SAMPLE. Your Child s Teeth. Parents. Helpful Tips for Parents and Caregivers W177

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1 Parents Your Child s Teeth Helpful Tips for Parents and Caregivers Produced in cooperation with the American Academy of Pediatric Dentistry ( and the American Association of Orthodontists ( W177 To order additional copies, call or visit American Dental Association. All rights reserved.

2 As our daily lives seem busier and faster-paced than ever, Mother s one phrase comes to mind: The future is now. Children s oral healthcare habits today will have an impact on their health as an adult. The good news is that preventive dental care has dramatically improved the oral health of many American children. It is now possible for children to reach adulthood without ever experiencing tooth decay. However, tooth decay remains a serious public health problem. It is the most common chronic childhood disease that will not resolve without treatment. It is five times more common than asthma. Here are some simple steps you can take to help your child enjoy a lifetime of beautiful smiles. Health Before the Baby Arrives Importance of a Balanced Diet A balanced diet is critical for the proper development of an unborn child. Teeth begin to form in the second month of pregnancy and to harden between the third and sixth months of pregnancy. A balanced diet that provides adequate amounts of vitamins A, C and D, protein, calcium and phosphorous helps develop healthy teeth. Inadequate nutrition, on the other hand, may result in poorlyformed tooth enamel that may make a child more likely to develop cavities once the teeth have erupted. Keeping Mother s Teeth and Gums Healthy A mother s decay-causing bacteria can be transmitted to her child, so it is important to have maternal teeth free of decay before the birth. Pregnant women may have the desire to eat more frequently between meals. While this is normal, frequent snacking can be an invitation to tooth decay. The decay process begins with plaque, an invisible, sticky layer of harmful bacteria that constantly forms on teeth. The bacteria convert sugar that remains in the mouth to an acid that attacks tooth enamel. Brushing your teeth twice a day and cleaning between teeth daily with floss or another interdental cleaner can reduce the risk of decay. Plaque that is not removed can irritate the gums, making them red, tender, and likely to bleed easily. This condition is called gingivitis and can lead to more serious periodontal disease that affects the gums and bone that anchor teeth in place. During pregnancy, a woman s hormone levels rise considerably. Gingivitis, especially common during the second to eighth months of pregnancy, may cause red, puffy or tender gums that tend to bleed when brushed. This sensitivity is an exaggerated response to plaque and is caused by an increased level of progesterone. Poor periodontal health in the mother may lead to adverse pregnancy outcomes like premature delivery and low birth weight of the baby. Mothers should see a dentist regularly throughout pregnancy. The dentist may recommend more frequent cleanings during the second trimester or early third trimester to help avoid problems.

3 The Growing Years: From Birth to Six 0-6 Baby s First Teeth People usually think of a newborn baby as having no teeth. But the 20 primary teeth that will erupt during the first three years already are present at birth in the baby s jawbones. At birth, most of the crowns of the baby s teeth are almost complete, and the chewing surfaces of the permanent molars have begun forming. Primary teeth are important in normal development for chewing, speaking, and appearance. In addition, the primary teeth hold the space in the jaws for the permanent teeth. Both primary and permanent teeth help give the face its shape and form. A baby s front four teeth usually erupt first, typically at about six months of age, although some children don t have their first tooth until 12 or 14 months. Most children have a full set of 20 primary teeth by the time they are three years old. As your child grows, the jaws also grow, making room for the permanent teeth that will begin to erupt at about age six. At the same time, the roots of the primary teeth begin to be absorbed by the tissues around them, and the permanent teeth under them begin to erupt. Typically, children have the majority of their permanent teeth by 12 to 14 years of age. The remaining four permanent molars, often called wisdom teeth, erupt around age 21 to complete the set of 32 permanent teeth. When teeth begin erupting, some babies may have sore or tender gums. Gently rubbing your child s gums with a clean finger or a wet gauze pad can be soothing. You also can give the baby a clean teething ring to chew on, but never dipped in sugar or syrup. If your child is still cranky and uncomfortable, consult your dentist or physician. Contrary to common belief, fever is not normal for a teething baby. If your infant has an unusually high or persistent fever while teething, call your physician.

