Teeth and teeth care

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• Tooth development 
• Teething
• Teething blisters (eruption cysts) 
• Dental care for children
• Cleaning teeth
• Fluoride toothpaste
• Visit your dentist
• Toothbrushes
• Tooth decay 
• Tooth erosion
• Asthma inhalers and teeth
• Fluoride
• Fluoride and formulas
• Swallowing toothpaste or fluoride tablets
• Dental fluorosis 

Teeth are some of your children's most important possessions. How you look after their teeth from the time they are babies will make a difference to how they grow and how healthy they are. This means not only how you clean them but also thinking about the things that can harm teeth. Tooth decay is preventable.

Tooth development

• Baby teeth begin to form about six weeks after the baby is conceived.
• By the time your baby is born all 20 baby (deciduous) teeth are present in the jawbones.
• The permanent teeth also begin to develop before birth.

When teeth come through

• The time when teeth appear varies from child to child.
• Occasionally babies are born with a tooth but these early teeth are usually lost soon after birth.
• Usually the first tooth appears between 6-10 months, but a few babies have no teeth until 12 months or later.
• The lower two front teeth usually come through before the upper ones.
• The teeth usually come through in pairs - one on the right, one on the left side.
• By about 2½-3 years all 20 baby teeth have come through.
• The first permanent teeth (molars in both jaws and the central (incisor) teeth in the lower jaw) begin to come through when a child is about six.
• By 12-13 years, most children have 28 permanent teeth. The last four molars (‘wisdom teeth’) usually come through between 17 and 21 years.
• View a chart showing when teeth come through.

Teeth grinding

• Babies can sometimes rub their gums together or ‘grind their teeth’ when new teeth are growing and starting to come through. 
• The baby teeth at the back (molars) usually begin to grow around 12 months of age. 
• When these new teeth appear it seems that this can be uncomfortable for the baby. It can also make the baby feel unbalanced if the molars do not come in on each side at the same time. 
• As babies like to explore new things, the grinding action can be the child’s way of feeling the new changes happening inside the mouth. 
• Rubbing the gums together seems as if it relieves some of the discomfort caused by the new teeth coming through the gums. 
• This is normal in babies and will probably subside by two years of age when all the teeth have come through.
• It is best to monitor your baby and watch for any other signs of discomfort. If you are worried, please contact your local dentist.

Teething

Teething is natural. A lot of research has been done which shows that babies are not more irritable or unwell when teeth come through.

Despite this many people, including parents and doctors, believe babies are in pain, irritable, have sleep problems, and get snuffly around the time they get new teeth.

If your baby seems to have the problems that are often called ‘teething problems’, the problems are real, but may not be caused by teething.

When a new tooth is moving up through the jaw into the mouth, the gums might look red and swollen. We might think this causes pain, but it might not cause pain.

Teething gels, biting on something hard (such as a teething ring), or paracetamol seem to help some babies.  If your baby seems distressed you could try them. They do not cause harm. Work out the correct dose of paracetamol for your baby, using information on the packet.

Other health problems when babies are at the age that teeth come through include:

• waking a lot at night 
• being restless and irritable in the daytime 
• colds or other infections can occur 
• they may have a temperature 
• they may have a rash, especially a nappy rash 
• they may get diarrhoea.

If your baby seems unwell, see your doctor as these are not likely to be caused by teething.

What parents can try (if their baby seems to be in pain)

• Some babies prefer mushy food for a while because it needs less chewing, others like something firm to chew on. Rusks can be good.
• If there is a lot of pain, some dentists or doctors may suggest using paracetamol or teething gels.

Teething blisters (eruption cysts)

• Sometimes when teeth start to come through a little bleeding happens under the skin, which causes a small blood blister (cyst) or bruise on the gum.
• This is a bluish colour and is likely to come where a tooth is about to come through.
• It goes away when the tooth comes through.
• The tooth will still come through in the usual way.
• Usually no treatment is necessary.
• The blister should not be pricked or cut as this may cause an infection.
• See your dentist if your baby has had one of these blisters for a month or so and the tooth has still not come through.

Dental care for children

• Do not give your baby or young child a bottle of milk, formula or fruit juice to suck on after a feed, or to go to sleep with. The sugar in milk and fruit juice can lead to decay if it is in the baby's mouth for a lot of time.
• Don't leave the bottle in your baby's mouth while baby is asleep.
• Healthy snacks and drinks are important for children. Try to keep away from too much sugar, especially between meals.
• Babies get the germs that cause tooth decay from other people, especially those who kiss them a lot.  If the adults have clean and healthy teeth, a baby is more likely to have healthy teeth. (Kissing and touching babies is important and should not be stopped.)
• It has been shown that young children exposed to passive smoking have more dental decay than other children.

