child Milk teeth, Baby teeth, INFANTS AND CHILDREN milk teeth, Caring for your child’s teeth

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Summary

Baby teeth, more accurately called primary teeth or deciduous teeth, are a person’s first set of teeth. They begin to form during the first trimester of pregnancy (first 12 weeks) and begin to emerge (erupt) through an infant’s gums around 6 months of age. All twenty primary teeth are typically fully erupted by the time a child is 3 years old and are later replaced by 32 permanent teeth.

Primary teeth have several functions. They help with biting and chewing, which contributes to good nutrition, and are crucial to a child’s ability to speak. They serve as a guide for permanent teeth to erupt and grow while maintaining the space. They also make a child look more attractive by supporting the shape of the face.

Proper dental hygiene is important for primary teeth, even though they eventually will be replaced by permanent teeth. Poor maintenance of baby teeth can cause them to fall out early, which in turn can cause permanent teeth to erupt prematurely and not in correct position.

If teeth are discolored when they erupt, it might indicate an underlying medical problem. Like permanent teeth, primary teeth are also vulnerable to plaque, a clear film that sticks to teeth and attracts bacteria and sugar. This can lead to cavities. Primary teeth are vulnerable to various injuries that can cause them to chip, fracture or completely come loose.

Proper care can help avoid many of the problems that sometimes affect primary teeth. After primary teeth begin to appear, they can be brushed with a soft children’s toothbrush. According to the American Dental Association (ADA), toothpaste should not be used until the child is 2 years old. As soon as two teeth erupt next to each other, they should be flossed at least once daily. Children who take good care of their teeth form habits that help keep their teeth healthy for a lifetime. Proper maintenance and care of all teeth remains crucial to maintaining good dental health.

About baby teeth

Baby teeth, more accurately known as primary teeth or deciduous teeth, are the first of two sets of teeth that people develop during their lifetimes. They begin to form during the first trimester of pregnancy and have fully formed by the time an infant is born. However, primary teeth usually remain hidden under the gums until they begin to emerge (erupt) between 5 months and 8 months of age. This process is known as teething.

A human tooth is composed of several parts:

Crown. Part of the tooth that is visible above the gum line.

Enamel. The hard, translucent outer shell that covers the crown. The enamel is hard enough to handle the strain of a lifetime of biting, chewing and grinding. It also protects the tooth from bacteria and changes in temperature when eating hot or cold foods. Nonetheless, it is brittle and may crack or chip.

Root. Part of the tooth that pushes into the upper (maxilla) or lower (mandible) jawbone. Each root has a tiny opening at the bottom called the apical foramen. Blood vessels and nerves enter the root through this space.

Cementum. Hard shell that covers the root and attaches to fibers that fasten the root to the jawbone.

Dentin. Layer of the tooth found beneath the enamel and the cementum. It makes up most of the tooth’s structure and is responsible for the tooth’s color. It typically has a whitish to yellowish hue.

Pulp. Located beneath the dentin at the core of the tooth. It is made up of blood vessels, nerves and connective tissue. The blood supply of the pulp provides the nutrients that keep the tooth alive. The pulp is made up of two parts. The pulp chamber is found in the crown of the tooth. The root canal is the part of the pulp located in the root of the tooth, where blood vessels and nerves enter the tooth.

Twenty primary teeth – eight incisors (four front teeth on both the upper and lower jaw), four canines (located in the front of the jaw behind the incisors) and eight molars (larger teeth in the back of the mouth) – typically erupt by the time a child is 3 years old. Eruption of the lower teeth generally precedes eruption of the top teeth. Eruption times for girls are generally earlier than those for boys.

