TEETH GO CHOMP

Tooth Eruption! The tooth materials start to assemble by week 6 in the womb. By the 12th week of pregnancy the soft tissue that will develop into the gums starts to form around these little future teeth. Babies are born with their baby teeth in the gum line and their adult teeth present (!) and still forming above the baby teeth. It’s kind of creepy to think of the head being full of all the teeth they will ever have.

At that point – there is a wide range of variability of when a first tooth may appear – some babies start around 3 months, others may not have any teeth until after their first birthday. Most teeth start around 6-8 months, and girls usually have teeth earlier than boys. No one knows why the variability, but below is a chart that can be used as a gauge for when that first set of 20 teeth come in (“erupt”) and fall out (“shed”).

Baby teeth come in over the first 3 years, and all kids will have different thresholds of tolerance to the discomfort associated with it (parents too). Here is a short article on teething support. Around 4 years of age, the jaw and facial bones grow, creating spaces between the primary teeth and making room for the larger permanent teeth to emerge. Primary/baby teeth shed between ages 6 and 7 years, and adult teeth make their way in until around about 12 years of age. It’s a long process.

TOOTH CARE TASKS

Tooth care doesn’t need to be complicated or a negative experience. Here are a few things to consider.

Tooth care starts whenever there is a tooth to care for. Like many aspects of raising a child, the goal is to help them form good habits that last a lifetime – it’s the long play. Brushing and flossing from the start can increase the chances of having healthy chompers into old age – and reduce your dental costs over the next 18+ years.

Tooth health revolves around three main things. 1) Genetics – if you and your partner have cavity prone teeth – you may need to watch your kids teeth a bit more. 2) Dietary Intake – when something is consumed that is sugary (including juices) it kicks off a 20min attack on the tooth enamel. 3) Cleaning Routines – much can be mitigated by good cleaning routines – brushing daily, flossing, and even drinking water with sugary food/drinks can help rinse/dilute the chemical attack on the enamel and gums.

Brushing

As soon as there is a tooth to brush, brush/wipe them one to two times a day. Get in there with a small soft brush/cloth and some water – brush/wipe the tooth/teeth and massage around the gums. This is also a good time to feel for hard spots on the gums where that next tooth might erupt. The main pointer is to make it FUN! Sing a song, play a song, make it suspenseful/dramatic like you are chasing around “sugar bugs”, have a special toy that only comes out during brushing, do a funny faces game. Bottom line – make it as fun and enjoyable as possible (for you and baby). It will be funky and new in the beginning – go slow and proceed with PLAY!

Here is a [YouTube Playlist] with selected videos on approaching brushing, including full body pins!

For the first couple teeth, you may not need any toothpaste. Wetting a soft toothbrush with water is fine, or using a wet washcloth. From there it’s on to toothpaste – using very small amounts. A grain of rice for under 3 years [left], and the size of a pea for over 3 years [right] (includes adults – most use more than needed).

[Controversy has entered the chat…]

Prior to 2014, the American Association of Pediatrics (AAP) recommended avoiding toothpaste with fluoride until 2 years of age (or even 3 years of age, when most children can reliably spit vs swallow toothpaste). Since 2014 they recommend using fluoridated toothpaste when brushing starts.

Fluoride is still in hot debate, so here are a couple of things to inform your own decision. First, fluoride that is ingested works internally to build bone and the adult teeth from within. Second, baby teeth are not the same as adult teeth and topical exposure via toothpaste is what dentists recommend. Fluoride, which occurs naturally in the body, can also be looked at from the mindset of DOSE and FREQUENCY. How much, how often, how long is the exposure. What science does agree upon is that there is likely a “right amount” for each person, but since we don’t know the right amount, some scientists are not comfortable with general recommendations. Essentially, if you have good oral genetics, and if you are drinking water from a water source has fluoride in it, you may not need as much topical fluoride exposure (especially if toothpaste is swallowed). On the other hand if there is a lack of fluoride exposure, or if there are genetic predispositions to tooth decay, then this could merit starting a fluoridated toothpaste earlier. In the end, it’s up to each family and much advised to discuss with their own dentist or doctor. If flouridated toothpaste is in your plan, learn to use it safely (spoiler: eating a full tube is not using it safely – dose!).

