Children's teeth and teething

Reviewed by Ms Lisa Taylor, dentist

When does the first tooth develop?
The age at which the first tooth appears differs greatly from child to child. Very occasionally, children are born with one or more teeth. These may need to be removed if they are very loose, as there is a risk that the child could swallow them, or have difficulties with breastfeeding.

Other children may not develop any teeth until they are more than a year old. Usually, however, the first tooth - which tends to be in the middle of the lower jaw - appears at around six months of age. The complete set of 20 primary teeth (baby teeth) is usually present by the age of two-and-a-half years.

The first permanent teeth appear at around six years of age. These tend to be the incisors in the middle of the lower jaw and the first permanent molar teeth. The molars come up behind the primary teeth, they do not replace them.

Myths about teething
Many things have been attributed to teething: rashes, crying, bad temper, runny noses, extra dirty nappies, etc. None of this can be proven, particularly as so many other things that might influence behaviour are happening in the child's life at the same time. The important thing is not to use teething to explain away what might be the signs of illness.

What to do when your child is teething
Some teeth come through with no trouble at all; in other cases, the gum may be sore and red where the tooth is pushing its way out. A child may dribble, gnaw and chew a lot or just be fretful, but it is difficult to tell if this is really due to teething.

• It can be helpful to give the child something hard to chew on.
• Teething rings that can be cooled in the fridge can be particularly soothing.
• Teething gels containing local anaesthetics can provide some pain relief from sore gums.
• Sugar-free paracetamol suspension such as Calpol may also be given. Be sure to follow the instructions according to the child's age.

Caring for your child's teeth

• Start brushing as soon as teeth appear.
• Brush thoroughly twice a day (just before bed is important).
• Help your child brush until they are able to do it well by themselves - usually around the age of seven.
• Use a fluoride toothpaste and encourage your child to spit after brushing; do not rinse afterwards as this reduces the benefits of the fluoride in the toothpaste.
• Use a tiny smear of toothpaste for babies and a pea-sized amount for children.
• Young children will swallow the toothpaste; use a children's toothpaste with reduced fluoride until they are able to spit well.
• Visit a dentist regularly to get your child used to the surgery.

Reducing your child's sugar intake

• As soon as you start your baby on solids, try to encourage a liking for savoury, rather than sweet tastes.
• Reduce the amount of sugary food or drinks you give your child and limit these to mealtimes.
• Use stickers, comics, crayons, hair slides, etc, as treats instead of sweets or biscuits.
• Only give water or plain milk in a bottle. Juices should be diluted and given in a cup.
• Limit fizzy drinks and natural fruit juices as they contain sugar and are acidic. They cause decay and erosion that will, literally, dissolve the teeth.
• Do not put anything sweet on dummies/comforters.
• The frequency of sugar intake is more important than the quantity; if you give sweets as treats, ensure they are all eaten at the same time.
• Ask for sugar-free medicines.
• Read labels carefully. Sugar may be listed as glucose, sucrose, honey, dextrose, maltose, fructose, hydrolysed starch or syrup. Remember that maltodextrin, invest sugar, honey, raw sugar, cane sugar, muscavado and fruit juices all cause decay. Remember that some drinks labelled as being 'tooth – friendly' may still contain significant quantities of sugar harmful to teeth.

. Other tips for healthy teeth
Every time even small amounts of sugar are consumed, the acid level in the mouth falls to a level where it can cause dental decay for about half an hour. For this reason, it is not recommended to brush teeth immediately after something sweet or acidic since the teeth are weakened and brushing 'scours' the surface of the enamel. It's a better idea to wait half an hour after eating before brushing.

It is also useful to chew sugar-free chewing gum after eating as this encourages the flow of saliva, which naturally buffers the acids that cause dental decay.

Alternatively, a small piece of cheese after eating has also been shown to be helpful.

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