Your child’s dental health is as much your pediatrician’s concern as it is your dentist’s. Poor oral hygiene causes significant infections of the mouth and gums and can lead to tooth loss and problems in the underlying bone.

Table of Contents

At what age is a first dental visit recommended?
At what age should a child no longer need parental assistance with tooth brushing?
At what age should a child start using fluoridated toothpaste?
How about babies without teeth?
At what age does the first primary tooth erupt?
At what age does the first permanent tooth erupt?
Do early-childhood cavities occur in breastfed infants?
What can be done to prevent cavities in breastfed babies?
What can you tell us about orthodontics, and what causes a child to need braces?
True or False: Diet soft drinks do not cause tooth decay.
How does fluoride work to reduce cavities?

At what age is a first dental visit recommended?

The American Academy of Pediatric Dentistry recommends that a “dental home” be established no later than age one, and a first dental visit between the ages of one and three years, depending on risk status. For high-risk patients, a first dental visit by age one is advised. In addition, the American Academy of Pediatrics recommends a risk assessment by a family’s pediatric provider by 6 to 12 months of age.
High-risk patients include those with the following:

• mother with poor oral health
• children in poverty
• high intake of juice or sweetened beverages
• bottle in crib or bed, or frequent snacking
• chronic illness
• inadequate fluoride intake
• poor oral hygiene

For low-risk patients, the first dental visit can be delayed to age three years as long as the pediatric provider is performing an oral-cavities risk assessment via history, performing an oral screening during the physical exam, and educating you about nutritional habits, oral hygiene, and the use of fluoridated water for cooking and drinking.

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At what age should a child no longer need parental assistance with tooth brushing?

Tooth brushing is very important for removing plaque (oral bacteria and bacterial by-products) and preventing tooth decay (cavities). In general, supervision is needed until the child has the manual dexterity to brush the teeth well and the oral motor skills to expectorate (spit out) toothpaste and accumulated saliva. Typically, this occurs at about age 7, the same time that a child is able to tie his or her own shoelaces. Parents should be responsible for dispensing fluoridated toothpaste to children younger than six years of age, applying a thin smear or pea-sized dollop onto the brush.

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At what age should a child start using fluoridated toothpaste?

Toothpaste containing fluoride is known to be a very cost-effective means of preventing tooth decay. However, because excess fluoride intake can lead to fluoride toxicity (fluorosis), fluoridated toothpaste should be used with caution.
For children at low risk for dental cavities, fluoridated toothpaste should not be used until the child is two to three years of age. The child should be taught to spit out rather than swallow excess toothpaste.
For children at high risk of cavities, a thin smear of fluoridated toothpaste should be used as soon as they have teeth. After mouth-care for a young child who cannot expectorate, excess toothpaste should be wiped away with gauze or a clean washcloth.

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How about babies without teeth?

Parents should regularly massage the gum pads and palate of infants who have not yet erupted teeth with a clean, damp washcloth. This cleansing of oral surfaces decreases plaque and bacterial load, which are major risk factors for early tooth decay. Cleaning the gums and palate in this way also serves to desensitize the baby’s oral cavity.

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At what age does the first primary tooth erupt?

The first primary tooth typically erupts at six to seven months of age. There is considerable variability, however, in the timing of tooth eruption. In fact, some children are born with teeth (called natal teeth). In others, the first tooth may not emerge until 12 or even as late as 18 months of age. Children born prematurely, or those with certain syndromes, such as Down syndrome, generally experience later eruption of teeth. Parents should become concerned about any child who has not erupted any teeth by 18 months, since there are a number of conditions associated with delayed dentition, such as hypothyroidism and other congenital syndromes.
The first primary teeth to erupt are the usually the lower central incisors, followed by the upper central incisors. These are followed by the lower and upper lateral incisors, the premolars (bicuspids), the canines, and the molars. There can be considerable variability in this order, however; in fact, tooth eruption is one of the most variable aspects of all pediatric development. The full primary set of 20 teeth should be completely erupted about three years of age.

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At what age does the first permanent tooth erupt?

