The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear. Next to break through the gum line are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child experiences significant delay, speak to your doctor.)

In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.

Adult teeth, or molars, come through around the age of 5. They appear at the back of the mouth. After this happens, children begin to lose their 'milk' teeth. The lower front teeth are usually lost first. By the age of 13 all adult teeth should be in place (except wisdom teeth).

When do wisdom teeth appear and will my child have problems?

Wisdom teeth can arrive at any time after the age of 18 and it is a common misconception that they always cause problems. As long as your child is going to visit the dentist regularly you should have fair warning if the wisdom teeth are going to cause a problem later.
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At what age should I start taking my child to the dentist?
Here at Haynesdental we strongly encourage you to bring your children to the dentist for their regular six monthly check up as soon as they are 2 or 3 years old. Even if they have no official appointment we recommend that children should start coming to the dentist as soon as possible - every time someone in the family has an appointment then bring them along too! A child who sees his relatives having a pain free experience at the dentist is more likely to trust the dentist the first time they get in the chair. These visits will and prepare them for their future appointments.

We normally like to see children for their first examination at around 2 and half years of age. You should then bring them regularly, as often as your dentist recommends - normally every six months. Remember, good habits started now will last them through life and the earlier these visits begin, the more relaxed the children will be.
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My child is worried about visiting the dentist - what can I do?

Regular visits to the dentist are essential in helping your child to get used to the surroundings and what goes on there. In the practice we recognise that children can be scared of the dentist - even the uniforms and masks we wear, or the smells, can make a child nervous so we try to keep them at ease at all times.

If you are fearful of the dentist yourself then it is imprtnat not to let your children see that. Try to be reassuring if you have any worries discuss them with the dentist when your child is not with you.

If you have a child that is nervous, please let us know and we will be happy to try and put them at their ease. We can talk them through any procedures and show them the equipment so that they are less fearful about what we are doing.

For those children that are really nervous we can refer them to the dental team in hospital for sedation, but hopefully if you have followed the above advice it will not be necessary.
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What can I do to prepare my child for their visit to the dentist?
For younger children we recommend that you prepare your child for their visit by playing 'dentists' with them at home: let them dress up as dentists and pretend to give you an examination - you can even examine their cuddly toys and give their dolls a check up! There are also a number of books published about going to the dentist (see below) that may help you discuss with them what may happen during their visit and allay their fears.

Older children may appreciate being shown this website - show them the animations on the site and the picture of the dentist (see here) that is going to see them and talk through their fears. Again, books may help.

All these things mean that your child will know what to expect when they come and is less likely to be scared. We are all friendly dentists here and do not want our patients, young or old, to be scared of us!
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Do you provide sedation?
Whilst we provide local anaesthetics, we do not offer general anaesthetic or sedation at this clinic - if your child requires this they will be referred to hospital.
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What is the best way to clean my child's teeth?
From the minute your baby starts getting teeth they should be having them cleaned morning and night. When your baby is teething they may even find it soothing having their teeth cleaned - especially as you need to make sure that you rub their gums too. Just use a small soft toothbrush or rubber brush that goes on the end of your finger, and a small amount of children's toothpaste. 

Remember, that children should not be left to brush their teeth unsupervised until the age of 7 as their manual dexterity is not developed enough. We would suggest that you offer them lots of encouragement to help them learn the best way of cleaning and that you hep them by gently holding their chin in your hands so you can reach all the sides of their teeth easily. You may find it easier to stand behind them. 

If possible make tooth brushing the last thing your child does before going to bed and that includes brushing after their bedtime bottle or breastfeed. Remember that breastmilk and formula are high in sugars and leaving them on the teeth overnight can result in tooth decay by the time your child even comes to the dentist for their first visit.

Children who have their 20 milk teeth should be brushing their teeth twice a day for two minutes each time - sometimes it is useful to use a timer - we normally give these out free to children who see us at Haynesdental. Try not to treat toothbrushing as a chore - a good way to encourage tooth-brushing when they are younger is by giving them a new toothbrush and toothpaste set for a present - you will be amazed how often they will want to use their new 'present'.
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Do I need to use fluoride toothpaste?
In London, the PCT recommends that all children up to 3 years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Once a child is three years old, they should use a toothpaste that contains 1350ppm-1500ppm of flouride. Most family toothpastes have a level of at level1400 ppm, some children's toothpastes are much lower: please check the level of fluoride on the packaging of the toothpaste. Please do make sure though that children spit out the toothpaste and rinse their mouth in order to avoid swallowing as little as possible.
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What sort of brush should children use?
For babies with teeth just starting to emerge we recommend rubber brushes that go over your finger allowing you to clean the teeth with some dexterity.