The following schedule for the top primary teeth was established by the American Dental Association (ADA):

Central incisor: 8 months to 12 months
Lateral incisor: 9 months to 13 months
Canine (cuspid): 16 months to 22 months
First molar: 13 months to 19 months
Second molar: 25 months to 33 months
Eruption of the bottom primary teeth occurs as follows:

Central incisor: 6 months to 10 months
Lateral incisor: 10 months to 16 months
Canine (cuspid): 17 months to 23 months
First molar: 14 months to 18 months
Second molar: 21 months to 31 months
The first primary teeth to emerge are usually the bottom two incisors, followed by the top four incisors and then the rest of the bottom incisors. After the incisors the rest of the primary teeth begin to fill the mouth, usually with two developing at a time. The roots of primary teeth are 50 percent formed when eruption first begins, and roots are completed by the time a child is between the ages of 18 months and 3 years.

Primary teeth have several roles. They help with biting and chewing, and are crucial to a child’s ability to speak. They may also make a child appear more attractive. Finally, primary teeth serve as a guide for permanent teeth. For this reason, primary teeth usually have more space between them to allow permanent teeth more room to erupt.

Primary teeth are smaller and whiter than permanent teeth. Some of the other ways in which primary teeth differ from permanent teeth include:

Crowns are shorter in primary teeth

Enamel depth is more consistent and thinner in primary teeth

Pulp chambers of primary teeth are larger relative to the size of the tooth

Roots are longer and more slender in primary teeth
Eventually, a child’s primary teeth begin to fall out. The middle teeth in front (incisors) typically fall out at age 6. Molars in the back are shed between the ages of 10 and 12. By age 13, children usually have their permanent teeth.

A total of 32 permanent teeth replace the original 20 primary teeth. Meanwhile, permanent first and second premolars (bicuspids) replace the primary first and second molars and permanent incisors and canines replace primary incisors and canines. The permanent molars which grow towards the back of the mouth do not replace baby teeth. This is why there are more teeth in permanent dentition.

Potential problems with baby teeth

Although a child’s baby teeth, or primary teeth, eventually will be replaced by permanent teeth, it is important to care for these initial teeth. When primary teeth emerge, they should be off-white or ivory in color. Teeth that erupt with a black tint or another color usually indicate an underlying problem. Most often, this is the result of plaque growing on the teeth due to a build-up of bacteria in the child’s mouth. Liquid medications containing iron, some antibiotics and certain supplemental vitamins also can cause this effect. Other potential causes of discoloration include:

Chronic illness or recurrent fevers

Excessive fluoride, which may cause bright white spots (fluorosis)

Injury to the teeth, which may cause pink or grayish discoloration

Jaundice in newborns, which may cause yellowish or greenish tint

Use of the antibiotic tetracycline by the mother during pregnancy
Poor maintenance of primary teeth can result in premature loss either naturally or by extraction. This can cause a change in the eruption schedule of the permanent teeth, which may lead to space problems for proper eruption. The permanent teeth may erupt crooked and misaligned.

Primary teeth are also vulnerable to dental plaque, a clear film that sticks to teeth and attracts bacteria and sugar. As the bacteria feed on the sugar, they are broken down into acids that eat into the enamel of the teeth. This causes cavities in the teeth, which can be painful. In addition, plaque can cause gums to become red, swollen and sore. This condition is known as gingivitis, or gum disease.

The first risk to a child’s primary teeth often comes in the form of baby bottle tooth decay (baby bottle syndrome or bottle mouth). This condition results from leaving a bottle in a baby’s mouth for long periods of time while the baby sleeps. Sugars from milk or juices that bathe and remain on the teeth for hours at a time begin to eat away at the enamel. Pocked, pitted or discolored front teeth are signs of the condition. In its most extreme form, this condition can lead to a need to pull a baby’s front teeth until permanent teeth grow in. As a rule, parents or caregivers should only allow a baby to have a bottle during meals, and to fill the bottle only with water if it is used at night.

