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Dental Milestones for Children

By HERWriter
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When will my baby get his first tooth? When should I start brushing my baby’s teeth? When should my child have his/her first dental appointment? When will my child start losing teeth? My son’s/daughter’s friends have all lost teeth, but my child hasn’t; is this okay?

These are just some of the many questions that mothers (and fathers) ask about their child’s dental health. This article has compiled the answers to those questions from a variety of sources. As always, this information should not be seen as a diagnosis of anything or ultimate recommendation of treatment. You should always consult your family dentist if you have any questions or concerns.

More than 1 in 4 children in the United States have cavities by the age of 4. Some have cavities by the age of 2. In some cases, poor oral hygiene has combined with genetics in these situations. But it is important for parents to realize their role in looking after their children’s teeth from the moment they are born for their children to have a healthy mouth.

Good Brushing Habits

Good brushing habits start from the very beginning, from the very first feeding. Just a simple swipe of the tongue, gums and cheeks with a soft facecloth can clear away bacteria that might settle on the gums and cause infections.

Doing this right from the beginning gets the baby used to something being in their mouth and touching their tongue, lips, and gums.

As teeth start to come in, transition to a soft toothbrush and water (more details later).

If you bottle feed, do not let your baby go to bed with a bottle with milk, formula, juice or anything other than, perhaps, water. These drinks will leave bacteria and sugar on your baby’s gums and teeth and without proper rinsing overnight by saliva, cavities and gum disease can develop.

Many pediatric, general and family dentists can attest to the serious harm done to babies’ teeth because of these practices including the need for crown placement or other restorative techniques to keep the baby teeth in place until the permanent teeth are ready to take their place.

First Teeth

Your baby should start teething around 4-5 months with the first tooth usually appearing at 6 months. Some babies will not have any teeth until 10 months. There are also stories of babies not having teeth until well into the first year. Some babies have been born with two teeth already in place. Each child is different. If you have any concerns about this consult your family dentist.

Usually the first two teeth to come in are the lower central incisors (front teeth), then the upper central incisors.

First Dental Visit

Your child’s first dental visit should be before the age of 1. For many babies, this will be an introductory visit, to introduce them to the environment. If you have already started using a toothbrush by this time, there should be any fear with the dentist using their instruments. You will also be able to discuss brushing habits, finger/thumb/pacifier sucking, and teething and developmental milestones.

If looking for a dentist for your toddler, ask your dentist at what age they start seeing children. With the increase of family dentistry, many dentists are taking very young patients. If your dentist does not, he/she may be able to refer you to a pediatric dentist – one that specializes in treating infants, toddlers and young children.

First Toothbrush/Toothpaste

Start with a very soft toothbrush. The major toothbrush manufacturers do produce a toothbrush especially for baby mouths with soft bristles. Many dentists recommend that you brush with just water before the age of 1, add half-a-pea-size drop of a fluoride toothpaste up to the age of 3, and then a full pea-size drop up to the age of 6. It is important that the child doesn’t swallow the toothpaste. Ingestion of too much fluoride can cause discoloration of the permanent teeth.

There are fluoride-free toothpastes available (ex. Orajel), which allow you to brush with a toothpaste without the worry of your child swallowing the toothpaste. This is a great alternative to get the cavity fighting protection of a toothpaste at an age where your child is not able to spit yet. This lesson can come later.

Start brushing as soon as the first teeth come through if not as they’re erupting. Brushing the gums gently actually helps stimulate the gums and prepare them for the eruption of the tooth, as well as keeping the area clear of bacteria and food particles.

Parents should brush for their children up until the age of 8, when a child’s understanding and dexterity is such that they can adequately care for their own teeth.

Other Firsts

Primary teeth – By the age of 3 your child should have a full set of primary teeth (10 upper/10 lower)

First permanent tooth – These are called the 6-year molars (first molars). These will come in in both the upper and lower jaws.

First loose tooth – Children can expect to loose their first tooth by the age of 6, generally in the order in which they erupted – lower central incisors first. The final baby tooth should fall out around age 12.

Some children start losing teeth as early as age 4, while others won’t lose their first tooth until age 8. It also depends on when their baby teeth first started coming in. If the baby teeth were late coming in, they will be late in falling out. If your child has not lost any teeth by the time they’re 7, your dentist may take an X-ray to determine the presence and development level of the permanent teeth. The advantage to later erupting teeth is that they will be harder and stronger than teeth that normally erupt earlier.