Some fluoride free toothpastes can be found here on amazon, with Hello, Tom’s, and Burt’s Bees being generally good products.

One final topic on brushing/cleaning – the scientific literature has pivoted from “bottles = tooth rot” to it being rooted in bad bacteria in the mouth disrupting the oral microbiome (yes, just like the gut…). Additionally, genetics + consuming breast milk/formula (diet) before bed and not “washing” the teeth or rinsing with some water can also contribute to early tooth decay. While drinking cow milk (sugars) or consuming honey (sugars) is on the “not until 1 year old” list – breast milk and formula both have sugars that can lead to dental decay in some kids if not wiped, washed, or brushed. It’s a good habit, regardless, to give the chompers a cleaning 2x a day – even though it’s not a very glorious job that one will be doing for 4-5 years.

Flossing

Brushing starts when there is a tooth. Flossing starts whenever there are two teeth that are touching. Grab some dental floss and do the pinky wrap (vs forefingers – hard to get two large fingers in there) or grab some flossers or floss sticks for kids that give a little more access. Here are a few on amazon that are biodegradable, since this option can create a bit of waste.

Dental Visits

Experts that write guidelines (which tend to change from time to time) recommend that children see a pediatric dentist and establish a “dental home” by age one or even as soon as their first tooth comes in. If you balance this out with advice from practicing dentists that see 100’s of kids a year – if the parents have good teeth history, if kiddo is brushing and flossing daily, and if everything looks normal in there – you can wait until 18 or even 24 months for that first appointment. Many practicing dentists balance the guidelines with practical sense and know that it’s not exactly fun or that useful to strap a 10 month old to a chair to poke around in their mouth. It’s no harm to find a dentist around their first birthday, and see what they recommend given the context you know.

As you do approach that first dental appointment, there are a few ways to reduce the shell shock some kids might feel. Consider a mock dentist visit staged at home, or consider reading some books on the topic to prepare the child with the concept. In general, books are great for teaching new concepts – from baby additions, to day/care or preschool, to potty time, to being afraid of the dark (can happen after 2 years). It’s like mental visualization exercises that elite athletes do to get in some practice – a little exposure during story time here and there can help with openness to that new experience or big change.

Here is a list of books on the Dentist Visit topic, though some are for older kids. The Berenstain Bears and Dr Seuss books are Fantastic Dads favorites.

Healthy teeth for life may seem like a big challenge, but it starts with simple habits in early life. Get after it!

Why the effort for little baby teeth? They fall out anyway, right?

Teeth live a fascinating life that many of us miss despite them being an important component to our daily lives – and it does actually start with the baby ones. Here are a few reasons why baby tooth health matters.

Baby teeth:
… help speech develop – try the “th” sound, it works better with teeth
… help process food to get most nutrition from it (missing/decayed teeth can make it difficult to chew and may cause children to reject foods)
… initially help to shape the face and jaw as babies learn to chew – which helps make room for adult teeth and may limit crowding
… that are healthy, help give a healthy start to the permanent teeth (decay and infection in baby teeth can cause dark spots or damage on the permanent teeth developing beneath it)

And that’s why taking care of the baby choppers is important. Since this was such a compelling look at oral health… best to close this out with two fun facts, worthy of wowing your friends (sarcasm).

Fun Fact 1: Mammals (well, most mammals) have two sets of teeth from an early age. The baby teeth, also called primary teeth, are there to accommodate our small heads, gums, and jaw. The adult teeth, also called permanent teeth, grow in as the head grows toward adult size and as the jaw and gums grow.

Fun Fact 2: There are two main categories of “tooth layouts” among animals – those for chewers and those for tearers. The teeth of a chewer are flatter, and close together with minimal gaps – like human teeth. The teeth of a tearer are pointier and spaced/gapped out – like alligator teeth. Chewers use their teeth to break down food by grinding it. This acts as a form of mechanical digestion before dumping food into the stomach for chemical digestion. The more mechanical grinding and chewing, the smaller the food, the more the body can extract nutrition. It’s not really obvious, but you do actually help your overall digestion and jaw health by chewing more – and that’s also what the mouth was designed for, to chew. Shredders/tearers, on the other hand, tend to rip foods apart and dump the large chunks right into the stomach where chemical digestion is the primary form of food breakdown.

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