4 The Developing Smile: Tooth Eruption Charts Tip Top Teeth for Tots Primary Teeth Upper Teeth Erupt Shed Central incisor 8-12 mos. 6-7 yrs. Lateral incisor 9-13 mos. 7-8 yrs. Canine (cuspid) mos yrs. After every feeding, wipe the baby s gums either with a clean, wet gauze pad or a washcloth or towel. This removes plaque and residual food that can cause decay. Brush and floss your child s teeth until the child has developed the necessary skills. Set a good example by cleaning your teeth every day. First molar mos yrs. Permanent Teeth Second molar mos yrs. Cleaning Your Child s Teeth Lower Teeth Erupt Shed Second molar mos yrs. First molar mos yrs. Canine (cuspid) mos yrs. Lateral incisor mos. 7-8 yrs. Central incisor 6-10 mos. 6-7 yrs. Upper Teeth Central incisor Lateral incisor Canine (cuspid) First premolar (first bicuspid) Second premolar (second bicuspid) First molar Second molar Third molar (wisdom tooth) Lower Teeth Third molar (wisdom tooth) Second molar First molar Second premolar (second bicuspid) First premolar (first bicuspid) Canine (cuspid) Lateral incisor Central incisor Erupt 7-8 yrs. 8-9 yrs yrs yrs yrs. 6-7 yrs yrs yrs. Erupt yrs yrs. 6-7 yrs yrs yrs yrs. 7-8 yrs. 6-7 yrs. Begin cleaning the baby s mouth during the first few days after birth. After every feeding, wipe the baby s gums either with a clean, wet gauze pad or with a washcloth or towel. This removes plaque and residual food and helps children become accustomed to having their mouth checked. When your infant s teeth begin to erupt, it is important to clean them regularly. You may continue to use a gauze pad or cloth to clean the incisors after feedings until the back teeth (molars) begin to erupt (usually around 12 months of age). Once a molar appears, brush all teeth gently with a child s size soft toothbrush and water. Position your child so you can see into the mouth easily; you might want to sit, resting his head in your lap. When your child can predictably spit and not swallow toothpaste, begin brushing the teeth with a pea-sized amount of fluoride toothpaste. (Consult with your child s dentist or physician if you are considering using fluoride toothpaste earlier). Check your child s toothbrush often and replace it when it is worn. Bent or frayed bristles will not remove plaque effectively. Begin using floss when adjacent teeth are touching. Flossing is important to prevent cavities from developing between teeth. First Dental Visit As your child s first tooth erupts, consult with the dentist regarding scheduling a first dental visit. It is advantageous for the first dental visit to occur within six months after the first tooth erupts, but not later than the first birthday. Treat the first dental visit as you would a well baby checkup with the child s physician. During the first visit, the dentist can: (1) review the medical and dental histories; (2) complete a thorough oral examination to assess growth and development, oral hygiene, injuries, cavities and/or other problems; (3) clean the teeth as indicated and provide suggestions about daily care; (4) evaluate and optimize your child s fluoride exposure because too much or too little can lead to problems; (5) review feeding practices and provide dietary counseling; (6) assess your child s risk of developing tooth decay; (7) provide information regarding oral development, teething, pacifier or finger/thumb sucking habits and injury prevention; and (8) plan for any needed treatment or the next check up. The dentist also will answer any questions the parents may have.

5 Preventing Decay of Primary Teeth As soon as teeth appear in the mouth, decay can occur. One of the risk factors for early childhood cavities (sometimes called baby bottle tooth decay) is frequent and prolonged exposure of a baby s teeth to liquids containing sugar, like sweetened water and fruit juice and potentially milk, breast milk and formula. Tooth decay can occur when parents or caregivers put a baby to bed with a bottle or use one as a pacifier for a fussy baby. Encourage children to drink from a cup by their first birthday, and discourage frequent or prolonged use of a training cup. If you give your child a pacifier, use a clean one. Never dip a pacifier in sugar or honey before giving it to a baby. Encourage healthy eating habits. This would include a diet with plenty of vegetables and fruits and whole grains. Snacks should be nutritious. Limit sweets to mealtimes. Healthy primary (baby) teeth Moderate to severe decay Severe (rampant) decay Holding Space Open for Permanent Teeth Sometimes a primary tooth is lost before the permanent tooth beneath it is ready to erupt. If a primary tooth is lost too early because of cavities or injuries, nearby teeth can tip or shift into the vacant space. When the permanent tooth is ready to emerge into the space, there may not be enough room for it. The new tooth may be unable to erupt or may emerge in an abnormal position. If your child loses a tooth prematurely, the dentist may recommend a space maintainer, a plastic or metal appliance that holds open the space left by the missing tooth. The dentist will remove this device once the permanent tooth begins to erupt. Sucking Habits A space maintainer reserves space for the eruption of a permanent tooth. Sucking is a natural reflex and infants and young children may suck on thumbs, fingers, pacifiers and other objects. It may make them feel safe and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep. Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with tooth alignment and the proper growth of the mouth. The frequency, duration, and intensity of a habit will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs. Usually, children stop between the ages of two and four. Your child s dentist can provide information regarding consequences of a habit as well as treatment to prevent possible dental or skeletal problems. Helping a Child Get Through Thumb Sucking Instead of scolding children for thumb sucking, praise them when they are not. Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking. Children who are sucking for comfort will feel less of a need when their parents provide comfort. Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents. Your dentist can encourage children to stop sucking and explain what could happen if they continue. If these approaches don t work, your dentist may recommend an oral appliance or other device to aid your child in correcting the habit.

