Children's Dentistry

Children's needs are often different to what we need as adults.
Taking children to see a dentist from an early age on a regular basis is very important.
Prevention is key! Focus on good habits at a young age which can be carried forward into adulthood.
Many children may benefit from orthodontic treatment. Your dentist can explain if your child is eligible and outline the treatment.

Tooth Eruption

The first primary teeth usually begin to erupt between 6 months and 1 year of age. By age 3, a majority of children have a “full” set of 20 primary teeth. We recommend that you schedule your child’s first dental appointment with a pediatric dentist when their first tooth erupts or by their first birthday.

The first teeth to emerge are typically the central incisors (the very front teeth) for the upper and lower jaws. They are followed by the lateral incisors and then the first molars. As the eruption of molars can be painful, you may want to use cool gauzes or teething rings during this stage of development to soothe your child’s discomfort. The canine teeth are usually the next teeth to erupt, followed by the second molars.

Your child will typically lose their baby teeth in the same order in which the teeth erupted, beginning with their front teeth and moving back toward their molars.

Most children follow a similar developmental pattern when their primary teeth begin to erupt. However, please remember that each child is different and that they may not follow this schedule. You may find that your child will go months without any new tooth erupting or that two or more teeth erupt at once.

PRIMARY TEETH

SECONDARY TEETH

Toothbrushing - Children aged up to 3 years

Start brushing your baby's teeth as soon as the first milk tooth breaks through (usually at around 6 months)
Parents or carers should brush or supervise toothbrushing.
Brush teeth twice daily for about 2 minutes with fluoride toothpaste.
Brush last thing at night before bed and on 1 other occasion.
Use children's fluoride toothpaste containing no less than 1,000ppm of fluoride (check label) or family toothpaste containing between 1,350ppm and 1,500ppm fluoride.
Use only a smear of toothpaste.
Make sure children don't eat or lick toothpaste from the tube.

Toothbrushing - Children aged 3 to 6 years

Brush at least twice daily for about 2 minutes with fluoride toothpaste.
Brush last thing at night before bed and at least on 1 other occasion.
Brushing should be supervised by a parent or carer.
Use children's fluoride toothpaste containing no less than 1,000ppm of fluoride (check label) or family toothpaste containing between 1,350ppm and 1,500ppm fluoride.
Use only a pea-sized amount of toothpaste.
Spit out after brushing and don't rinse – if you rinse, the fluoride won't work as well.

Toothbrushing - Children aged 7 and over

Brush at least twice daily for about 2 minutes with fluoride toothpaste.
Brush last thing at night before bed and at least on 1 other occasion.
Use fluoride toothpaste containing between 1,350ppm and 1,500ppm of fluoride (check label).
Use only a pea-sized amount of toothpaste.
Spit out after brushing and don't rinse – if you rinse, the fluoride won't work as well.
Children aged 7 and over should be able to brush their own teeth, but it's still a good idea to watch them to make sure they brush properly and for about 2 minutes.

Fluoride Supplements

https://www.nhs.uk/conditions/fluoride/

Fluoride Varnish

Fluoride varnish can be applied to both baby teeth and adult teeth by a dentist. The process involves painting a varnish containing high levels of fluoride onto the surface of the tooth every 6 months to prevent decay. It works by strengthening tooth enamel, making it more resistant to decay. From the age of 3, children should be offered fluoride varnish treatment at least twice a year. Fluoride varnish should be offered 2 or more times a year for children of all ages with tooth decay or those at high risk of developing it.

Duraphat® fluoride varnish may be prescribed for your child by a dentist. The correct dose for children with deciduous teeth (i.e. under 6 years old) is 0.25ml of Duraphat®. For children over 6 the recommended dose is 0.4ml. The toxic dose of fluoride ingestion is estimated at 5mg of fluoride per kg of child body weight (the average three year old weighs 11-20kg). The dose of 0.25ml of Duraphat® contains 5.6mg of fluoride – well within safe levels.

Fluoride Mouthwash

Fluoride mouth rinses can be prescribed for children aged 8 and above who have tooth decay. They should be used every day, in addition to brushing twice daily with toothpaste containing at least 1,350ppm fluoride. Rinses should be used at different times to brushing to avoid washing the toothpaste off your teeth, as this reduces the beneficial effects of the fluoride in the toothpaste.

First Visit

Most dentists recommend that children visit a dentist to receive an initial dental exam within six months of when their first tooth erupts. These first dental visits are designed to help your child begin developing positive associations with visiting the dentist.

A typical child dental appointment will include the following:

The dental team will greet you and your child.
They will review the health history of your child and your family.
Your dentist should ask about your child’s oral habits, pacifier use, diet and general development.
A gentle examination of your child’s teeth and gums will be undertaken, during which the dentist will note the development of the second set of teeth.
The dental team should provide advice as necessary, such as: brushing, flossing, how to prevent oral injury, fluoride intake and other topics to help you keep your child’s mouth healthy at home.
The dental team should provide a description of your child’s current oral health in detail and make any needed recommendations about oral habits, toothbrushes and toothpaste, diet, and pacifiers.
A schedule of regular appointments should be created for your child.
Address your questions and concerns.

