Infant Oral Care

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Importance of Primary Teeth (Baby Teeth)

Parents often ask: “Why should baby teeth be filled, since they will fall out in a short time anyway?”

Although primary teeth are called baby teeth, children typically don’t lose the first primary tooth until age 6. Some primary molars are not replaced until 12 or 13 years of age. Primary teeth play a crucial role in dental development. Without them, a child cannot chew food properly and has difficulty speaking clearly. Primary teeth are vital to the development of the jaws and for guiding the permanent teeth into place. Proper oral hygiene and regular dental checkups are necessary to prevent a number of dental problems.

  • Health: Neglecting to properly care for the primary teeth can cause severe pain and infection of the gums and jaws, which can affect a child’s overall health.
  • Permanent Teeth: Tooth decay (a cavity) is an infection. If primary tooth cavities are not treated, the infection can spread to the adjacent permanent teeth. The infection can also significantly damage the permanent teeth that are developing in the jaw.
  • Esthetics: Children need and want to appear normal, especially in the eyes of their peers. Children who appear abnormal due to missing teeth or an unattractive smile are often teased and ridiculed by their peers.
  • Tooth Alignment: Primary teeth guide the permanent teeth into place. Each primary tooth reserves a space for the permanent tooth to erupt. Children who lose their primary teeth early may need a space maintainer, a device used to hold the natural space open. Without a space maintainer, the teeth can tilt toward the empty space and cause permanent teeth to come in crooked.

Dental Development

Tooth Formation
The primary teeth typically begin to form during the fourth month of pregnancy. The teeth are not fully developed until age 1. The permanent teeth begin to develop at birth and will continue until a child is 12 or 13 years old. Beginning at birth through age 13, proper diet, nutrition and fluoride intake are essential.

Tooth Eruption
Normally tooth eruption begins at 6 months —the lower central incisors are first, then the upper central incisors. The remainder of the 20 primary teeth typically erupt by age 3, but the place and order varies.

As the first few teeth erupt, babies experience symptoms such as sore, tender gums, restlessness and irritability. Rubbing sore gums gently with a clean finger, the back of a cold spoon or a cold, wet cloth helps soothe the gums. Teething rings work well, but avoid teething biscuits—they contain sugar that is not good for baby teeth.

Teething does not cause diarrhea, ear infections or other serious illnesses. This is only a myth. Children experiencing symptoms associated with diarrhea, ear infections and other childhood illnesses should always be examined by a physician.

Permanent teeth begin to erupt around age 6, starting with the first molars and lower central incisors. This process continues until around age 21.

The Prevention of Tooth Decay

Tooth decay is a progressive disease resulting in the interaction of bacteria that naturally occur on the teeth and sugars in the everyday diet. Plaque is a sticky film that builds up on the teeth. It contains millions of bacteria. Sugar causes a reaction in the bacteria, causing it to produce acids that break down the mineral in teeth, forming a cavity.

Natural and added sugars can be equally harmful to teeth. Examples of harmful sugars include: honey, sucrose, molasses, and dextrose. An acid attack occurs for about 20 minutes each time sugar is in the mouth. The amount of sugar is not important; what matters is how often sugar is consumed and how long it remains in the mouth. An acid attack continues for nearly 20 minutes even after the sugary food or beverage is consumed.

Oral Hygiene
Parents are responsible for ensuring their children grow and develop properly and stay as healthy as possible. Proper oral care must be introduced early in a child's life – as early as infancy. We recommend children receive their first dental exam no later than age 1. Our dentists are experienced in treating infants and young children and can explain the best methods for preventing tooth decay.

Daily plaque removal is one way of preventing dental disease. An infant’s teeth should be thoroughly cleaned as soon as the first tooth erupts. This can be done with a clean wash cloth or a piece of gauze. A small soft-bristled, moistened toothbrush can also be used. Avoid using toothpaste. Clean the infant’s teeth at least one time every day, preferably after their last meal. After age 3, children can begin brushing with no more than a pea-sized amount of toothpaste. As more teeth erupt, flossing will become necessary. Dental floss is used to remove plaque between the teeth. We can recommend flossing aids as well as the proper technique.

Diet and Dental Health
The teeth, bones and soft tissues of the mouth require a healthy, well-balanced diet. Eating a well-balanced diet and following the guidelines below can help prevent tooth decay.

  1. Between meals, select nutritious snacks that contain little to no sugar.
  2. To reduce sugar consumption, children should avoid eating sticky foods, lifesavers, etc. These foods remain in the mouth for long periods of time.
  3. Desserts and other snacks that contain sugar should be eaten at mealtimes.
  4. Be conscious of “hidden sugars” and some healthy foods. Some healthy foods are high in natural sugar such as honey.
  5. Read all food labels.

Nursing Caries

Nursing caries or baby bottle tooth decay affects infants and young children. It develops due to improper feeding habits during infancy and childhood. Giving a child a naptime or nighttime bottle or allowing the child to have a bottle as a pacifier can cause nursing caries.

Though sugary beverages such as soda or Kool-Aid can cause baby bottle tooth decay, milk and formula can be just as damaging since these beverages also contain sugar. Children who frequently eat snacks that contain sugar can experience tooth decay. Following teeth eruption, breast fed babies can develop nursing caries due to nighttime or prolonged feedings. Breast milk actually contains more sugar (lactose) than cow’s milk.

The following guidelines can prevent nursing caries:

  • Use bottles for feeding only. Never use a bottle as a pacifier.
  • Do not give bottles at naptime or bedtime. If the child is accustomed to receiving a bottle, fill it with water.
  • Wean the child from the bottle by 12 months of age.
  • Only use formula in the bottle. All other beverages should be given in a cup.
  • Babies should not be breastfed all night and for long periods of time throughout the day. Frequent feedings should be avoided following teeth eruption.

Oral Habits

Thumb Sucking

Sucking is a natural reflex that relaxes and comforts babies and toddlers, and shouldn’t be discouraged during the first year of life. If the child prefers to suck a pacifier instead of their thumb, please make sure the pacifier is a made from non-toxic material, has a large plastic shield with two ventilating holes to prevent aspiration and does not tie around the child’s neck.

Children usually cease thumb sucking when the permanent front teeth are ready to erupt. Here are some ways to help your child outgrow thumb sucking:

  • Don’t scold a child when they exhibit thumb sucking behavior; instead, praise them when they don’t thumb suck.
  • Focus on eliminating the cause of anxiety—thumb sucking is a comfort device that helps children cope with stress or discomfort.
  • Praise them when they refrain from the habit during difficult periods.
  • Place a bandage on the thumb or a sock on their hand at night.

Thumb sucking that persists beyond the eruption of primary teeth can cause improper growth of the mouth and misalignment of the teeth. If you notice prolonged and/or vigorous thumb sucking behavior in your child, talk to your dentist.

Dental Injuries

Falls, bruises and bumps are common as infants and young children grow. As young children learn to walk, their unsteadiness can lead to dental injuries, including minor lacerations or a fractured tooth. Severe injures such as tooth fractures require immediate care from a dentist. Please view the Emergencies page for more information.