The importance of baby teeth

By Dr. Ashley Thean
Obstetrician and Gynaecologist
B.D.S (Melbourne)

Baby teeth, also called "deciduous teeth," are a part of a child's health that is often overlooked. Many parents believe that deciduous teeth are not overly important, that they are just a temporary stage before being replaced by adult teeth. But the baby teeth are important for the growth of the adult teeth and for the child's speech, function, and a beautiful smile. Tooth decay can lead to abscesses in a child's mouth, an infection that leads to pain and discomfort. Treating tooth decay as a dentist may then require extractions or pulpectomies (nerve treatment for deciduous teeth), and these possibly negative experiences may alter the child's perception of the dentist, leading to avoidance of dental issues out of fear as they grow up.

To keep the baby teeth healthy, it is important to pay attention to the child's diet, how often they brush their teeth, how much fluoride they get, and how often they go to the dentist.

What are some important things to look out for as my baby is growing?

1) Teething

Teething is a group of symptoms that can happen when baby teeth come in. These symptoms vary, from red and swollen gums, lack of appetite, discomfort, drooling, as well as difficulty in sleeping. If these symptoms are observed, please consult your pediatrician as there may be other issues at hand.

Ways to combat a teething baby include rubbing the baby's gums with a clean finger or wet cloth, or giving them cold teething rings or toys. If you intend to give your baby medication such as pain relief or numbing creams for the gums, please check with your paediatrician first.

 2) Injury to your baby's mouth

If an injury occurs to your baby's mouth, you should contact your dentist immediately. This is so we can look at your teeth and figure out the best way to treat you. If your child is in pain and the tooth is chipped or broken, you may want to give mild pain relief and, if possible, bring the tooth fragment to show your dentist.

If the tooth is completely knocked out of the mouth, take the tooth to your dentist immediately. Try to be as gentle as possible with the tooth and store it in milk until your dental appointment.

 3) Thumb sucking

You should not allow your child to suck their thumb beyond the age of four. Thumb sucking at an older age leads to crooked, crowded teeth and bite problems. This can also happen if the baby uses the pacifier for a long time. In the future, they may need orthodontics to fix their bite.

Dental decay and diet

Dental decay can manifest as dark, coloured lesions on the surfaces of the teeth. According to the National Dental Centre (Singapore), early childhood caries (ECC) affects 40% of our preschoolers. ECC is a severe form of dental decay that can make it difficult for children to eat or sleep well.

Looking after the child's diet is of utmost importance. As a parent, you have full control over the child's diet for the first few years; foods containing sugar should be avoided as much as possible. When you put sugar in your mouth, bacteria in dental plaque turn this sugar into acid, which is strong enough to cause tooth decay. Sugar can last up to 20 minutes after a snack has been finished, and this is why it is important to not only limit sugar in the diet but to avoid snacking as well.

Children should try and eat a well-balanced diet, sticking to core foods and having three proper meals a day. Any snacks should be limited to meal times. This is because excess saliva produced during meals can help wash away the extra sugar and acid that cause tooth decay. If your child did have something sweet to eat, try to brush their teeth right away. If this is not possible, drink lots of water or rinse the mouth with water.

The most frequent cause of ECC is letting your baby fall asleep with a bottle of milk or any other sugary drink. Parents should try and avoid overnight feeding as milk can pool in your child's mouth and stay on their teeth. This allows for the formation of acid-producing bacteria. Combined with the fact that saliva flow is greatly reduced at night, this bad habit can lead to rapid destruction of tooth structure.

At what age does my baby need to start brushing?

Good oral habits should begin at a very early age, even before the first tooth arrives. Start cleaning your child's mouth now, even if they do not have any teeth yet. Do this by gently wiping the mouth clean with a wet cloth or a small thimble-like soft rubber device that fits over your index finger to rub off excess food.

Once the first tooth erupts at about six months, brush the teeth twice daily with a toothbrush. Start children with a small, soft-bristled, colorful toothbrush with a big handle. Use a circular wiggling motion, especially where the tooth meets the gums. From the age of two, or once your child knows how to spit, start them with a pea-sized amount of low-concentration fluoride toothpaste. You can ask your family dentist to demonstrate proper toothbrushing at your child's first dental visit. Parents should always watch their kids brush, and every three months, they should get a new toothbrush.

Is fluoride good for me?

Fluoride is beneficial for preventing cavities and strengthening tooth enamel. It is in the tap water in Singapore, in toothpaste, in some mouth rinses, and in gels and varnishes that are put on by professionals.

While fluoride provides a wide range of benefits, its use in children must follow recommendations according to the child's age. When teeth are still in the developmental stages, excessive use of fluoride can lead to fluorosis, a process that changes the way teeth develop. Fluorosis can be mild and only change the colour of the tooth, or it can be severe and make the whole tooth brown and weaken the tooth.

For children under the age of 6, fluoride tablets, gels, and mouth rinses are prohibited under the European Acaedmy of Paediatric Dentistry (EAPD), American Dental Association (ADA), as well as the Australian Dental Association (ADA). This is especially so in Singapore as our tap water is already fluoridated at 1 part per million (ppm), and additional fluoride supplements may not be necessary.

Age group	Concentration of fluoride in toothpaste	Amount
6 months to 2 years	500 ppm	Pea sized
2 to 6 years	1000 ppm	Pea sized
6 years and up	1450 ppm	1-2 cm

EAPD recommended guidelines for toothpaste use in children

Young children have a high tendency to swallow toothpaste, so you should only switch to a fluoride-containing toothpaste once your child is able to spit. For all children below the age of six, toothpaste should be used under adult supervision.

It is imperative to balance the protective effect of fluoride against dental caries and to also minimise the risk of fluorosis. For children with rampant dental decay, you may consider additional fluoride-related treatment modalities based on the advice of your dentist. For more information about the oral health benefits of fluoride, please ask your dentist.

When should be my baby's first visit the dentist?

The first visit to the dentist should be right after his or her first birthday. At your child's first appointment, the dentist can keep you informed about caring for your baby's first few teeth, offer advice regarding oral hygiene recommendations, diet and nutrition, and inform you on how to avoid possible problems.

The second visit should be when your baby is 3 years old, when the full set of the deciduous dentition has erupted (20 teeth in total). The goal of this visit is to look at all the baby teeth to see if they are decaying or if there are any problems with how they are growing. A preventive dental programme may then be redesigned based on these findings.

Subsequent dental visits should then continue every 6 months. At every appointment, the dentist will continue to review your child's dental growth and development and will adjust the preventative programme tailored to your child. If necessary, fluoride treatment may be recommended at this stage.

The first few appointments your child goes through play an important role in their subsequent dental visits in the future. Children need to experience the clinical environment and slowly grow accustomed to seeing the dentist. Look for a dental clinic that is child-friendly, patient, gentle, and focused on your child's specific needs.