Remember, if you are calm, your child will feel calm. You can help your child feel happier and more comfortable in the dental office by being positive and calm yourself. You can encourage your child to develop positive associations with visiting the dentist by avoiding threatening language and providing positive explanations about what will happen during the appointment.

Check Up's

Most dentists recommend bringing your child in for a visit every six months to receive a routine dental exam. Your dentist may suggest more frequent visits if needed, and encourage you to get in contact if your child suffers from a dental emergency, pain or injury.

Dental X-rays may be taken to further evaluate your child’s smile and make certain that they receive the dental care they need. Regular dental cleanings may be recommended and prevention advice given to maintain good oral health, preventing cavities and gum disease, and making sure that any damaging conditions are treated as early as possible.

X-Rays

Diagnostic investigations should be focused on the needs of each patient, not just their age. The advice is based on a number of factors, some of which are stated below:

A history of dental caries, or cavities — if the teeth can’t be inspected visually or with a probe, posterior bitewing x-rays every 6 to 12 months.
Trauma or toothache
There is a family history of unique dental problems.
Periodontal (gum) disease
Loose teeth
Unexplained bleeding or sensitivity
Check for baby bottle decay
Teeth with uncommon traits, such as aberrant eruption, growth/development, color, or other variables
Determine the skeletal maturity of the underlying bones.
Erosion
Swelling

Fillings

A dental filling is a restoration used to repair your child’s minor to moderate tooth damage. A filling may be recommended if your child’s tooth has been damaged by decay (for example, if it has a cavity) or if a tooth suffers from minor fracturing or chipping. The dental filling is used to restore the tooth to its original structure and function and return your child’s smile to good health. There are two main types of dental fillings in use today: amalgam (metal) fillings and composite fillings.

The process for placing a filling typically requires just one visit. Your dentist will first gently remove any decayed or damaged material from your child’s tooth, then clean it to remove all traces of decay, before filling the area with the filling material and shaping it. Finally, the filling is hardened for a lasting restoration.

Teeth Grinding

Bruxism, or teeth grinding, is a common occurrence in children. While bruxism can occur at any time, most children grind their teeth while asleep, usually during deep sleep phases. Your child may grind their teeth for a number of reasons, including stress, misaligned teeth, as a pain response, hyperactivity, or as a response to medication or a medical condition.

In many cases, bruxism will go undetected and with no ill effects. However, in some cases, a child’s bruxism may result in headaches, earaches, increased sensitivity to temperature, facial and jaw pain, or chipped and worn teeth. Most children will outgrow their bruxism, but until they do, you and our dentists will need to monitor them to ensure that their teeth and smile remain healthy. You can do this by taking your child to your dentist every six months for their regular appointment and by watching out for the following signs at home:

Grinding noises while your child is asleep
Pain when your child is chewing
Complaints of a sore jaw or face after your child wakes up

Your dentist can perform an exam to determine the cause of the bruxism and recommend treatments and strategies to help resolve the problem and keep your child’s bruxism from causing any further damage.

The most common treatment our dentists may recommend is a night guard, a custom oral appliance that is worn at night to prevent the teeth from touching and becoming damaged by the actions of teeth grinding and clenching. Other strategies involve helping your child relax before bedtime and resolving issues that are causing stress or upset.

Hospital Dentistry

If your child needs more intensive care and requires IV sedation or general anesthesia, they may be referred into hospital.

Sometimes, young or special needs patients also require more rigorous treatment that is best carried our in a hospital.

Your child may be eligible for hospital dentistry if they:

Have multiple, severe cavities
Serious tooth infections
They cannot tolerate a regular clinical setting

Thumb Sucking Behaviour Management

If your child has developed a bad dental habit, your dentist may be able to offer suggestions to help encourage good oral behavior and set your child up for success.

Thumb and finger sucking is normal in children under the age of 4, and most children will stop sucking on their own between 2 and 4 years of age. However, if this habit persists it can cause significant damage to the teeth and jaw, including open bites, horizontal overlap of the front teeth and crossbites. Likewise, the constant pressure of the tongue against the teeth when swallowing, speaking and at rest can force teeth and arches out of alignment.

There are many oral appliances available to help break finger sucking and tongue thrusting habits. While thumb sucking appliances work to simply discourage sucking habits, tongue thrust appliances usually involve a type of “physical therapy” that helps retrain the muscles of the tongue so that it no longer thrusts forward. Your dentist can work with you both to help break these harmful habits so that your child can enjoy good oral health and a beautiful smile.

In addition to oral appliances, your dentist may also recommend simple things that you can try at home, such as putting an article of clothing (like a glove or a sock) over the thumb and fingers or creating diversions at times when your child usually sucks his or her fingers. Your child may also suck his or her fingers due to anxiety and may stop if the source of this anxiety is found and soothed.

My child is reporting pain from a tooth, should they see a dentist?

Pain can sometimes be temporary and resolves itself:

erupting tooth
transient inflammation of the gum

However, pain often does not resolve itself and an urgent appointment should be booked if any of the below features are present:

hole in a tooth
swelling on the gum
Pain that is uncontrollable with painkillers
Pain keeping your child awake at night

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