Pediatric FAQ

When do a newborn’s teeth first appear?

The first set of teeth are called primary teeth. There are 20 of them and they are already present at birth in the baby’s jawbones. The front four teeth, the central incisors, are the first to erupt, usually beginning at six months after birth. Next to erupt are the lateral incisors that lie next to the central incisors. At about 13 months, the first molars may appear, followed shortly thereafter with the canines. The second molars erupt last, approximately two years after birth. In general, the upper and lower primary teeth erupt at about the same time (for each of the positions described). There is considerable variability, so don’t be concerned if your baby’s teeth are appearing up to four months later than these time periods. Incidentally, shedding of the primary teeth are usually in the same order as erupting, beginning with the central incisors about 6-7 years and ending with the second molars at about 10-12 years of age.

My child has only two teeth and they appear greyish in color. Is this decay?

This may be decay if your baby has been sucking on a bottle with formula or juice for long periods of time. Other possibilities include tooth trauma, congenital (birth) abnormalities in the enamel, or iron supplementation. If your child is taking a liquid vitamin and mineral supplement with iron, this is likely the cause of tooth discoloration. This does not harm the teeth and the staining is reversible. If the discoloration is annoying you, try cleaning your child’s teeth immediately after vitamin and mineral supplementation to minimize staining.

How much concern is there with an injury to my child’s baby teeth, knowing they are replaced eventually?

The main concern with injuries to primary (baby) teeth is the effect on permanent teeth. Permanent teeth develop under the roots of primary teeth. Thus, any injury or infection of a primary tooth can affect the permanent tooth. The permanent tooth may have an altered appearance at eruption, depending on when the event (injury/infection, etc.) occurred. For example, the enamel could be inadequately formed in amount or quality.

What are proper brushing and flossing procedures for small children?

For infants about 6 to 24 months of age, begin brushing their teeth with a soft-bristled, infant toothbrush. Continue cleaning other areas of their mouth with a gauze pad or a washcloth after feedings and before bedtime. For children 2 to 6 years of age, allow them to brush with their own interest and dexterity, but remain responsible by assisting and encouraging them to brush. Use small (pea-sized) amounts of fluorinated toothpaste and be sure that all of the toothpaste is rinsed or wiped from the mouth after brushing. Begin flossing in any area where teeth are touching. For older children, transfer the responsibility of brushing and flossing to them when you sense they are doing a thorough and proper job.

Does thumb sucking cause crooked teeth?

Thumb sucking definitely can cause dental changes. The dental changes from a vary on intensity, duration, and frequency of the habit. Duration is probably the most critical. Four to six hours of force generally leads to movement of the teeth. Classic signs of thumb sucking are 1) front teeth do not touch when biting, termed “anterior open bite” 2) upper front teeth are farther forward than lower teeth, termed “increased overjet” and 3) a narrow upper arch, termed “maxillary constriction”. 

When do permanent teeth appear?

There are 32 permanent teeth, 16 upper and 16 lower. Usually the first permanent teeth to erupt are the first molars at about 6-7 years of age. They are often mistaken for an infant’s primary teeth, because they don’t replace any primary teeth. Between 6-8 years of age, the central incisors will appear, followed quickly by the lateral incisors. The canines, first premolars, and second premolars erupt between the ages of 9-12 years. The first and second premolars replace the infant’s primary molars. The second molars surface at 11-13 years, while the wisdom teeth, if they erupt, appear at about 17-21 years of age. There is considerable variability, so don’t be concerned if your child’s teeth are erupting sooner or later than these age ranges.

What is a sealant?

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces of the back teeth (premolars and molars), where decay occurs most often. The purpose of a sealant is to act as a barrier, protecting the areas of the teeth from plaque and acid that cause tooth decay. Sealants are more effective than fluoride in protecting the pits and fissures that form naturally in the surfaces of the tooth’s enamel. They are particularly beneficial for children’s teeth, especially the newly erupted permanent teeth. Sealants may last for several years, but the protective effect wears away with time. Therefore, have your sealants checked regularly to determine if reapplication is necessary. 

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