Cleaning teeth

• Start cleaning the baby's teeth as soon as they appear in the mouth.
• Clean baby's teeth with a clean cloth and children's teeth with a small, soft toothbrush each morning after breakfast, and before bed at night.
• Do not use toothpaste before two years of age.
• Parents need to supervise the use of toothpaste and brushing of teeth by their children until the children are about six years of age.
• When children start using toothpaste, use a low-fluoride toothpaste made for children.
• Only a smear of toothpaste (as big as a pea or less) should be put onto the toothbrush. You need to put the toothpaste on yourself until the child can do it properly.
• Try not to let your children eat or swallow toothpaste after brushing.
• Teach them how to spit toothpaste out. It is better to spit rather than rinse the mouth.
• Keep toothpaste tubes out of reach of children.

Fluoride toothpaste

• Fluoride is found naturally in food and water and is added to most water supplies and many oral care products such as mouth rinse and toothpastes.
• Using fluoride toothpaste twice a day is a very effective way of reducing tooth decay.
• Teach children to spit out the toothpaste after using fluoride toothpaste.
• Don't swallow. Swallowing the toothpaste may cause them to get too much fluoride.
• Don't rinse. Fluoride can go on protecting the teeth for some time after cleaning the teeth if the toothpaste is not rinsed out of the mouth.

Children under two years of age

• Fluoride toothpaste is not recommended for children under two years of age.
• Generally young children receive enough fluoride to benefit their teeth through food and water.
• From birth to two years of age the permanent front teeth are developing and if children swallow fluoride toothpaste they may get white flecks on their permanent adult teeth.
• To avoid this, fluoride toothpaste should not be used when brushing teeth and should be kept out of children's reach.
• However, if you live in an area which does not have fluoridated water, you could start using a low fluoride toothpaste when your child is about 18 months old, if your dental professional advises you to do this.

Children 2-6 years of age

• Low fluoride toothpaste is recommended for children 2-6 years to prevent dental disease.
• Research shows that children 2-6 years swallow a lot of toothpaste when brushing their teeth.  Therefore, it is recommended that they use a low-fluoride toothpaste such as Colegate my first toothpaste**, Macleans milkteeth** or Oral B children's toothpaste**.
• Use a smear of low-fluoride toothpaste twice a day, in the morning and last thing before bed at night.
• Toothpaste tubes should be kept out of children's reach and toothpaste put on the brush by an adult to avoid accidental swallowing of large amounts.

Children 7-18 years and adults

Fluoride toothpaste is recommended for children 7-18 years and adults to prevent dental disease. Choose a fluoride toothpaste that suits your taste and budget. General guidelines for using fluoride toothpaste are: 

• use twice a day, in the morning and before bed at night 
• spit the toothpaste out but do not rinse your mouth 
• don't eat or swallow toothpaste 
• follow advice given by your dental professional
• ask your dental professional about your child's fluoride toothpaste needs.

Visit your dentist

Dentists who specialise in children's dentistry recommend children are first checked by a dentist about six months after the first tooth appears. 

This means for many children that they should be seen when they turn one.

Toothbrushes

• Use a toothbrush with a small head and soft bristles.
• Clean the teeth, gums and tongue every morning and night.
• Every person should have their own toothbrush and should not use anybody else's toothbrush.
• Children do not have the skills needed to fully clean their own teeth until they are 8-9 years old.
• Store toothbrushes in a clean, dry, airy place so that they can dry out between uses. (You may need two brushes per person used turn and turn about.) Store toothbrushes separately so they do not touch other toothbrushes.
• After brushing the teeth, the toothbrush should be rinsed thoroughly under fast running water to remove toothpaste, bits of food and plaque. Then shake off the water from the toothbrush to help with drying.
• Replace toothbrushes regularly and when they become ‘shaggy’ or clogged with toothpaste.
• Also replace toothbrushes after illness such as colds and flu or after mouth infections.
• Follow personal hygiene practices such as washing hands after going to the toilet and washing the toothbrush if it falls on the floor or in the hand basin.

Tooth decay

• Tooth decay can start as a small white spot on the tooth, which is hard to see.
• It causes serious damage to teeth and is important even in baby teeth, because baby teeth prepare the way for healthy development of permanent teeth.
• Decay also causes pain and sleep problems.
• It can affect the way the child looks and what she is able to eat.
• If the decayed tooth has to be taken out it can mean that the remaining teeth move across and there could be less room for the permanent teeth when they come.
• Many children who have serious decay need to have a general anaesthetic to treat the damaged teeth.
• Dental treatment can be expensive.
• If your child has any sign of decay, see a dentist as soon as possible.
• Good tooth care in the early years prevents decay.
• Recent evidence suggests that there is more tooth decay in children who are around people who smoke. The more exposure to smoke, the more tooth decay children have.

Tooth erosion

Tooth erosion happens when acids damage and dissolve the layers of enamel that cover the tooth. This can cause permanent damage to the tooth. Acids can come from what the child eats, from medicines (such as Vitamin C tablets that are chewed in the mouth) and stomach acids from persistent reflux.