6 Your Child s Diet Toothbrushing for Children Brush and floss your child s teeth A good diet is essential for a child s growth and development. until he or she is at least six years Like the rest of the body, the teeth, bones and the soft tissues old. By age six or seven, children of the mouth need a well-balanced diet. The preschool years should be able to brush their are an important time to help your child establish good eating own teeth twice a day with habits. Children should eat a variety of foods from the five supervision until about age 10 or major food groups in line with the food pyramid: 11, to make sure they are doing a fruits thorough job. However, each child is different. Your dentist can help vegetables you determine whether the child breads, cereals and other grain products has the skill level to brush properly. milk, cheese and yogurt meat, poultry, fish, and alternates, such as Choose a child-size toothbrush for dry beans and peas, eggs and nuts ease of use. The variety of colors and designs can provide extra fun What you eat and how often you eat can affect your teeth. and motivation to keep children Although tooth decay has declined among young children brushing. There also are powered as a group, it still can be a problem for individual children, or mechanical brushes available and even teens and adults. That s because plaque, a sticky for children, so ask your dentist if film of bacteria, constantly forms on our teeth. When we one is right for your child. Proper eat food or drink beverages that contain sugar, the bacteria brushing removes plaque from the produce acids that attack tooth enamel. The stickiness of inner, outer and chewing surfaces. plaque keeps the harmful acids against the teeth, which can When teaching how to brush, you contribute to tooth decay. Frequent snacking may mean may wish to stand behind the child frequent acid attacks and an increased risk for tooth decay. and hold the brush to be certain Other factors that promote tooth decay are the amount of that brushing is done properly. bacteria in your mouth and lack of exposure to fluoride. Limit snacks. If your child does need a snack between meals, offer nutritious foods from the main food groups. Proper Brushing Techniques 1. Place the toothbrush against the gums. 2. Move the brush back and forth gently in short (tooth-wide) strokes. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. 3. Finish by brushing the tongue to help freshen breath and remove bacteria.

7 Floss once a day Your dentist and hygienist can tell you if your child needs to floss and also demonstrate how to floss. Flossing removes plaque between the teeth where a toothbrush can t reach. Focus on Fluoride Cavities used to be a fact of life. But during the past few decades, tooth decay has been dramatically reduced. The key reason: fluoride. Because flossing is a difficult skill to master, you should floss the child s teeth until he or she can do it alone. Show the child how to hold the floss and gently Fluoride is a mineral that occurs clean between teeth. At about age 10 or 11, the child should be able to floss naturally in all water sources, including the oceans. Research has shown that between teeth under your supervision. If you re unsure as to when your child no fluoride not only prevents cavities, it longer needs supervision while cleaning his or her teeth, check with your dentist. also helps repair the early stages of tooth decay even before the decay is visible. Proper Flossing Techniques During childhood, when teeth still are forming, fluoride works by making tooth enamel more resistant to the acid that causes tooth decay. After teeth erupt, the benefits are just as great. Fluoride helps repair, or remineralize, areas where the acid attacks have already begun. 1. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-andforth motion to guide the floss between the teeth. 2. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. 3. Repeat this procedure on each tooth. Don t forget the backs of the last four teeth in each corner of the mouth. Fluoride is obtained in two forms: topical and systemic. Topical fluorides may be found in toothpastes, mouth rinses and fluoride applied in the dental office. Systemic fluorides are those that are swallowed. They include fluoridated water and dietary fluoride supplements in the form of tablets, drops or lozenges. The maximum reduction in tooth decay is achieved when fluoride is available both topically and systemically. Water fluoridation provides both topical and systemic benefits for preventing tooth decay. Community water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal prevention of tooth decay. If you are unsure about the fluoride level in your community s water, ask your dentist and/or contact your local or state health department or water supplier. Children who regularly drink bottled water, well water or unfluoridated tap water may be missing the benefits of fluoride. While some bottled water naturally contains optimal levels of fluoride, the majority of bottled waters do not. Some companies produce bottled water with added fluoride. Check the bottle water label or contact the distributor for information. Before you give your child any vitamin or supplement that contains fluoride, check with your dentist to see if one is needed. Discuss your child s fluoride needs with your dentist or pediatrician. Based on your dentist s assessment of your family s oral health, the use of additional fluoride-containing products may or may not be recommended.