The first permanent teeth (usually the molars) erupt at about six years of age. Again, there is some variability in this timing, with some four-year-olds erupting their first permanent molar and others not until age 7 or 8. The eruption of the permanent molars then starts the cascade of first primary tooth loss (usually central incisors), the arrival of the Tooth Fairy, and the emergence of the permanent incisors.

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Do early-childhood cavities occur in breastfed infants?

Yes. Frequent, on-demand breastfeeding may be associated with early-childhood cavities. This occurs most frequently in a baby who sleeps with the mother and is reaching for the breast all night. In combination with sugary foods and drinks, on-demand breastfeeding, without good oral hygiene, may lead to early-childhood cavities.

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What can be done to prevent cavities in breastfed babies?

Brush the baby’s teeth twice a day with a smear of fluoride toothpaste if he or she is at risk for cavities (frequent, overnight, on-demand feedings or other risk factors), or wipe the baby’s gums after feedings if no teeth have yet erupted.
Spacing of breastfeeding also helps to prevent cavities by minimizing the conditions that cause dental plaque. Spacing of feedings also allows the pH of the mouth to return to normal (lower acidity) after feeding, therefore making it less hospitable for bacterial growth.

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What can you tell us about orthodontics, and what causes a child to need braces?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of problems in the alignment of teeth and jaws. The technical term for these problems is malocclusion, which means bad bite.
Your child’s dentist may recommend orthodontic evaluation. The orthodontist will determine whether your child would benefit from orthodontic treatment. There is an increased risk of tooth trauma in a child with too much overbite (greater than 3 mm). Overcrowding may make it difficult to maintain healthy teeth without decay and periodontal disease. In addition to the improved function gained through orthodontic treatment, the esthetic value of a good occlusion with minimal overbite may also be important to you and your child.
Orthodontic treatment involves the design and use of corrective appliances (such as braces, plates, headgears, and functional appliances) to bring the teeth and jaws into proper alignment. When the malocclusion is severe, orthodontics is performed in conjunction with jaw surgery to enable the teeth to “fit together” once the skeletal imbalance has been corrected.
Straight teeth are not just about looking good; they may make your child’s mouth healthier as well!

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True or False: Diet soft drinks do not cause tooth decay.

Answer: False. Although diet soft drinks do not contain sugar, they are very acidic, with a pH in the range of 3.0-3.5 (Diet Pepsi—pH 3.05; Diet Mountain Dew—pH 3.34; Diet Coke—pH 3.39). The lower the pH, the more acidic the substance (for example, the pH of battery acid is 1.0). Carbonation and other flavoring (i.e.phosphoric acid) in soft drinks is responsible for the low pH of these beverages.

For dental cavities, the critical pH is 5.5, the point at which tooth enamel may begin to demineralize. When ingested frequently, food and drinks with a pH of 5.5 or lower may weaken tooth structure and facilitate the development of cavities as a result of the movement of minerals out of the tooth. Regular soft drinks (including Gatorade) may result in dental decay because of both their high sugar content and the low pH caused by carbonation.

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How does fluoride work to reduce cavities?

Fluroide protects teeth through two mechanisms—topically (applied to teeth) and systemically (absorbed into the teeth through the bloodstream).

Topically, the principal action of fluoride is to enhance the movement of tooth-strengthening minerals into the tooth structure. Fluoride forms a protective, acid-resistant covering or “veneer” on the tooth that helps these minerals crystallize and solidify. Fluoride also inhibits demineralization—the movement of minerals out of the tooth. Finally, fluoride prevents the proliferation of cavity-causing bacteria in acidic plaque by entering into the bacteria and chemically incapacitating it.

Systemic fluoride is usually ingested into the body through fluoridated tap water or fluoride supplements. During tooth formation, ingested fluoride becomes incorporated into the tooth structure. Fluoride ingested regularly during the time that teeth are developing and before they erupt is deposited throughout the entire tooth surface and provides lasting strength and protection.
Because this beneficial effect on teeth, in cities where the water is fluoridated, tap water is preferred over bottled water, which is usually unfluoridated

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