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Dental care in children

Dental care in children

July 8, 2012


What is the function of teeth in our body?

It is easier to appreciate teeth when you understand their design and purpose. Although their main function is chewing, they are also important in speech. The shape of your dental arch and the way   your teeth fit together affect the way you speak. Many letters of the alphabet   cannot   be pronounced correctly without the aid of teeth. In addition, teeth help give your face its shape and form and, if they are healthy and well cared for they enhance your appearance.

What are the different parts of a tooth?

The visible portion of the tooth is called the crown of the tooth. The crowns of the front teeth are shaped like chisels; the crowns of the back teeth have pointed or rounded elevations-cusps-and central depressions. The major portion of the teeth-about two-thirds of the total length of each tooth- is the roots. Hidden by the gums, the roots anchor the teeth in the jaw-bone.

The ENAMEL is the hard outer covering of the tooth’s crown. The hardest tissue in the body, the enamel protects the inner portion of the tooth from being worn away by chewing. Directly beneath the enamel is the DENTIN- a bonelike tissue that makes up the bulk of the tooth. Within the dentin, at the center of the crown and root is the PULP, a soft tissue that contains nerves, blood vessels, and lymph vessels.

Why do we have teeth of different shapes?

Teeth have different shapes because they perform different functions when you are eating. When you chew, the cusps the teeth in one jaw fit into the depressions of the teeth in the opposing jaw to bite, tear chew, or grind food.

The INCISORS, which are located in the center front of the mouth, have sharp, chisel-shaped crowns that cut food.

The CANNIES (CUSPIDS ) flank the incisors, they have one long root and a crown with one pointed cusp to tear food.

PREMOLARS (BICUSPIDS ) are located next to the canines. They have two cusps and one or two roots and serve to crush and tear food.

MOLARS, at the very back of the mouth, are used to grind food. They have several cusps and two or three roots.


Infants’ teeth begin developing months before birth. In the fifth or sixth week of pregnancy, tooth “buds” appear; and between the fourth and sixth months, tooth formation proceeds according to an established pattern. By the time the baby is born, the 20 primary teeth [baby/milk teeth] that will appear during the next 2&1/2 years are already present in the baby’s jawbones. The crowns of these teeth are almost complete; however, they will remain hidden by the gums until the baby begins teething.

When will the primary teeth erupt?

The primary teeth are 20 in number, five in each quadrant {side}, they start erupting as early as 6 months until 30th month. The lowers are always the first to erupt followed by the corresponding upper tooth.

Central incisors start at 6-9 months and the lowers are first to erupt, followed by the upper two.

Lateral incisors are next to follow by about 7 -10 months.

First molars are the next to erupt and surface out by 12-16 months.

Canines are next in order of eruption at about 16-20 months.

Second molars are the last of primary teeth to erupt at the age of 23-30 months.

When do the primary teeth shed off?

Central Incisors shed off between 7-8 years.

Lateral Incisors shed off between 7-9 years.

Canines shed off between 10-12 years. 

First Molars shed off between 9-11 years.

Second Molars shed off between 10-12 years.

When do permanent teeth erupt?

Normally, all 32 of the permanent teeth have erupted by age 21. In the upper jaw, the central incisors appear at age 7 or 8; the lateral incisors at age 8 or 9; the canines at the age 11 or 12; first premolars at age 10 or 11; second premolars at age 10 or 12; first molars at age 6 or 7; second molars at age 12 or 13; and third molars between ages 17 and 21.

In the lower jaw, the central incisors generally appear earlier, at age 6 or 7; the lateral incisors at age 7 or 8; the canines at age 9 or 10; the first premolars at age 10 or 12; second premolars at age 11 or 12; first molars at age 6 or 7; second molars at age 11 or 13; and third molars between ages 17 and 21.

Why are first molars important?

These are the first permanent teeth to appear in the mouth, and they generally do so at about age of 6 years. Don’t mistake the first molars for primary teeth. These teeth help shape the lower portion of the face and affect the position and health of the other permanent teeth that will soon appear.

What teeth are still erupting in adolescence?

The second molars erupt by about age 13. The third molars, or wisdom teeth, can appear any time between 17 and 21 years. Third molars may develop at an awkward angle or become impacted behind the second molars. If third molars are impacted or if there is evidence of damage to the tooth alignment or to the jaws, surgical removal is recommended in the late teens or early twenties. Periodic checks during routine dental

examinations will allow the dentist to determine the best course of treatment. 

Is teething always painful? How do I manage teething?

