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The teething years
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Children can sometimes make their parents feel like they’re sitting next to Mt. Vesuvius, waiting for the next eruption
By Dr. Peter Hong
I remember when life was simpler, when my children were toddlers and their cries in the night meant only that another tooth was coming in. Back then their tears could be soothed away by a cold teether or a child’s dose of Tylenol. Now that they’re older I get to sleep through most nights uninterrupted, but they’ve grown into complex individuals, with more complicated dental needs. Prepare for what’s ahead, understand how a child’s teeth should develop and help make it so.
When your child reaches six to nine months, prepare to be initiated into teething angst — the next two years are going to be a lot of fun. The signs and symptoms of teething are as individual as kids themselves. Some babies teethe without any problems at all, while others face drooling, the need to bite or chew, and irritability. Fever is not a symptom; consult your doctor if it persists. If your child is a cranky teether, take heart: all 20 baby teeth are usually in by age three.
If a child’s baby teeth are just going to fall out, what’s so important about caring for them, right? Wrong. Baby teeth are vital to the health and development of a growing child. The teeth are essential in the proper chewing and digestion of food, the formation of sounds and words during speech — plus, a nice smile raises a child’s self esteem. Even though they’ll eventually fall out, baby teeth must be cared for and maintained, as they also guide the development of permanent teeth by reserving space for adult teeth and keeping the integrity of the arch.
Brushing and cleaning should begin as soon as the first baby teeth show at around that six-month mark. They usually erupt first in the lower front. Use a baby toothbrush or damp cloth to brush or wipe gums and teeth. New teeth can take a fluoride toothpaste, but only use the smallest dab, since young children tend to swallow it. In fact, the fluoride level is the same in fun-flavoured children’s toothpaste as it is in mintier adult flavours. Most municipalities now add fluoride supplements to their communal water supply, which is good news for kids, since fluoride greatly reduces cavities.
I encourage parents to brush their children’s teeth until they’re seven or eight years old, and to continue to inspect and reinforce cleaning to make sure the back teeth and along the gum line are brushed, even when kids brush independently. Bedtime brushing is a must so that food particles don’t sit in the mouth all night. Salivary flow decreases during sleep, and because the tongue and cheek don’t move, debris rests undisturbed. Children can begin flossing once their baby molars are fully erupted, usually by age three. Be warned, flossing can be a squirmy challenge, but it’s the only way to remove food from between teeth. And habits learned in childhood, whether good or bad, usually stick with us for life.
Prevent problems before they begin: both child and dentist will be grateful. It’s easier to treat a small problem than wait until it becomes major. Talk to your dentist about caring for your infant’s or toddler’s teeth long before that first visit, which is often made by the time children reach age three, when most of the baby teeth are in. The first visit is usually an inspection and a chat about properly caring for teeth. Try to coordinate it with an appointment for mom or dad or an older sibling, so neophytes have a chance to see what’s going to happen and familiarize themselves with their new surroundings.
Okay, so your child now has a mouthful of teeth. You’ve set up a thorough maintenance regimen and pulled the dentist into the picture. What’s next? Kids — and parents — catch a teething break until around age six, when the first permanent molars erupt behind the baby, or primary, teeth. Permanent teeth continue to erupt in fits and starts until age 11 or 12 after the baby teeth have all exfoliated, or fallen out.
Note the term, “fallen out.” Baby teeth should never be “forced out.” When children get their first loose tooth — usually at age five or six and usually one of their lower front teeth — you can encourage them to wiggle it, but forget about the old string-and-doorknob trick. Baby teeth have full roots until they’re ready to fall out, and yanking them can injure the gums and bone, as well as traumatize the child. The roots of baby teeth are resorbed or dissolved by the body, and when the tooth is ready it will fall out quite easily with little bleeding. A baby tooth can be loose for weeks before the Tooth Fairy’s called in.
The second wave of permanent molars usually comes in at around age 13, and the third molars, otherwise known as wisdom teeth, around ages 18 to 21.
Growing children need a nutritious diet to keep teeth healthy and prevent cavities. Canada’s Food Guide recommends two to three servings of milk or milk products daily for children, since strong bones and teeth need calcium. Common milk substitutes high in calcium are cheese, yogurt, beans and tofu.
Eating sugar increases the risk of tooth decay. The form or consistency of the sugar plays a role. Sticky candies like toffee, gummy bears or lollipops are hard to clear from the mouth and are more cariogenic, or likely to cause cavities, than sweet puddings and milkshakes. If children must eat sugary foods, serve them with meals. That way you can control the amount eaten, plus the increased saliva will help lower the risk of decay. Constant snacking on sugary foods or drinks throughout the day or at bedtime is especially harmful. Satisfy the junk-food craving with dentally acceptable (but nutritionally poor!) snacks like potato chips, pretzels, sugarless gum or popcorn.
Having strong teeth is a vital part of growing up healthy. Help children learn how to take care of them.
Teething tips
Cold teethers, and popsicles for older children, are useful to soothe sore gums, while the acetaminophen in Tylenol or Tempra eases teething ache.
Commonly asked questions
Q. What should I do when a permanent tooth appears behind or in front of a baby tooth that isn’t loose?
A. Call your dentist: it’s sometimes necessary to remove the baby tooth to make room for proper eruption. But don’t try to remove a firm baby tooth with force.
Q. Why fill a cavity in a baby tooth, when it will eventually fall out anyway?
A. If the baby tooth will fall out soon, the cavity doesn’t need to be filled. But some baby teeth have to function until age 11 to 12. A cavity can grow, and once it reaches the pulp or nerve, it can cause infection and discomfort.
Q. My child sucks his thumb. Can that hurt his teeth?
A. Sucking is a normal reflex in young children. However, after age four, thumb-sucking or using a pacifier can alter the shape of your child’s growing jaw bones and misalign his erupting permanent teeth.
Dr. Peter Hong, on staff in the department of dentistry, Sunnybrook Health Science Centre, is an instructor at the University of Toronto’s Faculty of Dentistry. He maintains a practice in Toronto.
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