The First Tooth

Posted on 02/04/2016

The First Tooth:  An addendum to Infant and Child Oral health

It has been two years since my last blog on this topic.  A lot has happened for me during that time.  My son is three and a half and I have a 19 month old daughter.  To say my world has changed would be an understatement and I have learned a ton in the process.  I have moved my family out of the city to a great community in the suburbs where almost every house has two kids under the age of 13.  My friends have caught up to me and are having kids of their own.  As a dentist and a young dad, I am approached daily by friends, neighbors, and patients with questions regarding their kid's teeth.  I would like to share some of these common parental dental questions and how I have addressed them.  

Disclaimer: I am not a pediatric dentist.  I am a dad and a general dentist who has patients who range in age from 18 months to 102 years old. 

My child is 12 months old and still doesn't have any teeth.  Should I be concerned?

Generally, the first two lower incisors should erupt around 6 months of age.  That being said, timing of eruption can be highly variable.  Some babies are born with teeth (sorry mom), others don't get their first tooth until 18 months old.  This is all normal.  Additionally, girls generally get their teeth and lose their teeth earlier than boys.  Both of my kids got their first tooth around 9 months of age.

Teething, when does this end?

Sorry, mom and dad, you are not going to like the answer to this one.  As mentioned above the first two lower incisors generally erupt around 6 months of age.  The last baby teeth to join the party in the mouth are the second baby molars.  Those come in around 2 years of age.  The effects of teething can be seen starting in the first few months of life and can become a roller coaster of discomfort, drooling, diarrhea, fever and sleeping disturbances sporadically until all 20 of the baby teeth have fully come into the mouth.  Children's Ibuprofen (Motrin/Advil) is far superior to Tylenol for alleviating oral pain (the same goes for managing dental pain in an adult).  As mentioned in my previous post, you should always consult with a pediatrician regarding any medications you give your kids.  Read below for my favorite (and my kid's favorite) teething toy. 

My child's first teeth finally erupted, when should I start brushing them?

As soon as the first teeth erupt into the mouth is when you should begin brushing.  The enamel of a baby tooth is much thinner than an adults tooth, so if a cavity forms it could progress rapidly.  At first, trying to bush a baby's teeth thoroughly will be very difficult.  Do not try and give them a "professional cleaning" right away.  The goals of early oral care should be to familiarize the child with brushing and make the activity fun.  My suggestion to new parents is to give your child a toothbrush as a toy during the teething process before they even get their first tooth.  Let them carry it around with them, let them drag it across the floor, let them chew on it.  A toothbrush is a great teething toy, plus it familiarizes the child with the feeling of the toothbrush in their mouth making the eventual ‘official' tooth brushing easier.   All the major tooth brush brands make early stage toothbrushes, my favorite is the Oral-B Stage 1 brush.  The brush head is small enough to fit comfortably in the mouth and they have fun designs that the kids love. 

When I brush my child's teeth should I use toothpaste?

Yes, a small amount of fluoride toothpaste is appropriate for children.  A great toothpaste to start with is Tom's of Maine, Silly Strawberry Kids Toothpaste.  Use a "grain of rice" as a size guide for the appropriate amount of paste to put on the brush, nothing more.  If you keep the amount that's on the brush very small you do not have to worry about your child swallowing the paste.  My three and a half year old son just learned how to spit and I've been brushing his teeth since his first ones came in around 9 months of age.  A great thing about an older sibling is that they teach things to the younger one sooner than they would have learned on their own.  My son's emergence into the art of spitting has been passed on to his younger sister, sometimes I feel like my house is a Wild West saloon.

When should I take my child to the dentist?

The American Dental Association has made a recommendation for the first birthday as the target age for the first dental appointment.  HA! Try putting your 12 month old in a dental chair for an exam.  My personal opinion is to slowly introduce dentistry to the child.  At our office I suggest that around 18 months to 2 years of age bring your child with you for your cleaning appointment.  Have the child sit on your lap or lay with you as you get cleaned.  That way they can see that our wonderful and gentle hygienists are not hurting their precious mommy or daddy.  Afterwards we show them the basic instruments and items around the dental office and let them interact with them.  If all goes well I take a quick peak which amounts to nothing more than me standing in front of them and watch them as they "give me a big smile", and "open as big as an alligator," and of course afterwards they get to raid the treasure chest.   As they get closer to two and a half years old we will attempt a more ‘official' cleaning and exam.  Generally I do not try and get any x-rays until at least 4.

In closing, I think dentistry should be fun.  We approach it that way with our pediatric patients.  Parents, if you have had a bad experience with dentistry or have dental anxiety; your child will pick up on that.  Try not to over prepare them for their appointment.  Don't talk about shots, or pain, things hurting, or sharp, pointy, silver instruments being put in their mouth.  Just tell them "we are going to the dentist to make your teeth as strong as a superhero," or "as pretty as a princess" and you be setting them up for years of dental health.