This is a common concern among parents and has a fairly simple response. In general, your pediatrician will recommend that you plan on discontinuing the use of a bottle by age one. There is, of course, a little flexibility with this so that the child can undergo a relatively smooth transition to the use of a sippy-cup.

Every child is different in their need for that warm bottle of instant comfort. It is indeed an amazing cure-all for infant displeasure, but like all addictions, it isn’t easy to stop. Other children will give it up easily, gladly welcoming the new benefits of becoming a toddler. Most child-rearing books, like the “What to Expect” series, will give you tips and tricks of how to wean both the bottle and the pacifier. My biggest advice would be to start sooner rather than later, especially if you have a strong-willed child.

If you are successful in weaning both the pacifier and the bottle around 12 months, then you have no concern that either one will affect the orthodontic relationship of your child’s teeth. If you go much beyond this time frame, then it is possible that you may have some future orthodontic problems. Again, there is leeway with this, and in general we say that most of the permanent effects occur if the child has not completely stopped by age four. Of course I assume that your four year old is not drinking out of a bottle anymore, so I am speaking particularly about the use of a pacifier. If your four year old is still drinking from a bottle, you are way overdue for a crisis intervention!

The other big concern to be aware of is that, the pacifier can also cause trauma to the child’s gums. This can cause painful ulcers but can also cause the gums to recede from the tooth. This can cause many problems including gum damage for the soon erupting permanent tooth, tooth decay of the baby-tooth or painful root exposure. Your child may experience mild to severe sensitivity to hot and cold foods or even just when the air from speaking passes by the area where the gums have receded. Adults experience this too, but generally it is not caused by the use of a pacifier! There are many causes for adults, but the end result is the same resulting in sensitivity, pain or possible loss of the tooth from becoming loose. So again, stop the habit early, as it will be better for everyone!

This answer is very similar to the one above. Let’s face it. We all have a crutch that helps us get through the tough times. Some people rely on faith, others on food and some on other addictions.
So, it should come as no surprise to you that our children have their own little “fixes” to get them through the tough times. One of the biggest of these is thumb-sucking or finger-sucking, with or without the use of a “blankie.” I would never dare ban the coveted “blankie.” In fact, I know several adults who still sleep with theirs! I sucked my thumb as a child, and oh, the relief was amazing! But again, at some point certain addictions have to end before they have damaging consequences.

Generally it is safe to let your kids suck away until age four. Before age four, you may notice the effects of sucking on their front teeth. What you will likely see is that your child’s front teeth are “bucked out” and perfectly fit the offending thumb like a key in a lock. Prior to age four, if the child stops, the teeth will usually drift back into their normal position. After age four, however, the effects become more permanent and may also affect the path of eruption of the permanent teeth and shape of the palate (roof of the mouth). This can result in your child’s permanent teeth also appearing “bucked,” crowded, spaced or some combination of these. And, you guessed it, an expensive trip to the orthodontist!

Okay. I am a parent also, so let’s be real. Despite some of my best and most deceptive efforts (bribery included), there are still things I just cannot get my two-foot tall bosses to do. Some try money. Others try candy. Others just try discipline. Yet, the thumb prevails over all. So then what? Well, unfortunately for your child (but fortunately for you), there is an alternative. If they don’t stop by age four, a trip to your dentist is recommended. You see, we have a special device made to cure thumb-sucking. It’s not pretty and it doesn’t hurt, but it will work. The appliance is called a “palatal crib” or “thumb-sucking appliance.”

The appliance looks a little like a medieval dental retainer but is painless. It is cemented to the child’s top teeth and spans the width of the roof of the mouth (also known as the hard palate). The smooth wire that makes that span does not allow the thumb to make the suction that is needed to perform the sucking motion. Voila! No gratification in sucking anymore. Eventually, (sometimes a few weeks or months) the child will no longer have the desire/addiction to suck their thumb or fingers and the appliance is easily removed. If your regular dentist is not comfortable making or placing this appliance, they may refer you to a pediatric dentist.
 

The appliance of course, should be your last resort. Your child-rearing books again are filled with a multitude of tactics and tricks, depending on your parenting style. Try a few and see what works best for your child. Some will recommend positive reinforcement or discipline while others will recommend a terrible tasting, harmless potion to place on the thumb or finger. Since each child is so different, what may work for one may not work for another. So, you will just have to be patient and persistent until you find what works for you!

I need to address a widespread problem regarding bottles and sippy-cups. NEVER let your infant or toddler fall asleep with a bottle of milk or juice. I know from personal experience that lack of sleep can cause us to take desperate measures. One of these measures is propping or allowing a child to have a sippy-cup or bottle of milk or juice to help them fall asleep. This is the number one cause of severe tooth decay in children and its effects can be devastating. This situation is called “baby-bottle tooth decay” or “bottle rot.”

Image courtesy of Dr. Martin S. Spiller

Once the baby/child falls asleep, the milk and juice pools in the mouth and those cavity-causing bacteria commence their attack. It can decay a child’s teeth so quickly and so severely, that that the child can actually end up losing all or most of their baby teeth. This is especially troubling considering they don’t start getting their first adult teeth until around age six or seven!

