Dental Terms

Tooth Eruption

The Primary Teeth
The following chart shows when primary teeth (also called baby teeth or deciduous teeth) erupt and shed. It's important to note that eruption times can vary from child to child. As seen from the chart, the first teeth begin to break through the gums at about 6 months of age. Usually, the first two teeth to erupt are the two bottom central incisors (the two bottom front teeth). Next, the top four front teeth emerge. After that, other teeth slowly begin to fill in, usually in pairs - one each side of the upper or lower jaw - until all 20 teeth (10 in the upper jaw and 10 in the lower jaw) have come in by the time the child is 2½ to 3 years old. The complete set of primary teeth is in the mouth from the age of 2½ to 3 years of age to 6 to 7 years of age.

Primary Teeth Development Chart
Upper Teeth	When tooth emerges	When tooth falls out
Central incisor	8 to 12 months	6 to 7 years
Lateral incisor	9 to 13 months	7 to 8 years
Canine (cuspid)	16 to 22 months	10 to 12 years
First molar	13 to 19 months	9 to 11 years
Second molar	25 to 33 months	10 to 12 years
1
Lower Teeth	When tooth emerges	When tooth falls out
Second molar	23 to 31 months	10 to 12 years
First molar	14 to 18 months	9 to 11 years
Canine (cuspid)	17 to 23 months	9 to 12 years
Lateral incisor	10 to 16 months	7 to 8 years
Central incisor	6 to 10 months	6 to 7 years

Other primary tooth eruption facts:

• A general rule of thumb is that for every 6 months of life, approximately 4 teeth will erupt
• Girls generally precede boys in tooth eruption
• Lower teeth usually erupt before upper teeth
• Teeth in both jaws usually erupt in pairs - one on the right and one on the left
• Primary teeth are smaller in size and whiter in color than the permanent teeth that will follow
• By the time a child is 2 to 3 years of age, all primary teeth should have erupted

Shortly after age 4, the jaw and facial bones of the child begin to grow, creating spaces between the primary teeth. This is a perfectly natural growth process that provides the necessary space for the larger permanent teeth to emerge. Between the ages of 6 and 12, a mixture of both primary teeth and permanent teeth reside in the mouth.

The Permanent Teeth

The following chart shows when permanent teeth emerge. As seen in this chart, permanent teeth begin to come in around the age of 6. In some children, the first permanent molars are the first to emerge; in others, the incisors are the first to emerge. By the age of 13, most of the 28 permanent teeth will be in place. One to four wisdom teeth, or third molars, emerge between the ages of 17 and 21, bringing the total number of permanent teeth up to 32.

Permanent Teeth Development Chart
Upper Teeth	When tooth emerges
Central incisor	7 to 8 years
Lateral incisor	8 to 9 years
Canine (cuspid)	11 to 12 years
First premolar (first bicuspid)	10 to 11 years
Second premolar (second bicuspid)	10 to 12 years
First molar	6 to 7 years
Second molar	12 to 13 years
Third molar (wisdom tooth)	17 to 21 years
1
Lower Teeth	When tooth emerges
Third molar (wisdom tooth)	17 to 21 years
Second molar	11 to 13 years
First molar	6 to 7 years
Second premolar (second bicuspid)	11 to 12 years
First premolar (first bicuspid)	10 to 12 years
Canine (cuspid)	9 to 10 years
Lateral incisor	7 to 8 years
Central incisor	6 to 7 years

Brushing & Flossing

Teeth should be cleaned as soon as they emerge. By starting early, your baby gets used to the daily routine. A soft washcloth wrapped around your finger can substitute for a brush at this time. Ask your dentist when you should switch to a toothbrush. Some dentists suggest waiting until four teeth in a row have emerged, others recommend waiting until the child is 2 or 3 years old.

Technique and Timing
To clean the front and back of the teeth, hold the bristles of the toothbrush at a 45 degree angle to the teeth and use circular strokes. To clean the chewing surface, use short back and forth strokes. Brush your child's teeth twice a day - in the morning and just before bed. Spend 2 minutes brushing, concentrating a good portion of this time on the back molars. This is an area where cavities often first develop.

When Children are Ready to Brush and Floss Their Teeth on Their Own
Most children lack the coordination to brush or floss their teeth on their own until about the age of 6 or 7. Up until this time, remember that the best way to teach a child how to brush their teeth is to lead by example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene. Not only does this set a good example, it's also a good oral hygiene practice. By reducing your own oral bacterial count, parents reduce the risk of passing cavity-causing bacteria to the child.

Toothbrush & Toothpaste

General Tips:

• Choose a small, child-sized, soft-bristled toothbrush. Soaking the brush in warm water for a few minutes before brushing can soften the bristles even more.
• Many dentists recommend using only plain water for brushing up to the age of 2. This is because young children swallow toothpaste and swallowing too much fluoride can lead to tooth discoloration in permanent teeth. Ask your dentist if toothpaste should be used. Also, check the manufacturer's label; some toothpastes are not recommended in children under age 6. If a toothpaste is to be used, squeeze out about a green pea-size amount of fluoride toothpaste onto the toothbrush.
• Replace the toothbrush every 3 or 4 months, or even sooner if it shows signs of wear. Never share toothbrushes between children.
• Start flossing your child's teeth once a day as soon as two teeth emerge that touch.