Fruit juices are a good source of vitamins such as vitamin C and carbohydrates including sugars, however they are much lower in fibre than fresh fruit. The Australian Guide to Healthy Eating recommends children from ages 4-11 years have at least one serve of fruit each day and for young people and adults 2-3 serves of fruit each day. Fruit juice is concentrated so half a cup is equivalent to one serve. 

Research has suggested that acidic soft drinks, cordials, or fruit juices such as orange juice may partially dissolve the surface of tooth enamel. Then the tooth surface can be damaged by hard brushing and this can cause loss of some of the enamel (erosion). Recent research shows that there is more erosion of the enamel when an acidic drink is drunk more than 3 times a day. Solid fruit is also acidic, but chewing causes an increase in the amount of saliva in the mouth. Saliva "neutralises" the acid. Neutral food or drinks do not damage the enamel.

In the hour or so following drinking acidic drinks, the tooth surface hardens again. Some people have recommended that teeth not be brushed immediately after drinking orange juice or other acidic drinks. In general this advice is sound. However, if children go to school without brushing their teeth, the dangers of damage to the teeth are likely to be much greater than if the teeth are brushed soon after having juice.

On balance, it is advised that parents can minimise the potential of acidic drinks, such as orange juice, that lead to erosion by: 

• limiting the number of times juice is consumed each day - solid fruit is better 
• drinking the juice with meals  
• using a fluoride toothpaste.

Remember, water is the best drink. Encourage your child to drink from a cup, so that a bottle is not used after about 12 months. Encourage children to drink their drinks all at once, not in little sips.

If you use a ‘feeding cup’, children are likely to drink more slowly from it so it is best to put plain water in it.

Give children fruit and fruit juice at meal times. Especially don't give them at bedtime after teeth cleaning.

Drinking juice through a straw can protect teeth.  The juice is swallowed from the back of the mouth and does not stay near teeth.

A drink of water after eating or taking medicines will help to clean the mouth.

Asthma inhalers and teeth

Asthma management plans which use puffers to prevent and treat asthma symptoms have led to a dramatic fall in asthma deaths, even though more and more people have been diagnosed with asthma. The benefits for breathing of using puffers are clear, but the powder in the puffers can cause problems with teeth. Many of the powders are acidic, and can erode the tooth enamel when used regularly. This can cause teeth to be sensitive and can cause holes in the teeth. The tooth problems can be reduced if children rinse their mouths with water after using a puffer and if they clean their teeth at least twice a day with a fluoride toothpaste. Fluoride protects the surface of the teeth.

Fluoride

Fluoride is found naturally in the earth and in water in most parts of the world (but in many places in Australia there is very little fluoride in the water).

It is also in the bones and teeth of humans and animals, and in plants.

There are small amounts in many of the foods we eat.

It is a normal and important part of human tooth enamel.

Too much fluoride during the time teeth are developing can cause permanent marks on teeth. There are no other health problems caused by having fluoride levels a little higher than the recommended levels.

What fluoride does
Fluoride acts both before and after teeth come through to prevent tooth decay.

Its main action is on the surface of the teeth after teeth come through. It makes them more able to resist decay.

Fluoride and formulas

Some time ago there was some concern that a baby's teeth could have marks on them caused by fluoride (fluorosis) because there was fluoride in baby formula powder as well as in the water added to make up the formula. There is no fluoride in infant formula made in Australia or New Zealand.

Swallowing toothpaste

Swallowing toothpaste is not likely to be a medical emergency unless a whole tube is swallowed. If you are worried about this, see your doctor or ring the Poisons Information Centre. In Australia the number is 13 11 26.

Dental fluorosis

Dental fluorosis is a problem with tooth enamel that happens when too much fluoride is taken in when the enamel is forming (birth to six years of age).

Mild dental fluorosis can look like very pale little white flecks on the tooth. If it is worse there will be pitting and grooves on the surface of the teeth.

While mild forms of fluorosis do not harm dental health or teeth, it can make a difference to the look of the teeth.

Causes of dental fluorosis
The most common cause is swallowing too much fluoride from toothpaste (too much on the toothbrush and not being able to spit it out after cleaning).

Fluoride tablets
The use of fluoride tablets is not recommended for children even where the water supply is not fluoridated. Using fluoride toothpaste twice a day should provide enough fluoride. If you have concerns about how much fluoride your child is getting, see your dentist.

Steps to prevent dental fluorosis:

• After the baby is one year of age it is advisable to switch to cow's milk or make up the formula with boiled rain water, boiled filtered water or boiled spring water.
• Use a small amount of low fluoride toothpaste specially made for children, and teach them to spit the toothpaste out.
• Some parents may want to use boiled rainwater, boiled filtered water or boiled spring water to make up the formula for babies under one year.
• Breastfeeding (there is very little fluoride in breastmilk).
• Give the baby something firm to bite on such as a cold teething ring, a toothbrush or a dummy.

** Any products referred to in CYH health topics are usually well-known brands readily available in Australia. The brand names are given as examples only, and do not necessarily represent the best products, nor the full range of effective products on the market.

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