Teeth

Oral care should start from even before your babys first teeth emerge, as certain factors can affect their future appearance and health. Tetracycline, an antibiotic, can cause tooth discoloration, so should not be used by nursing mothers or by women in the last half of pregnancy. The age when babies get their first primary (or milk) teeth varies. A few are born with a tooth already through, while others have no teeth at one year. Most infants sprout their first tooth at six to eight months, usually in front and at the bottom, with the last of the molars appearing between 20 to 30 months. There are 20 primary teeth in all, 10 at the top and 10 at the bottom. The first permanent second teeth come through at the back at around the age of six. Good oral care is one of the most important health lessons you can teach your child. Help your child brush their teeth twice each day, limit the number of sweet snacks and visit the dentist regularly.

Teething

Due to the discomfort of teething, your baby may experience increased drooling, gnawing and chewing, sleep disturbance and general unhappiness. Teething is often blamed for an onslaught of other problems such as coughing, diarrhoea and fever, but a recent study found these are often unrelated. Teething symptoms should only happen during the few days surrounding the eruption of each tooth, so if symptoms are prolonged, your child may be sick with something else.

Pain Relief

It can help to give your baby something hard to chew on such as a teething ring, though avoid stiff plastic or silver ones as they may exacerbate the pain if clamped down on too aggressively. Some soft plastic or liquid-filled rings may be frozen for extra comfort, but avoid the variety with small objects floating inside. Even gnawing on a wet washcloth, a crust of bread or breadstick, or a peeled carrot provides relief. Avoid rusks because almost all contain some sugar. Constant chewing and sucking on sugary things can cause tooth decay, even if your baby has only one or two teeth.

For babies over four months old you can try sugar-free teething gel, available from the chemist, applied on the gum. Speak to your GP or health visitor if your baby is younger than four months.

Possible Problems

If your baby hasn't started teething at the usual time, don't be alarmed. Like other milestones such as walking and talking, every child has their own pace. It may be as late as 14 months before a tooth will emerge. In rare cases, delayed eruption may be the result of rickets, a vitamin D deficiency. If your child hasn't begun teething by 18 months, see your GP to rule out this possibility.

Decay in babies teeth can be caused by frequent exposure to liquids containing sugars, including milk, formula, and fruit juices. The sugary liquids collect around the teeth for long periods of time, particularly as your baby sleeps, leading to cavities that first develop in the upper and lower front teeth. Try to prevent your baby falling asleep with a bottle of juice or milk, instead, when your child is ready to sleep give a bottle filled with water. If you breastfeed, avoid letting your baby nurse continuously and after each feed, wipe your baby's teeth and gums with a clean, damp washcloth.

Caring for your childs teeth

Brush your childs teeth thoroughly, twice each day, using a small pea-sized amount of fluoride toothpaste or a tiny smear for babies. Start brushing as soon as your babys teeth start to come through. Buy a baby toothbrush or one with soft bristles for older children and use it with a tiny smear of fluoride toothpaste. You can also clean your babys teeth by wrapping a piece of damp gauze with a tiny amount of fluoride toothpaste over your finger.

Check with your dentist whether baby toothpaste has enough fluoride for your babys needs. Dont worry if you dont manage to brush much at first. The important thing at the start is to get teeth brushing accepted as part of the everyday routine.

Gradually start to brush your childs teeth more thoroughly, brushing all the surfaces of the teeth twice a day. Not all children like having their teeth brushed, so you may have to work at it a bit. If it becomes difficult, try games, or try brushing your own teeth at the same time and then help your child to mimic you.

How to brush

The best way to brush a babys teeth is to sit him or her on your knee with the head resting against your chest. Stand behind an older child and tilt his or her head upwards. Brush the teeth in small circles covering all the surfaces, angling the brushes toward the gums. Let your child spit the toothpaste out afterwards.

It's a good idea to supervise your child's brushing until the age of six, following the guidelines below:

Cutting down on sugar

Its not just the amount of sugar in sweet food and drinks that causes tooth decay but more importantly, how often and for how long there are sugary things in the mouth. This is why sweet drinks in a bottle and lollipops are so bad, as the teeth are bathed in sugar for quite a long time.

From the time you start your baby on foods and drinks other than milk, avoid giving sweet things, this will to encourage a savoury taste. Watch for high sugar content in baby foods, even the savoury varieties can sometimes have large amounts. Baby drinks such as squashes and syrups, especially fizzy drinks, should be avoided.

If you give your child sweet foods and fruit juice try to limit these to mealtimes to avoid tooth decay. Well-diluted fruit juice containing vitamin C can be given with a meal, as this can help iron to be absorbed. It is better to give milk or water between meals.

Try to find treats other than biscuits or sweets and ask relatives and friends to do the same, instead use things like crayons or small toys.

If children are given sweets or chocolate, it is less harmful for their teeth if they eat them all at once and after a meal, than if they eat a little every hour or so.

Avoid giving baby juices or sugar-sweetened drinks at bedtime or in a bottle, and keep drinking times short. Only milk or water should be given as a drink during the night, unless your baby is still feeding in the night.

Try to avoid giving drinks containing artificial sweeteners such as saccharin or aspartame. If you do, dilute with at least 10 parts water to 1 part concentrate.

Ask your pharmacist and doctor for sugar-free medicine for your child.

Looking for sugars on the label

The following are sugars that can cause dental decay sucrose, glucose, dextrose, maltose, fructose, hydrolysed starch.

Invert sugar or syrup, honey, raw sugar, brown sugar, cane sugar, muscavado and concentrated fruit juices all contain sugars.

Fruit juices contain sugars, which can cause decay too. Always dilute these.

Maltodextrin is not a sugar, but may cause decay.

Taking your child to the dentist

You can take your child to be registered with a dentist under the NHS as soon as your child has been born, even before any teeth come through. In addition to monitoring your child's dental growth and development, dentists can give you information about tooth development, the need for fluoride, how to help your child maintain proper oral hygiene, diet and nutrition, and how to prevent oral injuries. NHS dental treatment for children is free.

Take your child with you when you go to the dentist, so that going to the dentist becomes a normal event. Try to emphasise that a dental visit is a positive experience and explain that visiting the dentist helps maintain good oral health. If you can create a positive attitude your child will be more inclined to see a dentist regularly throughout life.

If you need to find a dentist, you can ask at your local clinic or contact your local health authority.

Fluoride

Fluoride is a natural element found in our diet, mostly in fish and tea, which can help prevent tooth decay. It is also present in many water supplies, but usually at a level too low to be beneficial.

In areas with little or no fluoride in the water, some children may benefit by taking fluoride drops (for babies) or tablets as dietary supplements. They should not be used in areas with fluoride naturally present or artificially added to the water, as an excessive fluoride intake is undesirable. Therefore advice from your dentist is essential before giving them. Fluoride in toothpaste is very effective for babies use a tiny smear and for children only use a small pea-sized amount on the brush.

Thumb sucking

The sucking reflex is normal in babies, however, a thumb or finger sucking habit in older children can cause problems. The growth of the mouth and jaw, and position of teeth, may be affected if it continues after permanent teeth have come through, between the age of four and seven. Front teeth that point outwards and an open bite may result from habitual thumb or finger sucking. This can cause problems in adulthood that include premature tooth wear, increased dental decay and discomfort on biting.