As children grow older, the primary teeth remain at high risk for cavities. Cavities are one of the most common chronic conditions among children in the United States, according to the American Academy of Pediatrics. Among 3-year-olds, 18.7 percent have at least one tooth with a cavity that has yet to be treated. By the time a child is 8 years old, 51.6 percent have an unfilled cavity or at least one filling. Children who were born prematurely or who had a low birth weight are at increased risk for cavities. Other factors that increase the risk of cavities include:

History of ongoing health care needs
White spots or brown areas on teeth
Failure to regularly see the dentist
Inadequate brushing and flossing regimen
Poor socioeconomic status
Diet that includes too many sugary foods and drinks
Primary teeth are also vulnerable to injuries that can cause them to chip, fracture or completely come loose. Usually, an injury causes baby teeth to loosen rather than fracture. These injuries often occur as the result of falls, mishaps during play or accidents during athletics. If a child suffers an injury to the gums or a baby tooth that causes bleeding, parents may be advised to run cold water over a piece of gauze and apply pressure gently to the injury site. Sucking on an ice pop may be recommended to reduce swelling until the child can see a dentist.

Baby teeth that are knocked out do not require special care after they come loose, unlike permanent teeth, because they cannot be reimplanted. Reimplanting a baby tooth can damage developing permanent teeth and often results in death of the pulp.

Nonetheless, a child’s tooth injury usually requires a visit to a healthcare professional. In many cases, consulting the dentist is the best option. However, a visit to a hospital emergency room may be necessary if the child has suffered a blow to the head, which can be life-threatening, or an injury to another body part. In some cases of primary tooth loss, a dentist may use a space maintainer to keep the area open until the permanent tooth erupts.

Caring for your child’s teeth
Published by Bupa’s health information team, March 2009.

This factsheet is for people who would like information about caring for their child’s teeth.

Caring for a child’s teeth from an early age will help him/her to grow up with healthy teeth and gums. Diet, oral hygiene and visits to the dentist are all important in helping to care for a child’s teeth.

About your child’s teethWhat can damage my child’s teeth?How can I protect my child’s teeth?Further informationQuestions and answersRelated topicsSourcesAbout your child’s teeth
Children’s teeth start to develop before birth. There are two sets of teeth: “milk” teeth and permanent teeth.

Milk teeth
Children usually have 20 milk teeth. They start to push through the gums (erupt) at about six months. Most children have all 20 teeth by the age of two or three. The last milk tooth will fall out at around the age of 12.

Your child’s milk teeth are important for his/her eating, speech, smile and confidence. They are also important for the development of his/her permanent teeth, so it’s very important to look after them.

Permanent teeth
Permanent teeth usually start to erupt at the age of six. Adults have up to 32 permanent teeth.

Most of these will erupt by the age of 13. However, wisdom teeth (those at the very back of the mouth) often don’t erupt until the early- to mid-twenties, if at all.

If your child’s permanent teeth are damaged or need to be removed, there won’t be another set of natural teeth to replace them.

What can damage my child’s teeth?
Many children fall over and bump their teeth accidentally. If this happens to your child, take him/her, and the tooth if it has been knocked out, to the nearest dentist for advice.

Tooth decay and dental erosion are two preventable causes of damage to children’s teeth.

Tooth decay
Our mouths are full of bacteria that build up on the teeth in a sticky layer called plaque. These bacteria digest some of the sugar in our food and drinks, making acids that can weaken the tooth enamel (the hard outer layer of teeth). If acid remains on the tooth surface for a long time, it can cause those areas of the tooth to decay. This can happen if children often have sugary foods or drinks, or don’t clean their teeth properly.

If your child has tooth decay that isn’t treated by a dentist, it will eventually reach the centre of the tooth and can cause an infection or toothache.

Dental erosion
Dental erosion is the gradual wearing away of the enamel on the whole surface of the tooth. It’s caused by acid attacking the surfaces of the teeth. These acids usually come from drinks such as fruit juices, fizzy drinks and squashes – even the sugar-free varieties. These drinks are so popular that over half of all five-year-olds in the UK have some dental erosion. Acids can also be produced if your child vomits or has stomach problems.

Dental erosion can cause sensitivity and pain. Although enamel doesn’t grow back, it doesn’t usually need treatment. If your child has a seriously eroded tooth, his/her dentist may protect the tooth with a filling.