Once your baby has more than 3 or 4 teeth through, there are many different types of toothbrush to choose from - it all depends on your taste and budget and what suits your child - perhaps when they are a bit older you can let them choose one they like the look of - as long as it has the right size of head suitable for the age of your child.

When your child is much older and brushing independently it might be worth looking into getting them their own electric toothbrush or their own heads for yours - as long as they are supervised when they are using it and don't press too hard they can be very effective.
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Is teething painful and how can I help relieve it?
Children and babies of any age can suffer from teething pain - whether they are cutng their first teeth or getting their adult ones through. Babies can display any one of a number of symptoms such as red cheeks, high temperature, nappy rash - and of course dribbling. Try to keep a cloth handy so you can keep wiping their face to stop rashes occurring.

Give your baby something to chew on. Make sure it's big enough so that it can't be swallowed and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid -- just be sure to wash it after each use. Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, be sure to take it out of the freezer before it becomes rock hard -- you don't want to bruise those already swollen gums! and never tie a teething ring around a baby's neck -- it could be a choking hazard.

Teething gel containing painkillers is available from your local pharmacy but make sure you only use those that are specifically for teething - do not use adult products like Bonjela. Using clean hands, gently apply the gel with your finger and massage the gums. Alternatively you can use homeopathic teething powders which contain Chamomila which is said to calm down inflammation.
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My older child has toothache - what is causing it?
When adult teeth start to come through behind milk teeth it may cause some pain - also wisdom teeth can be painful when breaking through as they cut through virgin gum. Having said that, the most common cause of toothache is usually tooth decay caused by too much sugar or acid being eaten. Make sure that you take your child to the dentist if they complain of toothache. If you do need to give them pain relief, make sure you use a sugar free medicine.
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How can I prevent tooth decay in my child?
There are many things you can do to prevent decay but apart from regular check-ups the most obvious are:

1. Brush Regularly! Make sure your child brushes their teeth morning and night with toothpaste

2. Avoid sugary snacks! the main thing you can do to prevent tooth decay is restrict the number of times your child has sugary or acidic food. Make sure you check food labels and watch out for 'disguised' sugars in the form of fructose, glucose, lactose or sucrose. Even baby foods can have high concentrations of sugar. If you want to give your children something sugary then or sticky then try not to do it between mealtimes - this allows the sugar to coat the teeth. Giving a sweet snack with a meal means that the natural saliva and bacteria in the mouth caused by eating a meal can help break down the sugars and protect the teeth enamel.

3. Be careful with juice! Juice may sound healthy but actually contains a lot of sugar and acid that attacks the teeth. So another big no no is adding juice to a baby's bottle. Never do it! Juice being sucked through a teat will coat the teeth and make it harder for your babies mouth to fight decay. If you give your children juice, then use a straw as that delivers the drink to the back of the mouth and so it bypasses a lot of the teeth!

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Can I talk to the dentist about my child's diet?
We know it can be very confusing for parents to choose the best diet for their child as we are always being told different things by the press about what is good or bad for your child's teeth. For example many parents are conscientious about brushing their children's teeth straight away after a sugary snack but don't realise that if it has a high acid content (like an apple) they may be doing more damage by rubbing the acid into the teeth and would be better to wait an hour. Having said that, it is healthier for your child to have an apple rather than a biscuit!

