The importance of primary teeth

Maintaining the health of the primary teeth is crucial. Neglected cavities can and often do lead to problems that affect developing permanent teeth. Primary, or baby, teeth are important for:

  1. chewing and eating properly;
  2. providing space for the permanent teeth and guiding them into the correct position; and
  3. permitting 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 last until age 8, the back teeth (molars) stay intact until age 13.

Formation of your child's teeth

Children's teeth start forming before birth. As early as 4 months, the first primary (or baby) teeth erupt through the gums. These are the lower central incisors, followed closely by the upper central incisors. By age 3, all 20 primary teeth have usually appeared, though the pace and order of their eruption varies.

Your child's permanent teeth will make an appearance around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 32 permanent teeth including the third molars (or wisdom teeth).

The best toothpaste for children

Tooth brushing is one of the most important tasks for good oral health.

Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. Parents should use a tiny smear of fluoride toothpaste to brush baby teeth twice daily as soon as they erupt and a soft, age-appropriate sized toothbrush. Once children are 3 to 6 years old, then the amount should be increased to a pea-size dollop and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively. Children should spit out and not swallow excess toothpaste after brushing.


Sucking is a natural reflex; infants and young children may use thumbs, fingers, pacifiers and other objects. Sucking may make them feel secure and happy, or provide a sense of security. Since thumb-sucking is relaxing, it may also help them sleep.

Thumb-sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth, as well as tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb-sucking by the time their permanent front teeth are ready to erupt. Usually, they stop between the ages of 2 and 4.

Pacifiers are not a substitute for thumb-sucking. They can affect the teeth in a similar way as sucking fingers and thumbs. A pacifier, however, is easier to control and modify than the thumb or finger habit. If you have concerns about thumb-sucking or the use of a pacifier, consult the dentist.

A few suggestions to help your child get through thumb-sucking:

  • Instead of scolding your child when they are thumb-sucking, praise them when they're not.
  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety instead of thumb-sucking.
  • Reward your child when they refrain from sucking during a difficult period, such as being separated from you.
  • The dentist can encourage your child to stop sucking and explain what could happen if they continue.
  • If these approaches don't work, please talk to Dr. Rachel and our team about other possible suggestions

Pulp therapy

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in pediatric dentistry is to maintain the vitality of the affected tooth so the tooth is not lost.

Dental cavities and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a nerve treatment, root canal, pulpectomy or pulpotomy. The two common forms of pulp therapy in children's teeth are pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. Last is a final restoration, usually a stainless steel crown.

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). This treatment completely removes the diseased pulp tissue from both the crown and root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. A final restoration is then placed.

The best age for orthodontic treatment

The dentist can recognize developing malocclusions, or bad bites, in a child as early as 2 to 3 years of age. Often, early action can reduce the need for major orthodontic treatment later.

Stage I - Early treatment, ages 2 to 6 years old. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger- or thumb-sucking. Treatment initiated at this stage of development is often very successful and may eliminate the need for future orthodontic/orthopedic treatment.

Stage II - Mixed dentition, ages 6 to 12 years old, with the eruption of the permanent incisor (front) teeth and six-year molars. Treatment concerns at this state involve jaw mal-relationships and dental realignment problems. This is an excellent time to start treatment since a child's hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III - Adolescent dentition. This stage deals with the permanent teeth and the development of the final bite relationship.

Nightly teeth grinding (bruxism)

Parents are often concerned about their child's nocturnal grinding of teeth, which is called bruxism. You might notice wear (teeth getting shorter) to the dentition. There are many theories about the causes of bruxism. Stress due to a new environment, divorce, changes at school, and other psychological factors can influence your child to grind their teeth. Another cause could be pressure in the inner ear or due to normal growth and development. There may also be airway issues that require further investigation.

Most cases of pediatric bruxism do not require any treatment. If there is excessive wear on the teeth (attrition), the dentist will discuss restoration options with you.

Thankfully, most children outgrow bruxism, decreasing their grinding about age 6 to 9, and stopping around age 9 to 12. If you suspect bruxism, discuss this with your pediatrician or Dr. Rachel. If bruxism continues into the permanent dentition and abnormal wear on permanent teeth is evident, the dentist might recommend a night guard or refer to an orthodontist for an evaluation.