CHILDREN'S TEETH

Children's teeth start to develop before birth.  There are two sets of teeth: milk teeth (sometimes called baby teeth) and permanent (or adult) 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. However, this can vary so don’t worry if your child’s teeth come in faster or slower than this.

Your child's milk teeth are important for eating, speech, smiling and confidence. They are also important for the development of 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 erupt between the ages of 17 and 25, 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, take your child (and the tooth if it has been knocked out) to your dentist for advice as quickly as possible. If you can’t get to your dentist, contact the nearest dentist.

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, dental erosion doesn't usually need treatment. If your child has a seriously eroded tooth, his or 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 or her too many sugary or acidic foods and drinks
• encourage your child to brush his or her teeth twice a day with at least 1,000ppm fluoride toothpaste (ppm = parts per million, i.e. amount of fluoride in the 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 or 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 co-operation with the dentist when your child is older.

Your dentist will recommend check-ups at intervals suitable for your child. He or 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 remove bacteria and so prevent tooth decay.

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

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

Make tooth brushing a regular activity, in the morning 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 (such as orange juice) – this gives time for the teeth to build up their mineral content.

When your child is about seven, teach him or her how to brush his or her own teeth, using a gentle, circular motion and fluoride toothpaste. You should supervise your child while he or she is learning to brush. Give your child plenty of encouragement and praise. It's a good idea to check how well he or 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 about 10% of the UK. In these areas, there has been much less tooth decay. You can find out if your water is fluoridated by contacting your water supply company.

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 under three should use toothpaste that contains 1,000ppm fluoride. Children over three should use toothpaste that contains between 1,350 and 1,500ppm fluoride. Ask your dentist which is the best toothpaste for your child.

Use only a smear of toothpaste for children under three. After that, use an amount about the size of a small pea until your child is six.

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. Your dentist may recommend fluoride varnish which they apply to your child’s teeth for extra protection.

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.

They can last for several years, but your child should visit the dentist regularly to check that they haven't worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.