When a baby’s teeth are ready to break through the gums, the gums usually become swollen and tender. The baby may drool excessively and become irritable and restless.

Rubbing the baby’s gum with a clean finger or with a small, cool spoon may provide some relief. Giving the baby something to bite on, such as a teething ring, also may help soothing. If a baby is extremely uncomfortable, the dentist may temporarily numb the gums.

It’s comforting to keep in mind that teething is a natural process; and when the tooth emerges, the symptoms vanish. In some cases teething can be associated with loose stools and fever, and in some circumstance  swelling can occur due to infection in the tooth eruption site, in such cases dentist intervention is seriously required.

When should I begin cleaning my child’s teeth/oral cavity?

Even before teeth begin appearing, you should start cleaning the mouth to keep food residue and bacteria from damaging newly erupting teeth.

For infants as early as third month, with “finger brush” placed on the parent’s finger and with a sweeping motion on the gums, inner mouth and the space between gums and mouth should be cleaned.

Later after the teeth erupt, after every feeding, wipe the baby’s teeth and gums with a damp washcloth or gauze pad to remove harmful plaque. You can sit on the sofa with the baby’s head in your lap or lay the baby on the floor or changing table to make sure you can easily see in to the baby’s mouth.

If plaque is allowed to build on the baby’s teeth, the tooth enamel could become decayed. If the decay is left untreated, the primary teeth may be prematurely lost. Children need all 20 of their primary teeth for proper eating, speaking, and appearance. These teeth also reserve space in the jaw for the permanent teeth that later erupt. A complete set of healthy primary teeth allows proper development of a child’s jaw and face.

You should begin brushing and flossing your child’s teeth after each meal or snack and before bedtime when all the primary teeth have erupted—usually when the child is between 2 and 3 year old.

Which kind of toothpastes and tooth-brushes can I use for my baby/ child?

Special toothpastes are now formulated with 100% ingestible ingredients, without preservatives for infants and toddlers.

Ask your dentist to recommend a toothbrush for your child. Generally a brush with soft, end-rounded or polished bristles is recommended because it’s less likely to injure the gums. Children often need smaller brushes than those designed for adults.

Finger Toothbrush and gum massager are gentler than the softest toothbrush, easier for mother and baby to use, dishwasher safe, and is also used to soothe teething gums. These kind of brushes can be worn on mothers finger. They are made of rubber and can be used as early as the third month. It is superior method for cleaning tiny teeth and gums from birth .

Toothbrushes must be replaced when the bristles because bent or frayed, usually every 3-4 months. Preschoolers often wear out toothbrushes quickly because they brush imperfectly and chew on the brush. Inspect your child’s brush often; worn-out bristles do not remove plaque effectively. 

My doctor told me never to put my baby to bed with a bottle. Why?

If   you put your baby to bed with a bottle you risk development of “RAMPANT CARIES” also known as “NURSING BOTTLE MOUTH”, a dental condition that destroys your child’s teeth through early, serious decay.

Nursing bottle mouth occurs when a bottle containing sweetened liquid---milk, formula, fruit juice, sweetened water, or soft drinks—is given to the infant frequently, especially before the child goes to sleep.

Sugar in the liquid mixes with bacteria in the dental plaque to form acids attack the teeth for at least 20 minutes. When children are awake, their saliva tends to carry away the liquid .But during sleep, the saliva flow decreases and   these liquids pool around the child’s teeth for long periods, bathing the teeth in acid.

Don’t substitute the bottle with a pacifier dipped in   honey or sugar; it also can be damaging to the teeth. If your baby needs a bottle for comfort before falling asleep, fill the bottle with plain water.

At what age should your child be able to brush his teeth?

Cleaning the mouth requires some skill. By age 2, your child will be learning to handle a toothbrush and may imitate you. By age 4 or 5, children often are able to brush by themselves. However, until your child reaches about age 8, you will need to supervise and provide assistance in brushing and flossing to make sure your child is doing a thorough job. Importance of flossing which should start when a child is a toddler with the parents should be inculcated and well taught so the child carries on doing so for the rest of his life.

If you’ve given instructions and supervised their efforts all long, your children should be able to do a through job on their own by about age 8 or 9. It’s a good idea to periodically check whether they are brushing and flossing effectively by using disclosing agents. Disclosing agents color the plaque so that is can be seen. When the stained plaque is removed by brushing and flossing, you and your children will know their teeth are clean.

What is the importance of flossing?

“Flossing reaches where your brush cannot” – is the key to success for healthy teeth, preventing decay in between teeth, and prevents gum related problems like pockets and gum diseases. Developing countries, are quite unaware of the facts of flossing, parental education is lacking so it is being unable to be passed on to the next generation. Lack of dental appointments in infant stages are other things to be blamed.

