Leaflet: Looking after baby’s teeth (pdf)
Parents always want their children to have beautiful teeth when they smile. Although baby teeth are in the mouth for a short period of time, they are important because they: (i) help children eat nutritious food that is needed for growth; (ii) keep the shape of the jaws and face; (iii) help with the development of speech, (iv) maintain the space for the permanent teeth, (v) provide a good appearance and so maintain a sense of self-esteem and well-being. Conversely having decay can produce pain and distress.
Babies normally are born without any teeth. The first tooth normally comes through at about 6 months of age, with most of the 20 teeth, (10 in the upper jaw and 10 in the lower jaw), coming through by three years.
|1st Incisor||6 – 10 months||8 – 12 months|
|2nd incisor||10 – 16 months||9 – 13 months|
|Canine||17 – 23 months||16 – 22 months|
|1st Molar||14 – 18 months||13 – 19 months|
|2nd Molar||23 – 31 months||25 – 33 months|
The lower teeth usually erupt before the upper teeth and they tend to erupt in pairs — one on the right and one on the left. The primary teeth are smaller in size and whiter in colour than their permanent successors.
Babies can have problems with the teeth coming through (teething). These can include drooling more than usual, and the baby may not sleep well. If your child is uncomfortable when they are teething, offer them a cold teething ring or cold wash cloth. If the baby is having a lot of pain, then may give sugar-free paracetemol. Teething often goes along with an increase in other infections. If there are other symptoms like fever, diarrhoea or rashes talk to a dentist, doctor or a child and family health nurse.
Teeth easily can become decayed, and so it is important that dental care for babies should begin within a few days after birth: Right after each feeding, wipe the baby’s gums and inside of the cheeks, roof of the mouth and tongue with a clean damp washcloth or wet gauze pad to remove plaque. It is also easier to make sure good habits are started, and become fixed at an early age, rather than correcting bad habits later on. Dental decay is caused by sugar and acid, and it is not just the amount of sugar in food and drink but also how often there are sugary things in the mouth. Sometimes tooth decay in babies can cause pain. Babies don’t have the words to tell us but do so through their behaviour – they might cry a lot. Children who have really bad tooth decay sometimes have to be put into hospital for an operation under general anaesthetic to take out the bad teeth, which carries a certain amount of risk.
How to prevent dental decay
There are two main things that can lead to tooth decay in children:
- The amount and frequency of sugary food and drinks. The more frequent, the more likely decay occurs.
- Not brushing their teeth twice a day with fluoride toothpaste.
Decay can be avoided by reducing the amount and frequency of sugary food and drinks. It is not advisable to give infants a bottle for long periods or at night to calm them or fill the bottle with sugary drinks, fruit juice or adding sugar to drinks. Sugar is the main cause of tooth decay.
Breast feeding provides the best nutrition and all the essential nutrients that your baby will need. If you cannot breast feed, use infant formula and cooled, boiled water. However it should not be used as a replacement if possible. Soya milk is not recommended because it contains sugar. However, if your GP or other health professional has told you to use it, you should continue to do so. Exclusive breast feeding is advised for the first six months of a baby’s life. Infants should not be put to bed with a feeding bottle because this can lead to a lot of decay. Sugar containing drinks should not be given to young babies.
From 6 months infants should start drinking from a cup. It shouldn’t be the non-spill type as it continues the sucking motion and the spout can harbour bacteria. The ordinary “free-flow” cup with a lid (see photo) is much better because it teaches the baby to sip. The baby should be drinking from a cup and no longer from a bottle by the time they are 12 months of age.
When it comes to weaning, it is easier to start your baby on a healthy diet that is low in sugar than to try to tell them to give up sweet food and drinks when they are older. Labelling can be confusing: ‘low sugar’ may simply mean that the product contains less sugar than the standard product and ‘no added sugar’ may be sweetened with concentrated fruit juices or fructose. Other words may be used to describe ingredients that are harmful to teeth: glucose, glucose syrup, fructose, concentrated fruit juice, sucrose, dextrose, honey, invert sugar, maltose and hydrolysed starch. In general items listed ending in ‘ose’ are sugars; for example, sucrose, glucose and fructose. Cereals, plain biscuits, yogurts and dried fruit are also contain a lot of sugar.
You can begin to give a baby over 6 months of age the following food: – well mashed home boiled potatoes, pureed vegetables, unsweetened fruit purees and rice based cereals. From 6-9 months sugar free finger foods can be introduced including toast, cooked carrots, banana, and pear.
Between 9-12 months small pieces of the following can be introduced: – firmer fruits, raw vegetables, cooked potatoes, cheese and soft meats. You should stop bottle feeding from one year.
It is difficult to ban sweetened food totally, but it should be eaten with meals to reduce the chance of decay. The same applies in nurseries and schools where good eating habits should continue to be used.
Toothbrushing should start as soon as the 1st tooth appears. This will help to make sure that the child accepts the brush and toothpaste and brushing can be fitted into other normal routines like bedtime. Twice a day toothbrushing with fluoride toothpaste provides protection as soon as the teeth appear. With the baby lying down or cradled in your arms, use a small, soft toothbrush with a smear of toothpaste with at least 1000 parts per million (ppm) of fluoride. You can find this on the tube of toothpaste. After the age of 3, a pea sized amount of toothpaste with 1300 – 1500 ppm should be used. Brush all the surfaces – inside, outside and biting surfaces.
Dummies can cause a gap to form between the top and bottom teeth. If one is to be used, it should be an “orthodontic” dummy which won’t cause the teeth to grow out of line. Never dip the dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars. These contain harmful sugars and acids and can lead to a lot of decay of the teeth.
Sugar free medicines
Many medicines contain sugar, which causes decay. Often there is a sugar-free choice which you can ask the doctor or pharmacist for.
Visiting the dentist
A baby should be taken to the dentist by the first birthday and regularly after this to help stop decay. The dentist can also spot problems and provide preventative treatment, as well as giving advice. Dental treatment is free for all mothers during pregnancy and up to when the child is one year old. Dental treatment is free for all children up to the age of 18 years.
Accidental injuries should be seen by a dentist. Typical accidents involving a pre-school aged child may be:-
- Tooth knocked out completely
- Loosening of a tooth or teeth
- The whole tooth being pushed into the socket
- Bleeding from lips and gums
If your child or any child in your care suffers an accident involving the teeth or mouth, then the following actions should be taken:-
- Contact the parent, if possible
- Find the tooth or pieces.
- If the mouth is bleeding, stop this by the child biting on a clean towel, cotton handkerchief or flannel.
- Contact the dentist and arrange an appointment for the child to see a dentist the same day
Leaflet: Looking after baby’s teeth (pdf)