Baby teeth (or primary teeth) usually start coming in at age six or seven months of age. Your baby will get 20 baby teeth in all.  By the age of three, they should have their first full set of baby teeth.

Then, around five or six years old, they will begin losing this primary set of teeth. These teeth will continue to come out until they are 12 or 13, by which time their secondary teeth will have all come in.  The last teeth, or wisdom teeth, may come in by the time a child is 18 to 20 years of age, or they may stay impacted in the jaw and may never fully come in.

Those are the basic facts. But in between, there is plenty to learn.

How do I know if my child is teething?

When children have teeth erupting, they may experience pain and become irritable. This happens between four to five months and three years of age. They may drool, exhibit a lack of appetite, become restless or stick their fingers in their mouths excessively. They may also cough a lot, have red cheeks, and their gums may become red and sore looking.

My infant is teething and in pain, what should I do?

A frozen washcloth may give your baby relief because they can suck on it for a different sensation. You can also freeze teething rings, which offer relief for sore gums. While some children will suck their thumbs, this should be discouraged after teeth have erupted because it may interfere with future skeletal growth and development and cause an anterior open bite – a condition where the front teeth don’t touch when a child bites. This condition may require orthodontics to correct at an early age.

My child has a loose tooth, should I pull it?

Since teeth are attached with gum tissue and bone, when a tooth becomes loose, the skin can adhere to the tooth. If you think the tooth can be safely removed and is only hanging by a string, then you may remove it and use gauze to stop any bleeding.  If you prefer to have a dentist place a topical anesthetic and remove the skin gently, it may provide a more painless experience for your child, which can decrease fear in the future.

My child’s tooth has a cavity; can’t we just pull it if he’s getting a second tooth eventually?

Primary teeth provide a pathway for the permanent teeth to erupt. The secondary or permanent teeth erupt and erode the root of the baby tooth. This is how they know where to go as they come into the mouth. Prematurely removing a baby tooth can lead to ectopic eruption (it comes in crooked), which means that orthodontic therapy may be needed.

If my child’s tooth is rotted and can’t be saved, what do I do?

If a baby tooth cannot be saved, then an orthodontic appliance called a “space maintainer” can prevent drifting of the teeth.  This device is usually a band on the tooth behind the space with a little metal fence that comes forward and touches the tooth in front of the space, allowing the space to be maintained for the next tooth to erupt into this space. After the secondary tooth comes in the mouth, the space maintainer can be gently removed.

I heard that dental sealants could prevent decay. Is this true?

Dental sealants have been used for many years with great success. Bonding a thin plastic coating over the grooves of teeth can prevent food and bacteria from lodging in the grooves and leading to enamel dissolving and decay. Sealants basically act as a shield to stop anaerobic bacteria from lodging deep in the crevices of the teeth. Once a cavity starts and hits the underlying dentine, it expands seven times faster! So sealants can “seal” the surface and make it easier for a toothbrush to clean the top surface of a tooth. While sealants can stop decay, they are terribly under-used because parents often aren’t educated about their benefits.

How can I make sure my child never gets a cavity?

There are several things you can do.

  • Good nutrition: avoid sugary foods, starches and soda, and select fruits and vegetables for snacks.
  • Great oral hygiene: brush and floss twice a day and get regular checkups from the dentist (twice per year.)
  • Fluoride: use home fluoride, which is a prescription medicine, together with professional fluoride treatments performed at the dentist office.
  • Sealants: these plastic coatings will protect the top of teeth.

A few more words about sealants: It is important that sealants be monitored to make sure they don’t debond or become loose. If they do, they can be replaced easily. Though sealants stop dental decay, they do not prevent cavities from forming between the teeth! Only dental flossing and fluoride can help prevent cavities between the teeth.  Gum disease can still occur if patients don’t properly brush and floss the sides of their teeth.

Sealants are a cost-effective insurance policy against decay and are a wise investment. They are a lot less expensive than a filling. Ask your dentist about placing sealants for your child and for yourself! Sealants are not just for kids – they can help prevent decay for adults as well.

My child is a mouth breather and seems to sleep poorly. What can I do?

Mouth breathing can cause increased decay because it dries up the saliva that protects against cavity-causing bacteria. Since dentists see kids twice a year, they may be able to help a parent recognize when seasonal allergies are contributing to this problem and they can make an appropriate referral to check and treat allergies.

Related to mouth breathing: if a child has snoring or sleep apnea issues, these can be dangerous and you should have them evaluated at a sleep center, particularly if your child is listless, tired during the day, appears to stop breathing for periods of time at night or you are concerned for any other reason. Sleep apnea is a potentially dangerous problem and, when recognized, can be treated through proper channels. A dentist can also recognize swollen tonsils and adenoids and can make a referral to an ear, nose, and throat specialist.

Always talk to your dentist about issues like mouth-breathing. When your child gets help through intervention or sleep study evaluation, it often makes them feel much better. They can have increased energy, improved academic performance, better energy and overall improvement in lifestyle.