For March 21st, 2006 Health column:
The Independent
Teething: A 21-Year Process
By Tareq Khalifeh, DDS

The arrival of your child’s first baby teeth in the first year of life is an exciting development, even though it’s often accompanied by excessive drooling and cranky baby behavior. But many parents tell me they are confused about the progression of teeth eruptions after those first incisors arrive, about when to start dental hygiene, when to worry if the teeth don’t seem to be coming in properly., and how to handle emergencies involving their children’s teeth and gums.

This article will briefly address those concerns.

The Order of Teeth Eruptions
The vast majority of children develop their primary (baby) and permanent teeth on a predictable development schedule, shown in the charts below from the American Dental Association, (see Resources list below). Children’s teeth begin forming before birth, and by birth most babies have 20 teeth in their jaw, although they don’t start erupting – that is, breaking through the gums – until four to six months of age, starting with the incisors. The molars follow over the next 24 months.

These baby teeth are shed at various times throughout childhood to make room for the permanent teeth. Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21, by which time the young adult will have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

When to Start Dental Hygiene
It is very important to maintain the health of these primary teeth with brushing and regular dental visits. The earlier you begin, the easier it will be for the child to become accustomed to the idea that tooth care is part of everyday activities. Decay is the number one problem that dentists see in children’s teeth. Parents should start brushing their children’s teeth early, by one year of age, and should take them to see their dentist when they are one-year old to check their oral health and get fluoride applications to protect the tooth enamel against decay.

The pre-schooler and early school-age child should brush and floss their own teeth twice a day, with parental supervision. Older children should be taught to brush and floss their own teeth, and should have twice-yearly teeth cleaning and checkups.

Neglected cavities in baby teeth can and frequently do lead to problems that will then affect developing permanent teeth. The primary teeth are key to proper chewing and eating. They provide space for the permanent teeth and guide them into the correct position. And they permit normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front four teeth (incisors) last until 6 or 7 years of age, the back teeth (cuspids and molars) don’t get replaced with permanent teeth until somewhere between ages 10 and 13.

Discomfort and Orthodontics
The teeth shift considerably in the mouth as they come in. This process can cause considerable discomfort, which can be alleviated with Tylenol or Motrin (never aspirin!). Annual x-rays, and a full set of radiographs every three years enable your dentist to track the development of the teeth, to spot possible impactions or other alignment problems, and to identify troublesome decay.

Children who do not have enough room in their mouths for the erupting teeth will sometimes be referred to an orthodontist starting at around age 11 or 12. Earlier orthodontic assessment is sometimes needed, but most orthodontists want all of the permanent molars teeth to erupt before beginning to use any corrective braces.

Preventing and Handling Injury
Active children, particularly those involved in rugged sports, can injure teeth and gums as well as bones and ligaments. Soft plastic mouth-guards can be used to protect a child's teeth, lips, cheeks and gums from sport-related injuries. Ask your dentist about creating a custom-fitted mouth-guard to protect your child from injuries to the teeth, face, and head.

If a child falls or has a run-in with a ball or other hard object, they may crack or even knock out a tooth. The most important thing to do is to remain calm. Then find the tooth. Hold it by the crown rather than the root and try to reinsert it in the socket. If that is not possible, put the tooth in a glass of milk and take your child and the glass immediately to your dentist.

Actually, active adults are at risk for these injuries, too, and the same precautions and emergency responses apply to them.

Resources
For more information about tooth development and care, you can consult the following Websites:
American Academy of Pediatric Dentistry
American Orthodontic Society
American Dental Association

Charts:

Source: American Dental Association

PERMANENT TEETH

Dr. Khalifeh owns the Philmont Family Dentistry located on Rte 217 in Philmont, NY. A graduate of the New York City School of Dentistry, he completed his residency at Albany Medical Center and practiced in Albany until 2004. For more information, call 672-4077.