Type of Toothpaste
Many children's toothpastes are flavored with child-pleasing tastes to further encourage brushing. Select your child's favorite. Also, look for toothpastes that carry the American Dental Association's Seal of Acceptance. This indicates that the toothpaste has met ADA criteria for safety and effectiveness. Finally, read the manufacturer's label. Some toothpastes are not recommended for children under a certain age.

Mouthwash?
Generally, mouthwashes are not recommended in children who are incapable of spitting and rinsing - skills that occur around the age of 6. It's important to note that mouthwashes are not a substitute for brushing. Mouthwashes do not help clean the teeth.

Fluoride

Fluoride is a natural compound that protects teeth from cavities. Many communities add fluoride to the local water supply. It's also in toothpastes and mouthwashes. Children who start using products with fluoride from an early age have fewer cavities than those who don't.

How Fluoride Works
Fluoride helps prevent cavities and decay by coming in direct contact with the tooth enamel (the outside of the tooth). But, if you consume fluoride from sources such as drinking water, it gets absorbed in your bloodstream. Then it becomes part of the enamel on the inside of the tooth. If too much fluoride gets into the inside of the tooth, it can cause a condition called fluorosis.

Fluorosis

• Fluorosis means a person has had too much fluoride. People with fluorosis have white spots or blotches on their teeth. These spots can stain or become dark.
• Fluorosis usually happens during a child's first few years when the teeth are forming. Most cases are mild.
• Fluorosis is not a health problem, but it can be avoided.

How Much Fluoride a Child Needs

• The right amount of fluoride will prevent cavities, but not cause fluorosis.
• The best way to prevent cavities is to add fluoride to drinking water. It acts by coming into contact with the teeth.
• The right amount is about 0.7 parts per million (ppm) in drinking water, which is enough to prevent cavities but not too much so as to cause obvious fluorosis. You can check with your local municipality to find out how much fluoride is in water that comes from your taps.
• Natural sources of water may also have fluoride. If your water comes from wells or springs, you can have it tested. If it contains 0.7 ppm of fluoride or less, it is safe.
• If the level of fluoride in your water supply is 0.3 ppm or less, ask your dentist or doctor whether a supplement is needed.
• The dentist uses the following table to determine what amount of supplemental fluoride to prescribe, if indicated.

Supplemental Fluoride Table
Water ppm »	<.3	.3-.7	>.7
Age	1
3months-6yrs	0.25	0	0
6-16yrs	0.5	0.25	0
16+yrs	1	0.5	0

First Dental Visit

When and Why To Have a Child's First Dental Visit
The ideal time is at approximately one year of age. This is an ideal time for the dentist to carefully examine the development of your child's mouth. Because dental problems often start early, the sooner the visit the better. To safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.

What Happens at the First Visit
Many first visits are nothing more than introductory ice-breakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem.

Appointments for children should always be scheduled earlier in the day, when your child is alert and fresh. For children under 2years of age the parent may have to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.

If the child is compliant, the first session often lasts between 15-30 minutes and may include the following, depending on age:

• A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas
• If indicated, a gently cleaning which includes polishing teeth and removing any plaque, tartar build-up and stains; X-rays; a demonstration of proper home cleaning; assessment of the need for fluoride
• The dentist should be able to answer any questions you have and try to make you and your child fee comfortable throughout the visit. The entire dental team and the office should provide a relaxed, non-threatening environment for your child.

Nutrition

How Nutrition Relates to Dental Caries (Tooth Decay)
Early childhood caries is a serious public health problem. There are many factors that influence the rate of caries formation. Some of these factors include the types of foods you eat and how often you eat them.

Foods that contain fermentable carbohydrates increase the caries rate, more commonly known as tooth decay. Examples of these foods include soda, juice drinks, milk, starches, raisins, cakes, and candies. Your teeth have a sticky film on them called plaque. Bacteria live in plaque, and when you eat foods that contain starch or sugar, the bacteria produce an acid which breaks down your teeth and causes tooth decay.

It is recommended to limit foods high in starches and sugars because these foods may be substituting healthier foods from the daily diet. Healthier food choices from the five major food groups are recommended.

Baby-Bottle Tooth Decay

Baby Bottle Tooth Decay, or Baby Bottle Syndrome, or Nursing Bottle Mouth are all terms used to describe a dental condition which involves the rapid decay of many or all the baby teeth of an infant or child.

What causes Baby Bottle Tooth Decay?
Baby Bottle Tooth Decay is caused by frequent exposure of a child's teeth for long periods of time to liquid containing sugars. When your baby falls asleep with:

• a bottle containing formula, milk or juice
• a pacifier dipped in honey
• while breast feeding

How to Prevent Baby Bottle Tooth Decay

• clean your child's teeth daily
• never allow your child to fall asleep with a bottle filled with juice, milk, or formula (or when awake, sip on it for long periods of time as a pacifier)
• start bottle weaning by at least a year
• give your child plain water for thirst
• make sure your child gets the fluoride needed to prevent decay
• have regular dental visits for your child beginning when their first tooth erupts

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