8 The Transition Years: From Six to 12 As children develop, their jaws and faces continue to change. The transition from baby teeth to adult teeth is gradual. By the time they reach adulthood, most children will progress from their 20 primary teeth to 32 permanent (adult) teeth. All the while, the jaw gradually expands to make room for the additional 12 teeth. At about age six, maybe earlier, children begin to shed (lose) their front teeth on top and bottom. During the next six or so years, permanent teeth gradually will replace the primary teeth Dental Sealants A sealant is a material that is applied to the chewing surfaces of back teeth (premolars and molars), and sometimes to deep pits and grooves of front teeth, where decay occurs most often. The sealant acts as a barrier, protecting the decay-prone areas of the teeth from accumulating plaque that results in acid attacks and tooth decay. Pits and fissures are depressions and grooves in the surfaces of the teeth that often are difficult to keep clean because toothbrush bristles cannot reach into them. The sealant forms a thin covering that keeps out plaque and food and decreases the risk of tooth decay. Sealing a tooth is fast and there is virtually no discomfort. The dentist conditions the chewing surfaces to help the sealant adhere to the tooth and then applies the sealant to the tooth enamel. The first permanent molars usually erupt between ages five and six. For that reason, they are often called the six-year molars. They are among the extra permanent teeth in that they don t replace an existing baby tooth. These important adult teeth are often mistaken for baby teeth. However, they are permanent and must be cared for properly if they are to last throughout the child s lifetime. The six-year molars are especially important because they help determine the shape of the lower face. They also affect the position and health of other permanent teeth. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed. Both primary and permanent teeth can benefit from sealants. Ask your dentist if sealants will help your child. Dental Sealants Tooth groove Toothbrush bristle A single toothbrush bristle is too large to reach inside the fissure. Chewing surface before sealant. Dental Visits Regular dental visits are crucial to maintaining a healthy smile. During the dental visit, the dentist examines the child s mouth for tooth decay and growth or development conditions that may pose a problem in the future. How often should a child see a dentist? Children s needs differ, and your dentist is best able to suggest a schedule of visits for your child. The frequency of dental visits will partly depend on your child s eating habits; how clean the teeth are kept; past treatment needs; whether your child drinks fluoridated water; and other factors that can affect your child s susceptibility to dental diseases. Professional dental services, such as regular cleanings, fluoride treatments and the application of sealants that prevent tooth decay, can save money and reduce the need for further dental treatment. Set a good example for your child by brushing your own teeth twice a day, flossing daily, and visiting the dentist regularly. Malocclusion Malocclusion, or bad bite, is a condition in which the teeth are crowded, crooked or out of alignment, or the jaws don t meet properly. This condition may become Tooth protected by shaded sealant.

