1. Try to get children to drink only milk or water between meals
2. Dilute drinks, when applicable, as much as possible
3. Give sugary drinks at mealtimes only
4. Limit giving fizzy drinks as treats for special occasion meals only
5. After brushing their teeth at bedtime, let children drink only water
6. Liquid medicines: always try and get sugar-free formulas from the pharmacist.

During teenage years, life can be complicated as teenagers have to adapt to physical, mental and emotional maturity. As they become more independent, they should take steps to adopt a healthy lifestyle and ensure good health for the future. This includes looking after their teeth and gums for a healthy smile and fresh breath for life.

The main dental diseases are tooth decay (dental caries) and gum diseases (periodontal disease and gingivitis). There are some things that can be done to ensure that young people are not affected by these common conditions.

Tooth Decay

Tooth decay occurs when there is sugar in the diet. The bacteria that is present in everyone’s mouth and which form dental plaque, use the sugar to produce acids which damages teeth (decay). Tooth decay creates holes in the teeth and at its later stages can cause severe toothache and dental abscesses.

The most important way of preventing tooth decay is to restrict the amount of sugar in the diet. Sugary food and drink should be kept to a minimum. It is especially important to limit the number of sugary products taken every day, ideally only having them at meal times. Sugary snacks eaten between meals or just before going to sleep are particularly harmful.

Toothbrushing is also important to reduce the build-up of plaque that allows the bacteria to cause tooth decay. However, even effective tooth brushing will not prevent tooth decay if the intake of sugary food and drinks is still high. This is because bacteria can stick to teeth in areas which are inaccessible to normal tooth cleaning.

Fluoride is a naturally occurring substance. It helps prevent tooth decay by strengthening the tooth and making it more resistant to the acids produced by the bacteria. Fluoride is present in nearly all toothpastes and in some geographical areas the level of fluoride in the water is adjusted to prevent widespread tooth decay.

Gum Disease

Inflammation of the gums caused by bacteria found in dental plaque. After puberty gums will become more prone to gum disease (gingivitis). Gum disease can affect anyone at any time into adult life.

The main indicator of gum disease is bleeding from the gums (commonly seen after tooth brushing). Healthy gums will not bleed even after vigorous brushing. The gums may also become red and swollen and this may be an important cause of bad breath. The condition is usually painless.

At its early stages gum disease is completely reversible following simple treatment, including proper tooth cleaning. However, if gum disease persists then it can spread to cause damage to the supporting structures on the teeth, including the jawbone. Eventually the teeth will become loose, drift out of position and ultimately fall out. Gum disease is a very common cause of tooth loss in adults.

About 10 percent of adults are especially prone to a destructive form of gum disease (periodontitis) and it is particularly important that teeth are checked by a dentist from time to time. They will be able to pick up the first signs of disease. To prevent gum disease, it is essential that effective toothbrushing is regularly carried out. Teeth should be brushed at least twice a day for at least two minutes a time. It is important that all the surfaces of the teeth are cleaned, especially around the insides and the area where the teeth meet the gums.

Erosion

The wearing away of the tooth surface caused by acids found in fruit juices, fizzy drinks, sports drinks, citrus fruits and pickles. Stomach acids that enter the mouth, by reflux or vomiting, may also cause erosion. Eroded teeth are yellow, thinner and are more sensitive. In the long term, erosion can cause very severe tooth wear which is both uncomfortable and unsightly.

To help prevent erosion, limit the frequency of acidic drinks and foods. Teeth should not be brushed for at least 30 minutes after having an acidic drink. This is because the acid temporarily softens the surface of the teeth and brushing them straight away can make them wear away more quickly.

Orthodontic Treatment

This treatment is carried out in order to move teeth into a position that will improve their appearance and function. It is usually carried out during the teenage years as teeth and jaws undergo their final growth. Removable or fixed braces are placed on the teeth in order to move them and the process can take between 18 months and two years to complete. During this time regular visits to the orthodontist are made – every six to eight weeks.

While having orthodontic treatment it is essential that the teeth and braces are kept very clean as the braces will tend to encourage the formation of tooth decay and gum disease.

Wisdom Teeth

Wisdom teeth are the last teeth that grow at the back of the mouth and usually appear between the ages of 16 and 24 years. Some people do not have wisdom teeth. On occasions wisdom teeth can be painful and cause recurring infections, especially if there is not enough room for them in the mouth (impacted). It is sometimes necessary to have them removed.

Smoking

Smoking has a major effect on the likelihood of developing many diseases including heart disease and cancer. In the mouth, smoking causes staining of the teeth and bad breath, and increases the damage caused by gum disease. In the long term, it can also lead to throat or mouth cancer.

Quitting a smoking habit is always much more difficult than not starting in the first place. Smokers should seriously consider giving it up.

Visit the Dentist

Teenagers should have regular check-ups with a dentist who will be able to advise about all dental issues and detect any signs of developing disease. A dentist may on occasions refer to an orthodontist for orthodontic treatment and to a dental hygienist for preventative advice about diet, toothbrushing and treatment of gum problems.