My decision to create this site was made because of the many questions I get as a dentist from parents regarding their children’s oral health. It seems that many of the “What to Expect ” books and childcare guides omit something very critical in raising and caring for children. A subject that is so simple but so easily dismissed as common knowledge or topics that your pediatrician will discuss with you. Unfortunately, most pediatricians know VERY LITTLE about the dental health of your child. So, this leaves many parents wondering if they are providing adequate dental care for their children. Too often this lack of knowledge causes irreversible damage to their kid’s teeth and a serious dent in their wallets.

I hope you find the information on this site to be a  mildly humorous, very informative, myth-busting, easy to understand guide that should help you feel confident that you are on the right track with your child’s oral health. My other hope is that this knowledge will allow you to save money when it can be saved, and to spend it when it really needs to be spent.

These questions were chosen because they are by far the most common I receive at the dental office or more often, when I am at social functions for my own kids! The answers are then provided in a way which I think just about everyone can understand. I hope after reading some of these posts, you find yourself empowered and fully informed.
I hear all of these questions far too often, which leads me to believe that there is a serious lack of knowledge on the subject. Since dental decay in children is the #1 childhood disease, it is very important that parents are well educated on the subject. I feel strongly that we can better help the future of our children if we can share the knowledge to prevent these dental problems. These problems are far too often physically, mentally and financially challenging for parents and children, both short and long term. So, my hope is that after you find something useful or helpful, you feel confident in sharing the vital information with others so that they too can avoid some of the costly or worrisome situations.
You may also have friends in your social circle with younger children who may have questions that you will now feel confident answering for them. Even though you may only have a teenager now, life can be full of many unplanned miracles-so it is always better to be prepared now! Whatever the reason, share the knowledge with your friends and family.

Believe it or not, this situation is relatively common. This too tends to run in families, but not always. This brings back the important topic of x-rays. This situation is usually first noted when they child has the panoramic film taken around age 5-7. Typically, though not always, teeth will be missing in pairs. They are also usually missing the same tooth but on different side of the jaw. For example, the child might be missing both lower first premolars/bicuspids on the right and left bottom, but not on the top.

When this does occur, most dentists will give you the same advice: Do everything you can to take care of and keep the baby tooth so it can maintain the space and function of the missing permanent tooth. This is because it holds the space open for future treatment (if needed), which may otherwise be complicated by loss of the space.

If the tooth cannot be maintained, the dentist may suggest the use of a space maintaining appliance (discussed in the general questions section). There are situations where the baby tooth may actually be better of being extracted. For example, if the child already has abundant crowding, then this may actually alleviate the need for braces.

So, always talk to your dentist or orthodontist about what the best option for your child may be. If the baby tooth is unable to be retained permanently due to looseness or an extensive cavity, there are options to replace the tooth in adulthood if necessary. A few examples of what those options may be are: Dental implants, fixed bridges, denture or retainer with a tooth on it. Again, discuss these options with your dentist and see which one will best suit your child.

A very frequent question indeed, and one which you will likely be relieved by the answer! This is a very common situation and is usually at its worst between the ages of ten and twelve, depending on the child. It is so common in fact, that it has been given a name by orthodontists. It is called the “ugly duckling” phase of dental development.

Most times, the gap will resolve on its own once the permanent canine teeth come completely in ( around age eleven). This gap is caused by the canine teeth pushing on the roots of the front teeth as they make their way down into the mouth. This pressure pushes the teeth in the front apart temporarily and will start to close as the canines come further into the mouth. It can be a little embarrassing for teens until it resolves. So, reassure them that many of their other friends are likely to go through it also, and that it usually goes away on its own.

Occasionally, however, the gap remains slightly. This will depend on the skeletal and dental relationship of your child. If the canines have come in, and have been in for awhile but the gap still remains, talk to your dentist or orthodontist. There are many options for treating this if your child is unhappy with the final appearance of their smile. Some of those options may include anything from a small, tooth-colored filling placed to widen the appearance/close the gap, to brace or other appliances. Each child and situation is unique.

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?”

This is perhaps the most commonly asked questions about children’s teeth. In fact, parents who have children in the 0-6 year old range often wonder if they even need to worry about their kid’s teeth at all. I would like to stress that this age range is one of THE MOST IMPORTANT times in the care and maintenance of your child’s teeth. Repeat after me: “This age range is one of THE MOST IMPORTANT times in the care and maintenance of my child’s teeth.” You are officially now more informed than 98% of the world.