First orthodontic exam – Most children will be referred to an orthodontist by the age of 7; sometimes earlier if there are problems, sometimes later if there aren’t any.

Full set of permanent teeth – By the time the second molars erupt around the age of 13, your child should have all their permanent teeth in place.

Wisdom teeth (third molars or 8’s) – Wisdom teeth are usually visible on an X-ray in their earliest developmental stage as early as age 10, but usually by age 12. Between ages 17-21, they will be fully developed and will try to push through. In very few cases the wisdom teeth will erupt and be functional without any issues. Of those that do erupt, however, many develop infections and cavities because they are so far back in the mouth that they are hard to keep clean.

The vast majority of wisdom teeth will be impacted and will be recommended for extraction to alleviate associated TMJ discomfort and dysfunction, potential threats to orthodontic alignment, and headaches. Most will be impacted right side up, although there have been cases of teeth being impacted upside down or sideways. Depending on the position of the wisdom teeth and their proximity to the inferior alveolar nerve, which provides feeling to the lower lip, tongue and chin, some dentists may elect to leave them so as to not risk damaging the nerve. This situation will be monitored carefully over time to ensure that the tooth doesn’t become infected and cause other problems to the underlying bone and other tooth structures.

As always, if you have any questions or concerns, talk to your family dentist. Be an informed patient.

Sources: www.parents.com, www.professorshouse.com, www.seymourdental.com, www.colgate.com, www.drstevenfremeth.com

Add a Comment7 Comments

Hmm. That's interesting Susan. I have always read that as soon as your child sprouts his first tooth, he should pay a visit to the dentist (I secretly thought this was way too early. What if my child is born with a tooth?) But I agree with Darlene, there is probably no one age set in stone to take your child to the Dentist as long as you do :-)

September 13, 2009 - 6:57am

If that's what they're recommending and you have had no prior issues or concerns then go with that. Our dentist has suggested we bring our one-year-old in, so it's really a matter of practice and opinion.

September 11, 2009 - 11:54am

As with everything, the more you do it the more comfortable they get with it. I have been brushing my baby's teeth from the moment they arrived and he actually looks forward to it. I found Orajel has a fluoride-free toothpaste (with Thomas the Tank Engine on it), which is what I have been using.

Mine had six teeth by his first birthday, two below, 4 uppers and is now breaking through four molars (2 upper, 2 lower) - which is interesting because there are still teeth in between that haven't come in, yet.

Just like me. Doin' his own thing!

September 11, 2009 - 9:39am

Good Article. The Fluoride comment by Anon is also important considering Flouride should not be given to babies yet Nursery water for infants contains it :-/ I also agree that it's appropriate just to add since the article was about our children's teeth (even though it was about milestones, a little bit of extra information never hurts).

Sticking to the topic at hand, my 7 month old has already sprouted 4 (going on 5) teeth in a matter of 3 weeks. I purchased the little soft bristle brush that fits into your finger and brush his teeth with that. I am not sure how he will react to his first doctor's visit coming soon, he doesn't like to be assessed by his pediatrician so I can't even imagine what someone going into his mouth will do to him.

September 11, 2009 - 9:26am
EmpowHER Guest

This is a very helpful article. It should have included one other fact. The ADA and the CDC have warned not to use fluoridated water to mix infant formulas for infants or young children. The CDC also admits that swallowing fluoride has no value. It is known that over 50% of childen in fluoridated communities have damaged enamel (fluorosis). Even worse, reaearch shows an increase of lowered IQ, mental retardation and a dramatic increase in bone cancer. Adults suffer an increase in oral and other cancers, destruction of thyroid glands and brittle bones (broken hips).
Do your own research by reading the scientific facts at www.fluoridealert.org.

September 8, 2009 - 4:46pm
HERWriter (reply to Anonymous)

This is a completely different topic than what my article was about. I plan to tackle the debate over fluoride in a future article. Let's stay on the topic of children's dental milestones and the information provided.

September 8, 2009 - 4:59pm
EmpowHER Guest
Anonymous (reply to Darlene Oakley)

Ms. Oakley: I meant to stop with the statement about ADA and CDC recommending against giving fluoride to infants and young children because of the extensive resulting fluorosis. I think that is appropriate for your topic. Then I got carried away with the other fluoride facts. Sorry.

September 8, 2009 - 10:33pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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