Do you remember your first visit from the Tooth Fairy? Perhaps she left you money or a small gift in exchange for that first little baby tooth to drop out. The different stages of dental development mark meaningful milestones of childhood. As children experience teething, the natural loss of baby teeth and the emergence of permanent adult teeth, parents and pediatricians have important roles to play promoting dental health. Together with your child’s dentist, I want to help you learn how to care for your child’s teeth at each stage.

What to expect

The first teeth to appear are usually the lower central incisors. teething pediatric dental healthThese usually appear between 6 and 10 months of age and at least by 16 months. These are followed by the upper central incisors, then the lower and upper lateral incisors, the first molars, the canines and the second molars (usually in that order). Of course, some babies forget to read the rules and get their teeth in a different order! Most babies have all their baby teeth by 30 months of age.

Generations of parents have noted that teething infants may be cranky, drool, have irritated looking gums and like to chew on things. While some infants are warmer than usual when teething, research shows us that teething does not cause fevers at or above 100.4 degrees (the number doctors consider to be a fever). Giving babies something cold to chew on like a teething ring can help with their discomfort. Be careful not to give babies anything with small parts that may be choking hazards. Recently, teething necklaces have become popular but I do not recommend these as the beads can break free and choke babies. I also discourage use of numbing medications like Oragel or viscous lidocaine. These medicines have no proven benefit and can cause a life-threatening condition called Methemoglobinemia.

Your Child's First Dental visit

Children should begin to see a dentist beginning as early as 1 year but no later than 3 years. We recommend a pediatric dentist as these providers are specially trained to care for the unique needs of children’s teeth and are skilled at putting kids at ease.


When can I expect a visit from the tooth fairy?

When can I expect a visit from the tooth fairyMost children begin to lose their baby teeth around 6 years of age. It is abnormal to lose these teeth before age 4 years and such loss may be the sign of a medical problem. The first teeth to go are the upper or lower central incisors.


What about cavities?

One of the primary goals of pediatricians and pediatric dentists is to prevent cavities or dental caries. The earliest signs of cavities are chalky, white spots on the teeth. If these spots are identified early, improved brushing, plaque removal at the dentist’s office and the application of fluoride to the teeth can reverse these changes. This is one reason why frequent visits to the pediatrician are important in the early years.

The following list describes situations that may place your child at particular risk for cavities. You may notice that we ask you about these situations during well visits. Gathering this information helps us reduce your child’s risk.

  • Parents with active cavities
  • Breastfeeding or bottle feeding past 12 months of age
  • Using a sippy cup containing anything other than water in between meals
  • Frequent consumption of sugary snacks and drinks including natural juices
  • Exposure to second hand tobacco smoke
  • Insufficient fluoride
  • Insufficient brushing that allows thick plaque to develop on teeth
  • Genetic characteristics of teeth

How can I reduce my child’s risk for cavities?how can I reduce my child's risk for cavities

  • Limit any juice consumption to meal-time only. This includes watered down juice. Remember, we encourage children to avoid juice altogether!
  • Avoid any consumption of carbonated drinks
  • Avoid sugary foods especially sour, acidic or gummy snacks like RingPops and Gummy Bears
  • Brush teeth twice daily
  • Floss daily as soon as the teeth start to touch each other on the sides
  • Do not allow children to be exposed to second-hand tobacco smoke
  • Make sure your child is receiving adequate fluoride from these 3 sources:
  1. Fluorinated drinking water
  2. Fluoride toothpaste
  3. Fluoride applications to the teeth at the dentist or the pediatrician’s office

Proper Hygiene

As soon as the teeth emerge, they should be cleaned with a soft cloth or toothbrush twice daily. Proper hygiene pediatric dental healthParents should apply a very small amount of fluoride toothpaste to the toothbrush. How much is that? It’s either an amount the size of a grain of rice or a smear that covers only ½ of a child-size toothbrush like so.

Flossing is also critical to the prevention of cavities. Start helping your child floss their teeth once a day as soon as the teeth begin to touch one another. Pre-threaded flossers can make this job easier. Children often resist brushing and flossing at first. You may want to sit down with your child in your lap facing a mirror. You can then reach around them to clean the teeth. If you practice this consistently, children will soon accept it as part of their routine.


When I was 4 years old, I thought it was a good idea to jump off the swing when it was at its highest arc. After I landed on my face and broke off a portion of my front tooth, it seemed like less of a good idea! Many types of injuries can result in a broken or loose tooth or a tooth that has completely come out of the gum. If this happens, push the tooth back into the socket as soon as possible. You can give your child a towel or a piece of gauze to bite down on to hold the tooth in place. If you have a piece of broken tooth, place it in a cup of milk. Call your dentist immediately.

Of course, if your child has sustained other head or mouth injuries that concern you, call our office at (919) 467-5543.