I want to first dispel a major dental myth that we touched on briefly in the general questions section. You know, the one that says, “They’re just baby teeth, they are going to fall out anyway.” WRONG. Those cute, milk-white, little-bitty, ankle-biting pearly whites are the foundation that will determine whether or not you may have to pony-up $5000 for braces several years from now. Baby teeth are crucial in holding the space in the dental arch for the future permanent teeth. They predict and help guide the underlying permanent teeth into their future locations and thus will have a huge impact on both the appearance and functionality of adult teeth. Extracting them rather than filling them in many cases can cause mild to severe crowding, spacing and asymmetry of adult teeth that may not have otherwise occurred.

Without those baby teeth, we lose many opportunities to prevent later orthodontic problems. Not to mention when you extract teeth, adult or otherwise, you greatly affect the ability to chew. I think it is only fair that we allow our children to experience the delight of eating as we do, but children need to eat for nourishment to allow for proper growth. The ability to chew can limit what a child is able to eat and thus have effects on both their mental and physical development. So, we can see that in most cases it is better to try to save a baby tooth rather than extract it.

Too often parents consider baby teeth “disposable,” since they will fall out anyway. They are far from disposable and almost always benefit the child most by doing what it takes to save them. There are exceptions to this rule. For example, if a baby tooth has a cavity but no infection present, and the tooth is within 6 months of falling out, your dentist will probably recommend the baby tooth not be treated. This makes sense as it would be pointless to waste money on a tooth that will very soon come out on its own. In addition, removal of baby teeth can sometimes actually help prevent braces altogether. While braces may be unavoidable whether you maintain baby teeth or not, you’ll see that there are other extremely important reasons to keep baby teeth healthy. So, with this new paradigm shift in thought of caring for your child’s baby teeth, let’s go into more detail about these curious topics!

This particular question always makes me a little frustrated.  Mainly because I constantly hear whispers and chatters in stores and random places of moms saying to one another, “My dentist recommended braces and my child is only 8.  I just think they are placing braces too young these days and I think they are just doing it to make more money.”

Okay.  I am a parent, so believe me, I understand the logic behind this comment.  But, being the trained professional that I also am, I have an advantage of the “inside scoop” of why things really happen.  And, when it comes to braces (and I am NOT an orthodontist, so I am completely unbiased) there are some serious considerations to examine.

For this, I need to give you a quick lesson on growth and development of children.  Children are amazing creatures and also have many advantages over us adults, especially when it comes to teeth.  Kids go through many growth spurts throughout their entire body, including their jaws.  The upper and lower jaws grow at slightly different rates, at different ages and also in different patterns and shapes.

We all get the similar end result, but with some minor to major differences depending on our genetics and other factors.  Some kids appear to get “bucked teeth” while some resemble a “bulldog,” and many other variations in between.  However, many of these problems can be corrected by simple means if addressed early in development.  Often,  an evaluation by the orthodontist, even at the age of five, can help correct problems with use of different techniques.  Some of these techniques include simple expanders, retainers, selective tooth extraction and more, thereby avoiding braces altogether.

If these problems are not addressed early, often times the only way they can be corrected later is through braces or even surgery.  Before puberty, the skeletal bones of the jaw can be easily manipulated to achieve a desirable dental and facial profile.  This can be accomplished with braces and head gear combination. Sometimes just by strategically extracting baby teeth, we can speed up the eruption of the underlying permanent teeth, which can then also be extracted.  This allows room in the jaw and alleviates future crowding.  Sometimes a combination of braces or appliances will also be used at the same time. It is actually quite complicated, but if discussed early on can be a simple process, saving everyone time, money and future heartache.

Many times we see adult patients who are embarrassed by their facial profiles and crowded teeth and disappointed when they find the only way to correct the problem now is by surgery, extensive orthodontics or costly veneers or crowns.  You may have also seen on the “Extreme Makeover” shows, the frequent use of chin implants.  This is a quick fix to avoid major jaw surgery.  This may have been avoided by an early trip to the orthodontist and a simple combination of braces and/or extractions. If we could have just taken advantage of our adolescent growth potential and ability to heal easily, we could have had the face we always wanted as an adult.