 
This loss of teeth can lead to many disheartening situations, such as the child having to wear a partial or complete denture just to be able to eat. This is a very tough ordeal for a child to have to go through on many levels, including functionally, socially and psychologically. Not to mention the many extra trips to the dentist the child will have to endure throughout their childhood. So please try to remember to reserve those cups and bottles for mealtime only. You can see for yourself the devastating consequences that it can have.

If this is your first child, please pay close attention! This is a great time to conquer something in your child rearing that few others have! Children do not have access to sweets, sodas or juices without YOU. So this is the time to make your mark on your child’s health. Kids do not know what they are missing out on if they are never given it in the first place. Both of my boys were never given juice or soda as a toddler. Not because I was mean (I am-but that’s not the reason why) but because I knew once I introduced it, it would be almost impossible to control it.

Spaces between baby teeth are indeed normal as well as helpful. However, occasionally a child has a much larger than normal space between the upper two front teeth. This large space is what we call a “diastema,” which really just means a large space or gap. They are usually caused by the presence of a little extra muscle tissue between the underside of the top lip. This muscle attaches the lip to the gum tissue between the top two front teeth. We all have this muscle attachment, but occasionally the attachment may be a little excessive or attach a little further down toward/in between the teeth than usual. This slightly different attachment is sometimes just enough to keep the two front teeth from coming together. If not corrected, this attachment can stay present as an adult and may or may not cause other problems.

In general however, this is not something to be overly concerned about until the child is older. Your dentist may choose to have your child evaluated by the orthodontist, as sometimes the space will not close on its own. It is fairly easy to fix, sometimes requiring reshaping and or relocating of the attachment to a better cosmetic place with or without the help of orthodontics. Typically no treatment is performed to fix it until the child has all or almost all of their permanent teeth. If you and your child decide not to fix it, there is usually no problem associated with leaving it other than having the space there permanently. Occasionally if left alone, (this is usually when the problem is on the lower front teeth) the attachment can cause a defect in the bone and gums, causing a host of other problems. So, it is always best to have your dentist evaluate the area regularly during check-ups or if you have concerns about the space.

The great news is that your child is perfectly normal! Spaces between baby teeth are a great thing-especially for your wallet! As I said earlier, the body is amazing and the design of teeth is no exception to the rule. Those little gaps are the body’s pre-built mechanism to allow enough room for the larger, later erupting permanent teeth. Those spaces (called Leeway spaces) are your hopeful chance that you will avoid having to pay for braces later on.

The time to be more concerned is when your child has teeth like a supermodel. In other words, they have no spaces and perfect alignment. Beautiful as they may appear now, you are pretty much guaranteed that without any orthodontic treatment or strategic preplanning, your child will have crowded teeth as a teenager and adult. The good news is that dentistry has advanced in ways that now make it possible to understand the relationship between baby teeth, permanent teeth and skeletal growth in children. This knowledge now allows us to pre-plan in certain situations, possibly avoiding braces altogether. For further information, please refer to the “general questions” section of this book. More information will be found under the question: “How early should my child be placed in braces. How do I know if my child needs braces?”

Alright, let’s face it-most adults do a poor job of brushing their teeth on their own. So, it should be no surprise that most kids do an even worse job (including my own). My oldest boy is nine and highly intelligent. However, if I let him brush on his own and then check after him, you would swear that he just ate a plaque sandwich right before I looked. Disgusting, I know, but incredibly true.

Now, we of course have to let our children acquire their independence whether we like it or not. Trust me, if I had it my way, I would drive him everywhere and keep his curfew at 10 PM until he was 30. But I can’t, so I have to go with the flow. With brushing, this too is the road I must take. You need to allow them the independence to brush on their own, even from a young age (at 2 or 3 years old). However, like all parents, we must be undercover detectives and be sure they are doing an okay job. So, I will often check after brushing and give helpful hints on areas they may have missed.

Another completely covert method of checking up to ensure adequate brushing is the use of those plaque dyes made just for kids. They swish it in their mouth for a few seconds (the child must be old enough to spit it out to use it) and it will stain any plaque on their teeth. The child will think this is so cool to see and then has the job of removing all the colorful stain. You can obtain these dyes in a few different ways: First, you can ask your dentist if they can give you the little pink or blue tablets (chewable) that stain their plaque (called disclosing tablets). Then, your child just chews them up, spits out the excess and voila-a beautiful bounty of stained bacteria to brush off! Second, you can use a plaque staining rinse for children (i.e. Agent Cool Blue by Listerine). Then they simply rinse instead of chew. I personally prefer the tablets, as they work much better and stain much brighter. They can be harder to find over the counter however.

Speaking of stain-those little tablets and swishes are also fabulous as staining lots of other items, so you may want to supervise the process! As mentioned earlier, the child should be old enough to rinse and spit the mouthwash out without swallowing to avoid any potential toxicity. As a side note, teenagers seem to be the worst at brushing. So be prepared for some dental challenges. Don’t fret too much, however, for us dentists are fantastic at giving lectures and guilt-trips to teens, especially in front of their parents. You can use this tactic however you choose. Parental threats to teenagers have ranged from taking away TV and video games, all the way to making the child help pay for any cavities found at the next appointment!