How can I protect my child’s teeth?
To reduce your child’s risk of tooth decay and dental erosion:

take your child to the dentist regularly
don’t give him/her too many sugary or acidic foods and drinks
encourage your child to brush his/her teeth twice a day with at least 1,000ppm fluoride toothpaste
encourage your child to spit out toothpaste and not rinse with water, as this reduces the effect of the fluoride
take advice from your dentist about protective treatments such as fluoride supplements and fissure sealants (see Fissure sealants)
Going to the dentist
It’s a good idea to take your child when you go for your routine dental check-ups, even when he/she is too young to have teeth. This helps your child get familiar with the people and the surroundings at the dental surgery. Your dentist will look in your child’s mouth in an informal way, and may count how many teeth have erupted and spot any early signs of decay. Quick check-ups like this help to encourage good cooperation with the dentist when your child is older.

Your dentist will recommend check-ups at intervals suitable for your child. He/she may take X-ray images to check for decay. Children usually need dental visits more often than adults. Milk teeth are smaller and have thinner enamel than permanent teeth, so decay can spread very quickly. Regular check-ups help your dentist to help you prevent and treat decay before it causes toothache.

Diet
Reducing sugar in your child’s diet is the best way to prevent tooth decay. However, it’s how often your child eats sugar (rather than how much) that is important. Similarly, it’s how often your child has acidic food and drinks (rather than the amount) that affects dental erosion.

Keep squashes, fizzy drinks, natural fruit juices, sweets and cakes to a minimum. Don’t give your child sugary foods and drinks as snacks between meals or before bedtime. Watch out for hidden sugars in sauces, breakfast cereals, etc.

Fruit, vegetables, cheese and milk are all healthier snacks because they contain natural sugars. Remember, however, that as well as natural sugars, fruit contains acids, which can cause decay if eaten in large amounts. You can help to protect your child’s teeth against erosion by finishing a meal with an alkaline food such as milk or cheese. This will neutralise the acid in your child’s mouth.

Older children can chew sugar-free gum after meals, especially containing Xylitol, as this helps prevent tooth decay.

Plain water and plain milk doesn’t cause tooth decay or erosion. Your child may find it hard to drink plain water or milk if he/she usually has sweet drinks, but most children get used to it over time.

Toothbrushing
You should start cleaning your child’s teeth as soon as they come through the gums. There are special toothbrushes for babies.

Make toothbrushing a regular activity, after breakfast and before bedtime, so that it becomes part of your child’s daily routine. Don’t brush for one hour after eating or drinking anything acidic.

When your child is about seven years old, teach him/her how to brush his/her own teeth, using a gentle, circular motion and fluoride toothpaste. You should supervise your child while he/she is learning to brush his/her teeth. Give your child plenty of encouragement and praise. It’s a good idea to check how well he/she is getting on every few days.

Disclosing tablets are small pills that, if chewed for 30 seconds, turn plaque a bright colour – usually pink. This can help you show your child any areas that have been missed when brushing.

Toothpaste
Most toothpaste contains a mineral called fluoride, which strengthens the tooth enamel making it more resistant to decay. Fluoride is also added to the water supply in some parts of the country. In these areas, there has been much less tooth decay.

However, too much fluoride in young children can result in a spotted appearance on their permanent teeth (dental fluorosis).

The amount of fluoride in different brands of toothpaste varies. Children aged up to three years should use toothpaste that contains 1,000ppm fluoride. Children over three years should use toothpaste that contains between 1,350 and 1,500ppm fluoride. Ask your dentist which is the best toothpaste for your child.

If your child is less than two years old, only use a smear of toothpaste. After that, use an amount about the size of a small pea.

Fluoride supplements
If you live somewhere where there is no fluoride in the water or if your child’s teeth are particularly at risk of decay, your dentist may recommend extra fluoride in the form of tablets, drops or mouthwashes.

Fissure sealants
Some children have very deep fissures (crevices) in their permanent back teeth, which can be difficult to keep clean. These fissures can be sealed with a resin film to protect the surface from decay.

Fissure sealants are quick and painless to apply. The dentist cleans the tooth with a special acid, then washes and dries it. The resin is then painted on to the tooth and hardened with a bright, blue light.

Fissure sealants can last for several years but regular visits to the dentist are needed to check that they haven’t worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.