So the question then becomes, “At what age should my child have braces or see the orthodontist.”  There really is no set age and truly depends on the dental situation encountered.  I have sent children as young as five to the orthodontist, knowing that we are going to have problems in the future based on what I see now.  This doesn’t necessarily mean that the child will have orthodontics at that time, but does ensure that the orthodontist and parent can plan strategically for the future.  The hope is, that most problems if evaluated early on can be fixed with the simplest, cheapest and best treatment for the child.

The answer I am going to give you is going to sound ridiculous at first, but if you listen to my reasons, you will see exactly why we recommend the following:  In general, a child should first see the dentist when their first tooth comes in.  There are two reasons for this.  The biggest one, at least the one they teach us in dental school, is because teeth exhibit many possible signs of underlying bodily diseases that may otherwise not be discovered until a much later time.  There are many genetic disorders and syndromes that show their signs first in the teeth before in any other part of the body.  A few examples include ectodermal dysplasia, amelogenesis and dentinogenesis imperfecta and many more. While most of these disorders are indeed somewhat rare, I think common sense tells us that the sooner we can catch them, the better opportunity we have to treat them.

In addition to this, parents must remember a long used phrase about children: “Kids are NOT little adults.”  Now, I am sure this makes complete sense to you when you think about the daily things, like why kids think it is fine to eat mac n’ cheese for every meal or why they still can’t put their shoes on the right feet at 10 years old.  Or how they can have 103 degree fever and still be functional when us adults would be bedridden and begging to be put out of our misery.   So, this phrase is applicable in many areas, but is particularly true in the world of dentistry.

One thing parents need to know about their kid’s teeth is that children’s teeth are “softer” than adult teeth and therefore decay at a much faster and easier rate.  Not only are they more susceptible to decay, their nerve tissue within the tooth is much closer to the outside of the tooth than an adult.  This makes it much more likely that they will need a “child root canal” or extractions, even with the presence of only small amounts of decay.  So, with this in mind, we can see how an early trip to the dentist can minimize problems which may have otherwise become huge problems by waiting.

Another important thing to know is that those baby teeth which seem so unimportant are actually a blessing in disguise.  As you will read in subsequent chapters, those little teeth will help pave the way for the future position of the permanent teeth.  Extracting them prematurely can cause many cosmetic and functional problems which can be very costly later on.

While I am a dentist, my most challenging job is being a mom.  That is why I actually feel that this next reason for going to the dentist at an earlier age is one of the most important. I have rarely seen a child in this age range that is eager and excited to hop up in a large, squeaky chair, in an unfamiliar place and open their mouths for a total stranger wearing latex gloves and a scary mask.

To top it off we expect them to open willingly and let us come at them with large, sharp instruments. Yikes!  If they scream just sitting on Santa’s lap, what makes us think they will be excited about going to the dentist?  If we take our children young enough and make it a fun place without all the scary stuff first, then their visits will be an experience to look forward to rather than fear.  So, the mom side of my persona always wants me to create fun and wonderful experiences for my kids and the kids I treat.  The earlier they start seeing the dentist, the less fearful they will be.

I usually suggest that you bring them in with you when you have your own cleanings done every six months (provided you, yourself are not a big chicken).  This will reinforce that you are not scared and get them familiarized with the office so that they are comfortable with the surroundings.  Eventually, the child will recognize your dental office and look forward to coming with you because they always get a toothbrush, a sticker and a sugar-free lollipop!  The biggest miracle of all is, that after a few times, you’re little one will actually beg the dentist to look at their teeth and will ask them to be cleaned.  Easy as taking candy from a baby (which, by the way, your baby shouldn’t have candy in the first place-but we’ll talk about that more later)!

If you, as a parent, are a dental-phobe, then have your spouse or someone else take your child so that they ALWAYS begin their dental journey with nothing but a positive experience.  Keep in mind that if someone other than the child’s legal guardian takes the child, you will need to give the caretaker some form of written and/or verbal consent for treatment.  The laws vary by state, so be sure to inform yourself and also keep good communication with the dental office staff about treatment and finances involved in your child’s care.

If your child is still uncooperative despite all efforts, or your current dentist is not great with kids, then I would highly recommend seeing a pediatric dentist.  This kind of dentist sees only children and has the entire office set up for kids, from music, TV, giant kid-friendly murals, puppets and most importantly…sedation.

