Dentistry for children
When should a child first see a dental professional?
By the first birthday, or within six months of the first tooth appearing. Early visits are mostly about checking development, spotting decay early, and letting a child get used to the room before anything needs treating.
Why so early, if the baby teeth fall out anyway?
Because decay in baby teeth is not a minor matter that resolves when the tooth is shed. It hurts, it disturbs sleep and eating, and it can become infected. Untreated decay in a primary tooth can also damage the permanent tooth developing directly beneath it, and losing a baby tooth early lets the neighbouring teeth drift into the space the permanent tooth was going to use.
There is also a practical argument that has nothing to do with the teeth. A first visit at age one, when nothing is wrong, is a very short and undramatic appointment — the child sits on a parent's lap, the mouth is looked at, and that is largely it. A first visit at age five because a tooth is hurting is a completely different experience, and it becomes the child's template for what dentistry is.
Early visits also give parents specific, personalised guidance at the point where habits are being set: how much toothpaste, whose job the brushing is, what to do about a bottle at bedtime, and whether an ongoing thumb-sucking or dummy habit is affecting the developing bite.
What happens at a child's dental visit?
It is deliberately unhurried, and for a very young child a great deal of it is simply familiarisation — counting teeth, letting them hold the mirror, letting them see the chair go up and down. Nothing is gained by forcing a first examination, and quite a lot is lost.
The examination itself covers the teeth, the gums, the bite and how the jaws are developing, along with any habits leaving visible traces. Gentle polishing removes plaque. Where the decay risk warrants it, fluoride varnish may be applied to the tooth surfaces, and fissure sealants may be placed on the deep grooves of newly erupted permanent molars — neither of which involves drilling or an injection.
Brushing and diet advice is given to the child directly, in language they can follow, and separately to the parent with the detail behind it. Children are considerably more receptive to being told how by someone other than a parent.
Where treatment is needed, it is explained first and carried out at a pace the child can cope with. A conservative approach matters more in children than anywhere else: primary teeth are small, their nerve chambers are proportionally large, and preserving structure keeps the tooth in place until it is meant to come out.
- Examination of teeth, gums, bite and jaw development
- Gentle cleaning and polishing to remove plaque
- Fluoride varnish or fissure sealants where the decay risk indicates them
- Brushing, flossing and diet guidance pitched at the child
- Discussion of thumb sucking, dummy use and bottle feeding where relevant
What should I expect while my baby is teething?
Teething usually begins somewhere between four and seven months, though starting as early as three months or as late as twelve is within normal range. The lower front teeth — the central incisors — typically appear first, followed by the upper front teeth. By around age three most children have their full set of twenty primary teeth.
Common signs are increased drooling, red or swollen gums, chewing on everything within reach, irritability and disturbed sleep, and a reduced appetite. Babies vary enormously in how much this affects them.
What teething does not cause is important. It does not cause a high fever, diarrhoea or serious illness. A temperature above 38°C is not teething and should be assessed by a doctor. Attributing a genuinely sick baby's symptoms to teething is the real risk in this area.
A fever above 38°C, persistent diarrhoea, vomiting or a baby who seems genuinely unwell needs medical assessment, not teething remedies. Teething causes local gum discomfort, not systemic illness.
How can I soothe a teething baby safely?
Cold and pressure are what actually help. A teething ring chilled in the fridge — not the freezer, since a frozen ring is hard enough to bruise gums — gives both. So does a clean damp facecloth cooled in the fridge, which has the added advantage that the fabric massages the gum as the baby chews.
Rubbing the swollen gum firmly with a clean finger often settles a baby faster than anything else, and costs nothing. For babies already on solids, chilled soft food such as banana offered in a mesh feeder provides cold and chewing pressure together, with supervision for choking risk.
Manage the drool as well as the gums. Constant saliva irritates the skin around the mouth and chin, so wipe rather than rub, and use a barrier cream if the skin is becoming sore. Keep fluids up if feeding has dropped off, and hold to normal nap and bedtime routines where you can — a disrupted routine makes a fractious baby worse.
On teething gels, be cautious. Do not use products containing benzocaine or lidocaine on babies; these carry recognised risks in infants and are not appropriate for home use. Check with a pharmacist, doctor or dental professional before giving any teething product, and the same for pain relief and dosage.
- Chilled teething rings from the fridge, never the freezer
- A clean damp facecloth cooled in the fridge
- Firm gum massage with a clean finger
- Chilled soft food in a mesh feeder for babies on solids, with supervision
- Wipe drool away and protect the skin around the mouth
- Avoid benzocaine and lidocaine gels; ask before using any product
How do I look after my child's teeth at home?