9 particularly noticeable between the ages of six and 12, when the permanent teeth are erupting. This bad bite may be inherited or result from events in the child s development. Every child should receive an orthodontic evaluation by age seven. Early examination and treatment may help prevent or reduce the severity of malocclusions in the permanent teeth. An early evaluation allows the dentist/orthodontist to determine when any recommended treatment should begin. The developing occlusion should be monitored throughout eruption. Starting treatment or preventive care at the best time may reduce the overall treatment time and result in the best outcome. Dentists/orthodontists try to prevent the development of malocclusions, when possible. Some preventive orthodontic treatment may be started when the primary teeth are still in place. Often effective preventive treatment is done during a child s growth period. Different types of orthodontic appliances, including some that are removable, are used to prevent and treat malocclusions. Orthodontic treatment may be divided into distinct stages or it may be continuous over a period of many months or more. The starting age, the duration of treatment, the Here are some of the problems that can occur when there is a significant malocclusion: It s more difficult to keep teeth and gums clean where teeth are crooked or crowded. This increases the risk of tooth decay and gum disease. Malocclusion may interfere with the proper development of the jaws. Protruding teeth are more easily chipped or fractured. type of appliances used, the outcome of the treatment, and the cost of treatment depend upon the nature and the severity of the malocclusion being treated. In most cases, the cooperation of the patient practicing good oral hygiene and maintaining scheduled appointments with the dentist are major factors in the success of orthodontic treatment. Mouth Protectors Some malocclusions may interfere with eating and normal speech. Teeth that are out of position are more likely to wear abnormally or faster than those that are properly aligned. Dental Emergencies Knowing how to handle a dental emergency can mean the difference between saving and losing your child s tooth. Here are some helpful tips: Knocked-out tooth Keep tooth moist at all times. Hold the tooth by the crown, and if the tooth is dirty, rinse the root in water. Do not scrub the tooth or remove any attached tissue fragments. The tooth must not be left outside the mouth to dry. If possible, gently insert and hold the tooth in its socket. If it cannot be replaced in the socket, put it in one of the following: When a child participates in sporting Emergency tooth preservation kit and recreational activities, injuries can Milk occur. Mouth protectors, also called Mouth (next to cheek) mouthguards, are an important piece of If none of these is practical, use water protective face gear. You ve probably seen (with a pinch of salt, if possible). mouth protectors used in contact sports, such as hockey, football or boxing. Coaches Bring the patient (and don t forget the tooth!) to a dentist or endodontist and team members know that mouth as soon as possible ideally, within 15 minutes. However, it may be possible to save the tooth even if it has been outside the mouth for an hour protectors cushion blows that would or more. Baby teeth that have been knocked out typically are not replaced otherwise cause broken teeth, injuries because of the potential damage to developing permanent teeth. to the lips and face and sometimes even jaw fractures. Non-contact sports such Cracked or broken tooth Rinse the mouth with warm water to clean as soccer, volleyball, and gymnastics and the area. Put cold compresses on the face to keep any swelling down. leisure activities such as bicycling, roller Take your child to see a dentist right away. If possible, take the broken skating and skateboarding also place a tooth fragment with you. The dentist may be able to bond the fragment child at risk for dental injuries. If your child to the tooth. participates in such pastimes, ask your Jaw possibly broken Apply cold compresses to control swelling. dentist about custom-fitted and storepurchased mouth protectors. Take your child to your dentist or a hospital emergency department immediately. Objects caught between teeth Gently try to remove the object with dental floss. If you re not successful, visit your dentist. Do not try to remove the object with a sharp or pointed instrument. Toothache Rinse the mouth with warm water to clean it out. Gently use dental floss to remove any food caught between the teeth. Do not put aspirin on the aching tooth or gum tissues. Take your child to visit the dentist as soon as possible. Bitten tongue or lip Clean the area gently with a cloth, and put cold compresses on the area to keep the swelling down. If bleeding is excessive or does not stop in a short period of time, take your child to your dentist or a hospital emergency room.

10 Tobacco Social attitudes and acceptance of smoking have greatly changed in the past decade but in spite of all the negative publicity, some youth are still drawn to cigarettes and chewing tobacco. Tobacco in any form can jeopardize your child s health and cause incurable damage. Smokeless tobacco also called spit tobacco, chew or snuff often is used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception, as studies show that spit tobacco may be even more Periodontal diseases addictive than smoking cigarettes and may be more difficult to quit. One can of snuff Periodontal (gum) diseases are caused per day delivers as much nicotine as 60 by bacterial infections that attack the cigarettes. As little as three to four months gums, tissue and bone. When plaque is of smokeless tobacco use can cause gum not removed it can harden into a rough, disease and produce pre-cancerous lesions porous deposit called calculus, or tartar. called leukoplakias. Abrasive ingredients It can only be removed when teeth are and sugars in smokeless tobacco also lead cleaned in the dental office. Tartar that to greater tooth abrasion and decay. Users forms below (under) the gumline makes should watch for unusual lesions that might it more difficult to remove plaque film appear on the lip, inside cheek or on the and may interfere with the attachment gums. Better yet, don t let a dangerous of the teeth to the gums. This can dependency start. Work with your dentist create conditions that lead to chronic to educate your child on the dangers of inflammation and infection. tobacco use. An early sign of periodontal disease is gums that bleed easily, especially when teeth are brushed. If not treated at an early stage, serious problems can result. Eventually, bony support can be lost and teeth may become loose, fall out or require extraction. Periodontal diseases can occur at any age. Several forms of periodontal disease can affect even teenagers. Adolescents may need reminders about practicing good oral hygiene. It is important that both children and adults have regular dental checkups. Results of Smokeless Tobacco Use Forms of Periodontal Diseases Sores, receding gums and tobacco stains often result from using smokeless tobacco. Gums that have receded leave the roots of teeth exposed and more likely to become decayed or sensitive to extreme temperature changes. Healthy Gums Gingivitis Periodontitis