My general feeling about sedation is that if it is necessary to help your child have a great dental experience, then strongly consider it.  If you have to consider sedation as an option, please be sure to discuss with your dentist all of the risks involved with this type of chosen sedation.  While sedation is a great opportunity to complete your child’s dental care with ease, there are risks you should be aware of.  Though rare, there is the possibility of accidental death as a result of sedation and so the procedure should be considered only if truly necessary.  Due to the wide variety of sedation options and the fact that selection of the type of sedation varies by child,  I will not go into specific details.  Just inform yourself well and use that information to aid in making your decision.

By and large, the number one complaint I hear from my adult patients who are terrified to go to the dentist is that they had a traumatic childhood dental experience.  If we start out positively as a child, then we will have no reason to fear the dentist as an adult.  Going to the dentist regularly will become a desired, regular occurrence, like birthdays or  holidays.  Okay, okay, maybe I am exaggerating a little, but they still can be fun experiences for kids!

These bi-annual check-ups and cleanings allow us to catch problems while they are small, thereby keeping most dental procedures extremely conservative for both kids and adults.  I know it may seem hard to believe, but going to the dentist really can be an enjoyable (not just a tolerable) experience.

Much of what I will tell you in regards to nutrition will be similar to what you may have already heard from your obstetrician. Of course, nutrition is crucial to the overall health of both mother and child. A balanced and healthy diet can help mom feel well, avoid pregnancy complications such as gestational diabetes and aid in proper development of the baby.

But proper nutrition also plays a key role in the developing baby’s tooth enamel. Proper amounts of vitamins A, C and D, phosphorus, calcium and protein will help yield stronger, more decay resistant baby teeth in your child. Many of these vitamins and proteins are absorbed by consuming foods such as fruits, leafy vegetables, non-fish meats and low-fat dairy products. In addition, always add a prenatal vitamin to your diet unless your doctor says otherwise.

If you have never seen an x-ray of a newborns jawbone you may be surprised to see 20 developing teeth. So, even though you can’t see them, they are there. This is one reason that illness or injury as a toddler can have adverse effects on teeth later on. Your toddler’s first teeth are known as”primary” teeth and play an important roll in development. It is important for parents not to treat their child’s primary teeth as “temporary” or “replaceable” . Many preventable problems can be avoided by proper care of your toddler’s primary teeth.

At about six month of age, your toddlers teeth may be starting to erupt. The front four teeth are usually the first to arrive. Remember that ever baby develops at a different rate so if your toddler does not have his or her first tooth at 6 months+one day ,don’t sweat it! It is not uncommon for the first teeth to take 12 to 14 months to come in. Both of our boys seemed to take forever to get/lose teeth.

When your toddler’s teeth begin coming in(erupting), your child may experience sore or tender gums. This is normal. You can help soothe the discomfort by gently massaging the gums with a clean finger or moist gauze pad. Granted this will only provide temporary relief but sometimes that’s enough to help a fussy baby. If you prefer the “hands off” method, you can give your toddler a clean teething ring to chew on. Remember never to put any sugar or syrup on the teething ring. I know it seems obvious but as you may have guessed, there is a reason I mention it!

If your toddler is excessively uncomfortable and cranky, you can call your dentist or pediatrician to ask about over the counter pain remedies. Keep in mind also that contrary to popular belief, if your infant/toddler is running a fever while teething, this is not normal. Any unusually high or persistent fever is an indicator to contact your pediatrician.

Having a baby teeth chart is a great way to compare your child’s teeth with the average dental development of other children’s teeth. However, remember that this is just an “average” and many children will develop slower or faster than what is shown on this baby teeth chart.

The lower central incisors are usually the first to come in and may be followed quickly by the upper central incisors.

Next should be the lateral incisors followed closely be the first molars.

Canine teeth will be coming in somewhere in the 16 to 24 month range and lastly the second molars.

Remember that a baby teeth chart is simply a guide to assist you in det3ermining your childs dental development. There are also a lot more important things to learn about childrens teeth. Make sure that you are familiar with all of the issues affecting children’s teeth and dental development.

I would also like to mention that children’s teeth should by no means be considered “disposable” or unimportant. These little jewels will help pave the way for permanent teeth and may determine whether or not you as a parent will have to spend a great deal of money on orthodontic treatment later on.

So take good care of those baby teeth and use the baby teeth chart as a general and not a definite guide.