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.

The first permanent 'adult' molars (back teeth) will appear at between 4.5-6 years of age, behind the baby teeth at the front of the mouth.The permanent 'adult' teeth will then replace the 'milk' teeth. It is usually the lower front teeth that are lost first, followed by the upper front teeth shortly after. All permanent teeth should be in place by the age of 13, except the wisdom teeth. These may erupt any time between 18 and 25 years of age. Please remember that all children are different and develop at different rates.
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When should I take 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 let them get used to the noises, smells and surroundings 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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What if my child is very nervous about going to the dentist?
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 can make a child nervous so we try to keep them at ease at all times.

Children can sense fear in their parents, so it is important not to let your child feel that a visit to the dentist is something to be worried about. Try to be supportive if your child needs to have any dental treatment. If you have any fears of your own about going to the dentist, don't discuss them in front of your child

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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How should I clean my child's teeth?
From the minute your baby starts getting teeth they should be having them cleaned morning and night and they should not be left to brush their teeth unsupervised until the age of 7 as their manual dexterity is not developed enough. Remember to encourage your child, as praise will often get results!

Cleaning your child's teeth should be part of their daily hygiene routine. When your baby is teething they may even find it soothing having their teeth cleaned. For an older child, you may find it easier to stand or sit behind your child, cradling their chin in your hand so you can reach their top and bottom teeth more easily.

Once all the teeth have come through, use a small-headed soft toothbrush in small circular movements and try to concentrate on one section at a time. Don't forget to brush gently behind the teeth and onto the gums.

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.
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Should I use fluoride toothpaste?
Fluoride comes from a number of different sources including toothpaste, specific fluoride applications and perhaps the drinking water in your area. These can all help to prevent tooth decay. In London, all children up to 3 years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a toothpaste that contains 1350ppm-1500ppm. 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. You should make sure that children spit out the toothpaste and don't swallow any if 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 children's toothbrushes available, including brightly coloured brushes, some of which change colour, those with favourite characters on the handles, and some with timers. These all encourage children to brush their teeth. The most important point is to use a small-headed toothbrush with soft, nylon bristles, suitable for the age of your child.

When your child is older 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.

If in doubt, look for the British Dental Health Foundation symbol on toothbrush and toothpaste packaging. This logo means that the product claims made on the pack are supported by scientific testing.
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Is teething painful and how can I help relieve it?
Most children do suffer some teething pains. Babies may suffer from a high temperature when they are teething and their cheeks may appear red and be warm to the touch. Also they will dribble a lot so wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing.

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.

There are special teething gels that you can use to help reduce teething pain. There are some that contain a mild analgesic (painkiller). make sure you only use those that are specifically for teething - do not use adult products like Bonjela. You can apply the gel using your finger, and gently massage it onto your baby's gums. Alternatively you can use homeopathic teething powders which contain Chamomila which is said to calm down inflammation.
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What could cause my older child to have toothache?
When adult teeth start to come through it may cause some pain - also wisdom teeth can be painful when breaking through as they cut through virgin gum.

Toothache is painful and upsetting, especially in children, and the main cause is still tooth decay. This is due to too much sugar or acid, too often, in the diet.

If your child needs pain relief, make sure you choose a sugar-free medicine and also remember to check with the doctor or pharmacist that you are being prescribed sugar-free medicines at all times. If the pain continues then contact your dentist for an appointment.
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How can I prevent tooth decay in my child?
The main cause of tooth decay is not the amount of sugar or acid in the diet, but how often it is eaten or drunk. The more often your child has sugary or acidic foods or drinks, the more likely they are to have decay. It is therefore important to keep sugary and acidic foods to mealtimes only. If you want to give your child a snack, try to stick to cheese, vegetables and fruit, but not dried fruit.

It is also worth remembering that some processed baby foods contain quite a lot of sugar. Try checking the list of ingredients: the higher up the list sugar is, the more there is in the product. Sometimes, these are shown as fructose, glucose, lactose or sucrose. Thorough brushing for two minutes, twice a day, particularly last thing at night, will help to prevent tooth decay.
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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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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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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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