When should my child first see a Dentist?

Your child's first visit to a dental clinic must be a pleasant experience. A bad first impression may last a lifetime. The right time to bring a child for a dental visit is before all the primary (milk) teeth have appeared - before the child has completed 2 years of age. This sets the stage for optimal preventive dentistry.

Reasons for an early visit:

• Bringing a child when there is no emergency will make the visit a pleasant experience.

• Parents may not recognize a dental problem in it's early stages.

• Your dentist can prevent problems like decay from occurring

• Advise on nutrition and home care can be provided.

Fear of the dental clinic is learned from personal experience or what a child hears from others. Be completely natural when you inform your child about this visit. Make it sound like a routine item. Allow your child to get familiar with the dental clinic. Most important - do not show any anxiety or fear yourself. Children pick-up nonverbal cues very quickly and tend to mirror the emotions of their parents.

Children have two sets of teeth, primary (milk or baby) teeth and permanent teeth. Both sets are important for children's speech, chewing, and for appearance. Additionally, milk teeth help in the proper development of muscles for chewing, and they also maintain the space so that permanent teeth can erupt in their correct positions.

From birth to the age of 6 months there are no teeth in the mouth. It is necessary for parents to clean the gum-pads with a soft cloth.

The first tooth appears in your child's mouth at the age of 6 months. Parents are required to begin brushing these teeth to prevent them from decaying. All the milk teeth erupt in the mouth by the age of 2 years. There are 20 milk teeth. Parents must brush their child's teeth, as the child will be unable to do so. The child can gradually be taught to brush his/her own teeth as soon as they have learnt to spit out the toothpaste.

These teeth are shed between the age of 7 and 12 years, and are replaced by permanent teeth. But we have 32 permanent teeth, and the additional 12 permanent teeth erupt behind the milk teeth. The first one of these erupts at the age of 6 years, and is called the first permanent molar. This is a very important tooth.

All permanent teeth erupt by the age of 14 years, except the wisdom teeth, which usually erupts between the age of 17 and 25 years.

Between the age of 6 and 12 years, a child has both milk and permanent teeth. This is called the mixed dentition stage. Parents of these children often mistakenly think that the teeth, though decayed, do not require treatment and will fall off, as they will be replaced with new teeth.

(Click to see diagram)

Teething Myths

Teething does not cause fever and diarrhea! If present it is only a coincidence. At this age, children are very active and tend to put everything into their mouth and nostrils. This contributes to cold and flu like illnesses.

Double Teeth

Usually the permanent teeth are located just below their milk predecessors. With pressure from the permanent tooth, the root of the milk tooth gets dissolved / eaten away, and the milk tooth falls out to make way for the permanent tooth. However, if the permanent tooth is placed too far away, it will erupt even without the primary tooth falling out. This causes double teeth, a new tooth behind or by the side of the old one.

Such a situation should corrected promptly if several weeks have elapsed. Timely removal of the milk tooth in such a case will allow the permanent tooth to take its correct place.

Correcting the Alignment

The age for correction of alignment differs from case to case, but in general, it is best done after the child has completed 12 years and all the permanent teeth have erupted. Many times early commencement of treatment gives better results, but treatment is possible at an older age also. The right person to consult is an orthodontist.

Tooth Decay

Causes of tooth decay in children are the same as in adults, but occurs more quickly. Being very small in size, decay reaches the nerve of a primary tooth very fast and causes pain.

Tooth destruction can occur so fast that some parents feel that the teeth were decayed when they first erupted. Remember, teeth can decay only after eruption and not before.

1	An important factor in children responsible for causing tooth decay is the child being bottle-fed and put to bed. This type of decay is extensive and is called as nursing bottle caries.

Treatment of tooth decay is similar to that for permanent teeth and can involve fillings, root-canal treatment, and/or crowns. If the child is not cooperative, your dentist may suggest treatment under general anesthesia rather than lose the advantages of treatment.

Decay of the primary teeth indicates that the child is susceptible to tooth decay and requires proper attention to maintain a healthy dentition. It does not mean that the permanent teeth will also get decayed.

Why Primary Teeth should be saved

Although all primary teeth are replaced by permanent teeth, this must happen at the right age. There is an appropriate time for each milk tooth to fall and the permanent successor to take its place.

If a milk tooth is lost much earlier than the scheduled time of eruption of the permanent successor, it is likely that space created by loss of the milk tooth will reduce or even close due to drifting of near by teeth. When the permanent tooth erupts it may not have enough space and grow in crooked.

Removal of the front primary teeth should be avoided before the age of 4 years, and the other primary teeth before the age of 9 years. If early removal of teeth is necessary, an appliance called a space-maintainer should be constructed for the child to wear. The function of this appliance is to maintain the space created by the loss of the primary tooth for the permanent successor.

Habits

Thumb sucking, mouth breathing and tongue thrusting are very often observed in growing children. These habits, if discontinued by the age of 5 years, do not affect the positions of permanent teeth, but if continued beyond this age can cause mal-alignment of teeth. These habits are usually due to a variety of reasons, including psychological. Attempts must be made to pinpoint the cause and treat it to break the habit. If such attempts fail or do not reveal any particular cause, certain habit-breaking appliances can be constructed by the dentist to be worn by the child to get rid of the habit. 1

Are often seen in kids involved in sporting activities. In case a tooth is fractured or is knocked out of its socket, the child should be immediately taken to the dentist. The tooth may be preserved and transported to the dental clinic in a wet medium, or milk, or kept in the mouth of the child. Under certain (not all) circumstances the dentist may put the tooth back into its original place, making it possible for the tooth to last its intended life-span. Primary teeth that are accidentally knocked out are often not replaced because of risk that the primary tooth will fuse to the socket and require surgical extraction when the permanent tooth erupts. For primary teeth that have been knocked out prematurely it is best to call your dentist for advice.

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Advise to Parents

• The first visit of your child to the dental clinic could be as early as 1 year, but definitely not later than 2 years, to be followed by 6 monthly regular check-ups.
• The child's teeth should be brushed thoroughly twice daily using a fluoridated toothpaste. This brushing has to be done by the parents initially, till the child has mastered the necessary skills.
• Allow the child to eat what he/she likes, but with or immediately after meals. This should be followed by brushing or thorough rinsing of the mouth. These measures will ensure that the food particles are cleared from the mouth, thus reducing the incidence of tooth decay.
• Sealants should be applied onto the biting surfaces of the permanent back teeth as soon as they erupt. This will prevent decay from occurring in the pits and fissures of these teeth.
• Fluoride treatment may be considered if your child has a high incidence of decay, or if the level of fluoride in your drinking water is inadequate.

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Resources

1. "Childrens First Visit" from Dr.Vaswani's Dental Page @ http://members.rediff.com/deepakvaswani/index.htm

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