If you have any concerns about your children's teeth we are happy to give you advice - just feel free to ring anytime or talk to us when you visit. 
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How can I help my older child/teenager keep their teeth bright and healthy?
It is important to always brush twice a day with a fluoride toothpaste to remove plaque. Plaque is the main cause of tooth decay and gum disease. Also, encourage them to floss daily to remove plaque from between teeth and under the gumline. If plaque is not removed daily, it can harden into tartar-an unsightly, hard yellow build-up. Very unsightly! Limit their intake of sugary or starchy foods, especially sticky snacks. Visit the dentist regularly for professional cleanings and check up's. Point out to them that if they have a clean bright smile and healthy it will make them feel good and give them more confidence.
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Can teenagers have their teeth whitened?
We do not usually recommend whitening for children under the age of 16 but if you have staining your dentist will advise you on the best course of action.
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How can my teenager keep their teeth clean whilst wearing orthodontics?
If you wear braces extra care should be taken to clean in and around the braces. Removeable braces will need cleaning every day to prevent food sticking to them then teeth should be cleaned as normal. Fixed braces will need a bit of extra care. Braces make it harder to remove plaque. Brackets, bands and archwires create nooks and crannies that are hard to reach, therefore cleaning can take up to three times longer. Poor oral hygiene (cleaning) during orthodontic tooth movement can accelerate deterioration of your gums and the bone around your teeth leading to tooth loss. Flossing whilst you wear braces is even more important and waxed floss tape should be used - others will shred. The floss must be placed under the main wire before it is passed between the teeth - alternatively interdental brushes can be used.
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What other issues could affect my teenagers teeth?
Eating disorders - If your child suffers from bulimia and anorexia it can seriously erode their teeth - please tell your dentist if this is happening to your child.
Mouthguards - if your children play sports then it is advisable to get them a mouthguard to prevent any injuries to their teeth - they are worn over the upper teeth but if they wear braces they may need a lower guard too.
Smoking - apart from causing other health problems smoking is linked to gum disease and can cause heavy staining on teeth and bad breath. Discourage your teenagers from smoking by pointing out that no-one wants friends with halitosis!
Drinking - again, we hope that your child is not undulging in underage drinking due to the widely known health problems that can occur but most alcoholic drinks are also heavily acidic and because they are 'sipped' over a length of time they can cause more dental erosion.
Oral Piercings -we don't recommend any oral piercings as they can cause infections, uncontrollable bleeding and nerve damage. In addition metal jewellery can chip the teeth, damage gums and even cause choking.
Nutrition- It is important to eat a healthy diet and limit your intake of sugary snacks and drinks. Fizzy drinks like cola or pop, and even sports drinks with a high sugar content can lead to severe dental erosion - every time you eat something sugary the teeth are under attack for up to an hour. This is because the sugar reacts with bacteria in the mouth and produces harmful acids. The best drink is still water which clears the mouth. Do not brush the teeth for up to an hour after consuming acidic sugary foods to give the mouth a chance to fight off the bacteria naturally - otherwise you are just rubbing the acids into the teeth enamel.
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Other online resources that may help you with your children's teeth are here:
www.bdasmile.org
www.dentalhealth.org.uk
www.nhs.uk/livewell/dentalhealth

In an emergency:

What shall I do if my child's tooth is knocked out?
A knocked out permanent tooth is a dental emergency - baby teeth do not need to be put back in but quickly putting a permanent tooth back in its socket is key to preserving a tooth. A permanent tooth can often be saved if prompt action is taken and it is replaced within 30 minutes. To put back a missing tooth, please handle the tooth carefully and follow these steps:
1) Hold the tooth by the crown NOT the root
2) Rinse the tooth immediately with saline solution or milk (tap water should only be used as a last resort as it contains chlorine which can damage the root)
3) Do not scrub the tooth but ensure that any dirt or debris is removed
4) The best place to preserve the tooth on the way to the dentist is in its socket. If your child is old enough and mature enough not to swallow it, replace it gently, then have the child bite down on a gauze pad to keep it in place.
5) If the tooth can't be re-inserted, put it in milk (which has the same chemical make-up as teeth and acts as a preservative) or if milk is not available put it inside your own mouth, between your cheek and lower gum and get to a dentist or hospital as soon as possible. Give your child a gauze pad or handkerchief to bite down on, which will help lessen the bleeding and ease the pain.

What shall I do if a permanent tooth is chipped or broken?
1) Collect all the pieces of the tooth
2) Rinse the damaged area of the mouth with warm water
3) Give the child a cold compress to hold on the injured tooth
4) See a dentist straight away. If the tooth is chipped badly and you can see pink on the bit of tooth that is left then that means the root is exposed on the tooth and the dentist will need to do some remedial work before the chipped pieces can be stuck back together.

What shall I do if my baby or toddler has injured their gums or teeth?
1) If there's bleeding put cold water on gauze and apply pressure to the site
2) To reduce swelling give your child ice to suck
3) Call a dentist as he may want to see the child to assess the need for re-alignment or removal of a very loose tooth. If the child is very young, the dentist may recommend a spacer to keep the rest of the teeth in place until the permanent tooth appears.
4) Over the following week watch for signs of an abcess such as fever and swollen or tender gums.
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