Leaflet: Looking after children’s teeth (pdf)
Parents 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.
By this stage the children should have some of their teeth. Below are the dates that teeth normally come through.
|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.
Infants can have problems with the teeth coming through. (teething). These can include drooling more than usual, and the child 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 infant is having a lot of pain, then 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.
Decay is one of the most common diseases in the West and is responsible for a large number of days off school and work. Sugar is the main cause of tooth decay and so decay is completely preventable and is due to diet and oral hygiene. Because of this, dental care for babies should begin within a few days after birth. It is easier to make sure good habits are started, and become fixed at an early age, rather than correcting bad habits later on.
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.
There are two main things that can lead to tooth decay in children:
- Frequently eating sugary snacks and drinking unhealthy drinks. The more frequent, the more likely decay occurs.
- Not brushing their teeth twice a day with fluoride toothpaste.
An unhealthy diet, and the quantities of each category of food that a child eats, has a huge impact on the likelihood of decay. Many foods that contain added sugars also contain large numbers of calories, but often have few other nutrients. Eating these foods often can contribute to a person becoming overweight as well as causing decay. To eat a healthy, balanced diet, we should eat these types of foods only occasionally, and get the majority of our calories from other kinds of foods such as starchy foods and fruits and vegetables.
Sugary foods and drinks can also cause tooth decay, especially if eaten between meals. The longer the sugary food is in contact with the teeth, and the more frequently it is eaten, the more damage it can cause.
For this reason, restricting sweet or acidic food and drink to mealtimes only, while offering safe snacks in between mealtimes, can help prevent decay. Snacks such as fresh fruit, vegetable sticks, small quantities of cheese, wholegrain breadsticks or bread and suitable sandwiches are good alternatives for snacks. Similarly, water or milk with no flavourings should be consumed between meals. This ensures that there isn’t exposure to sugar and therefore acid too frequently.
However, the sugars that are added to a wide range of foods, such as sweets, cakes, biscuits, chocolate, and some fizzy drinks and juice drinks are harmful and their consumption should be reduced.
The sugars found naturally in whole fruit are less likely to cause tooth decay, because the sugars are contained within the structure of the fruit. But when fruit is juiced or blended, the sugars are released. Once released, these sugars can damage teeth, especially if fruit juice is drunk frequently. Fruit juice is still a healthy choice, and counts as one of the recommended five daily portions of fruit and vegetables. But it is best to drink fruit juice at mealtimes in order to minimise damage to teeth.
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. Good eating habits should continue to be used.
Decay can also be caused by giving infants a cup for long periods or at night to calm them and filling the cups with sugary drinks, fruit juice or adding sugar to drinks.
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.
It is easier to start your child on a healthy diet that is low in sugar than to try to tell them to give up sweet food and drinks later.
Sugar containing drinks should be limited and given at mealtimes. If they are taken, they should be diluted and, if possible, taken in an open cup or beaker. It is important that babies and young children have enough to drink to prevent constipation and a child’s normal fluid intake should ideally be plain water or milk.
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. Younger children are often happy to brush their own teeth but haven’t the hand skills to do it properly. Parents or carers should supervise or help with brushing until the children can do it correctly, usually by the age of seven years. The use of an electric brush can be useful.. The key to brushing is to make it fun and not a chore.
For children up to the age of three, 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 three, a pea sized amount of toothpaste with 1300 – 1500 ppm should be used. Brush all the surfaces – inside, outside and biting surfaces.
Care should be taken that the child does not swallow or eat the toothpaste and should spit out without rinsing after brushing.
Dummies can cause a gap to form between the top and bottom teeth. So you should, if possible avoid, dummies. If one is to be used, an “orthodontic” dummy can be used which won’t cause the teeth to grow out of line. If dummies are used never dip the dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars, particularly at bedtime. 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
Everyone should visit a dentist at least once every year 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 children up to the age of 18 years.
Extra fluoride treatments (e.g. fluoride mouth tablets, drops, rinses, varnishes, gels and foams) help to protect teeth against decay. The dentist will be able to recommend these if the child needs them. They should be kept out of children’s reach. Parents must follow the correct dosage and they should not be used where there is added fluoride in the water supply.
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. In the unlikely event it is a permanent tooth see “Play Well”.
- 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 children’s teeth (pdf)