When we are first-time parents, we often have many new gadgets and gizmos to figure out how to use. Luckily, taking care of your child’s teeth is fairly devoid of a fancy products needed to complete the task. When your child is in the infant stage, you may want to consider using one of those super-cool finger brushes. You do not want to put toothpaste on them yet. They are made primarily to massage the gums during the teething stage to help the teeth come in more comfortably for the baby. It may also help in getting the child prepared for having a toothbrush at a later time. You could also have the same effect with a wet washcloth-just be sure it is clean before using.

Once the baby has teeth, we usually recommend the child chew on a toothbrush without toothpaste. It is my preference to place the child in a highchair or on your lap where they cannot fall or slip and become injured by the brush. Always supervise the child and no time restrictions are necessary at this point-just watch and enjoy! At around age two to four you can introduce fluoride toothpaste to the brush. They make special toddler toothpaste with tastes that are more appealing to your little tike. You should use a very small, less than pea-sized amount!

As a general rule, I usually tell parents that if your child tries to swallow the paste or is not able to spit, then do not use a fluoridated paste yet, regardless of their age. Fluoride can have toxic effects to the body and to the teeth if taken in larger amounts, so always be sure that you monitor your child while brushing. Rinses are generally not recommended until children reach age six years old and can definitely spit out with no problems. Again, I rely less on the child’s age and more on their ability to spit the rinse out without swallowing it.

Flossing. Let’s face it, we all hate flossing. It takes too much time, we forget, we don’t like it, we don’t have time for it. All valid reasons. However, flossing happens to be one of the most important things you can do for your gums and also for your body. Flossing helps prevent gum disease, which can lead to premature tooth loss, bad breath and a multitude of other dental problems. In recent studies, scientists have also linked gum disease to other health problems such as pre-term labor, heart disease, stroke and diabetic complications. So, though we hate it, we really need to do it (sort of like paying taxes, right?). The earlier we can introduce the habit of flossing to our children, the easier it will be to incorporate as part of their daily routine.

When kids finally have multiple teeth, you can start by demonstrating on yourself and then see if they will let you try it out on them. If you are unsuccessful, continue to show them while you do it and eventually you will find that they might at least try on themselves. You will also find that your child may have spaces in between their teeth and thus not much there to floss. The spaces are actually there for a reason and so just go through the flossing motions for now, and let your child practice. The spaces will likely go away once permanent teeth come in and so they will already be a pro at it! The child may complain that the floss stings a little bit. This is normal and is because the gums are not used to having floss touch them. This will be the same for adults. Be sure that they are gentle when they floss and occasionally a little bleeding will occur at first. This is normal, so reassure your child that flossing will make it go away and the more they floss, the happier their gums and teeth will be! Occasionally, flosses coated with mint flavoring can cause stinging during use. So consider buying flavorless floss.

There are many handy devices to make flossing easier and more appealing. One of my personal favorites is the “floss-pick“. It is a little plastic toothpick with floss attached to it. There are many brands, but I will warn you that cheaper is not better, as the less expensive ones tend to break after the first attempt. If your teeth are very tight, I also recommend Glide brand floss. It is a little more expensive but well worth the price! Also, regular floss is really the best, but if it is too difficult for you or your child to use, then you simply won’t use it. So, the bottom line is, use whatever you will use!

This is a very common question, particularly with first-time parents.  One thing you must understand is that children are highly variable in their personalities, growth and especially their teeth.  There is no hard and fast rule as to when your child will get their first tooth, but rather general guidelines to refer to.  These relative times of tooth eruption can vary by many months, so when I say it is a general guideline I truly mean it.  Generally speaking, the first tooth will appear between 6 and 9 months of age.  My youngest son did not get his first tooth until he was 11 months old!  So don’t worry too much if your child is not following the guidelines exactly.

There are also extremes on the other end of the spectrum.  There are some infants that are actually born with a tooth or two.  These are called “natal teeth” and are a lot of fun for breastfeeding moms! It is usually only a concern  if they interfere with breastfeeding or if the teeth are loose and feared to be a choking hazard..  This is a situation that your pediatrician will discuss with you.

Here is a quick reference guide to follow and refers only to baby teeth:

6-8 months old

The first tooth usually appears and is almost always a lower front tooth (called lower central incisors)

8-12 months old

The top front teeth appear (called upper central incisors)

9-13 months old

Upper lateral incisors appear; these are the teeth immediately next to the already existing top teeth (lateral simply means “to the side of”)

10-16 months old

The lower lateral incisors appear; these are the teeth next to the now existing lower front teeth

13-19 months old

The first primary/baby molars appear on the top and bottom; They may appear simultaneously or at various times; There will be a large space between these molars and the other existing baby teeth.

16-22 months old

The canine teeth appear (also called cuspids or “fangs”) on the top and bottom and may appear simultaneously or separately.