Start before the teeth arrive. Wiping the gums with a soft damp cloth after feeds gets the child used to having their mouth cleaned, which makes the transition to a toothbrush far less of a fight.
Once the first tooth erupts, use a small soft baby brush with a smear of fluoride toothpaste roughly the size of a grain of rice. That quantity increases as the child gets older — ask at a check-up what is appropriate for your child's age. Brush twice daily, and take over or supervise the brushing yourself for considerably longer than most parents expect; young children do not have the manual control to clean their own teeth properly, however willing they are.
The single most effective thing you can do about decay is control how often sugar is in the mouth, rather than how much. Frequent grazing and sipping keeps the mouth acidic all day; the same amount of sugar taken with a meal does far less damage. Water and plain milk between meals, sugary things at mealtimes.
Never put a child to bed with a bottle of milk, juice or anything sweetened. Saliva flow drops during sleep, so the liquid pools around the upper front teeth for hours — this is the classic cause of early childhood decay, and it can affect several front teeth before a parent notices anything.
How do I help an anxious child cope with a dental visit?
Mostly by managing what happens before you arrive. Talk about the visit positively and matter-of-factly, in the same register as a haircut. Avoid words the child has not raised themselves — 'sore', 'hurt', 'injection', 'you'll be brave' — because reassurance about pain plants the idea that pain is expected.
Be careful about passing on your own history. Children read parental anxiety accurately, and 'I've always hated dental visits' does more damage than anything that happens in the chair. If you find them difficult yourself, it is worth saying so to the practice quietly rather than in front of your child.
Practical things help. Book a time when your child is rested rather than at the end of a long day, bring a familiar toy, and where possible let a first visit be a look-around with no treatment. Reading books about going for a check-up and brushing together at home both make the setting feel ordinary.
Tell the practice in advance if your child is anxious, has had a difficult experience previously, or has additional needs affecting how they cope with new environments or being touched. That is useful information, and it changes how the appointment is run.
When should I bring my child in sooner?
Do not wait for the next routine check-up if there is toothache, sensitivity to hot or cold, or if your child is avoiding chewing on one side. Pain in a child is generally reported late, so by the time it is being complained about it usually needs looking at.
White, brown or dark spots on the teeth, visible holes, or teeth that are chipping need assessment. Early white spots along the gumline are decay in its earliest, most reversible stage, and it is worth catching them at that point.
Swollen or bleeding gums, a lump or swelling on the gum near a tooth, bad breath that persists after brushing, or any facial swelling all warrant a prompt appointment. Facial swelling in a child, particularly with fever or where it spreads towards the eye or under the jaw, is urgent — see the emergency guidance rather than waiting for a routine slot.
Any injury to the mouth or teeth should be seen, even where the tooth looks intact. A knocked baby tooth can affect the permanent tooth developing beneath it, and a tooth that has been displaced or has darkened weeks after a knock needs assessing. Persistent thumb sucking or dummy use past the age when the permanent teeth are arriving is worth discussing too, as is difficulty chewing.
A knocked-out permanent tooth is time-critical — handle it by the crown, do not scrub it, keep it in milk, and seek care immediately. A knocked-out baby tooth should NOT be put back in the socket, as replanting it can damage the developing permanent tooth. If you are unsure which it is, phone straight away.
Common questions
Do baby teeth with cavities really need to be filled?
Often yes. Decay in a baby tooth causes pain and infection, can damage the permanent tooth forming beneath it, and losing the tooth early lets neighbours drift into the space. Whether to treat or monitor depends on the tooth and how long it is meant to stay.
How much toothpaste should my child use?
From the first tooth, a smear of fluoride toothpaste about the size of a grain of rice. This increases as the child gets older. Ask at a check-up what is right for your child's age, and encourage spitting rather than rinsing afterwards.
At what age can a child brush their own teeth?
Children can start brushing themselves early, but they lack the manual control to clean effectively for several years yet. Supervise and follow up with your own brushing well into primary school. Let them do it first, then you finish the job.
Is thumb sucking or a dummy a problem?
In infancy it is normal and usually harmless. If it continues once the permanent front teeth are arriving, it can affect how the teeth and jaws meet. Raise it at a check-up so it can be assessed rather than guessed at.
My child knocked out a front tooth. What do I do?
If it is a permanent tooth, hold it by the crown, do not scrub it, keep it moist in milk, and seek care immediately. If it is a baby tooth, do not put it back — replanting can damage the permanent tooth developing above. Phone straight away either way.
Does my child need X-rays?
Only where clinically indicated — typically to check between teeth that are touching, or to assess development. Modern digital radiographs use very low doses. The dental professional should explain why a particular image is needed before taking it.