Dental floss is the most generally recommended device for the removal of interproximal plaque. There are a variety of types of floss ranging from thin unwaxed strands to thicker waxed tapes. Floss holders and newer devices are also seen in the market nowadays.

Parental involvement not only enhances effectiveness but also provides a role model for the child that promotes the development of good oral hygiene habits. Parents should be encouraged to institute oral hygiene procedures for their child beginning very early in life to achieve primary prevention, which is to prevent dental diseases before it begins

Does my toddler need any dietary supplements for stronger teeth?

Dietary supplements should not be given without your dentist’s or physician’s advice. If your drinking water is fluoridated, it will provide the anti-cavity benefits of fluoride. If you do not have flouridated drinking eater in your community, your dentist may prescribe a fluoride supplement.

If your child eats a balanced diet, including three glasses of milk daily, he or she will receive all the calcium and phosphorous necessary for developing teeth.

Try to keep your child’s sugar intake low, and that includes use of honey, brown sugar, and sugary syrups, which are just as harmful as refined sugars. A recommended diet for children includes daily consumption of four servings of breads and cereals, four servings of fruits and vegetables, three servings of milk and diary products, and two servings of meat or other proteins.

Will fluoride keep my child safe from developing dental cavities? 

Children who are born and raised in communities where the drinking water is fluoridated have had up to 65% fewer cavities than children whose drinking water is not floridated at optimal levels. Although the benefits of fluoride are life-long, drinking fluoridated water is beneficial to children because the fluoride is incorporated into the enamel as the tooth is formed. If you don’t live in a community in which drinking water is fluoridated, ask your dentist about fluoride supplements.

Your dentist may also apply a fluoride solution or gel to your child’s teeth during office visits as an additional precaution against tooth decay. At home use of fluoride toothpaste

is effective in reducing dental caries.

Three year olds take lot of snacks. Does it harm their teeth?

At this age, children need to eat snacks at some point in the day. They simply can’t eat enough food at mealtimes to obtain the nutrients they need. But if your child snacks too often—especially on foods containing sugar—she runs the risk of developing tooth decay. Offer sensible foods as snacks, such as: fruits, hard-boiled eggs, pizza,

Peanut Butter (without sugar) sandwich, milk, soups, fruit juices, cheese and plain yogurt. Cheddar cheese is an especially good choice: recent studies have shown that it contains substances that neutralize the acids produced by bacteria in plaque.

What are pits and fissure sealants?

To prevent decay, the dentist can apply a clear or shaded plastic coating to the biting or chewing surfaces of back teeth. These molars have natural grooves and depressions [pits and fissures] where plaque and food particles collect. The sealants act as a barrier, protecting the decay-prone areas of the back teeth from plaque and acids.

Application is usually simple and fast, often requiring only a few minutes for each tooth.

The teeth to be sealed are cleaned and swabbed with a solution that helps the sealant adhere to the tooth surface. The sealant is then brushed onto the tooth and allowed to harden by a special light. The sealants should be checked periodically since they do wear away and need to be reapplied.

What should I do if my child injures a tooth?

School age children often injure their teeth accidentally. Teeth can be broken, cracked, or pushed out of alignment. If this happens, consult your dentist/ maxillofacial surgeon immediately.

 If a permanent tooth is knocked out, save it. If it’s dirty, gently rinse it, do not scrub, and insert the tooth into the socket and hold it in place. If it cannot be repositioned, immediately place the tooth in a container of milk or cool water or gently wrap it in a clean, wet cloth. In either case rush your child and your tooth to the dentist, within 30 minutes if at all possible. This type of accident constitutes an emergency, so call your dentist even if it occurs at night or on a weekend. If you cannot reach your dentist, call a hospital emergency room: they may have a dentist on call.

The dentist may be able to replant the tooth and apply a splint that will keep the tooth in position until it reattaches itself to the jaw and is able to function normally.

If a tooth is broken , gently clean any dirt or debris from the injured area with warm water. Apply cold compresses on the face over the injured tooth to keep swelling down, and seek dental care immediately.

If your child accidentally bites his tongue or lip, apply direct pressure to the bleeding area with a clean cloth. If the lip is swollen, use cold compresses. If you can’t stop the bleeding, go to a hospital emergency room.

Dental Care, Teething, Teeth eruption, Primary teeth, Secondary teeth, Toothbrush, Brushing teeth, Dental injuries, Flossing, Dental caries, Dental cavities