By age two, most of the twenty primary teeth are in place, and the child should have been to the dentist at least once for an examination. Fluoride treatments will help to harden teeth against the ravages of children s diet and improper oral hygiene. Until about age seven, you should allow your child to brush correctly.

A Conversation With a Parent

I recall one parent, whose child had multiple cavities at every visit, telling me, “Dr. Bonnick. I do everything right with this child. I brush her teeth every night myself. She does not eat candies. My husband and I have decided not to buy snacks. I just don t know what to do?

She continued, “Well, Dr. Bonnick, it must be genetic. My whole family has soft teeth. It runs in the family. This dental thing is getting expensive, and I have three children. They all come here.”

I asked her, “When do you brush their teeth in the morning?”

She replied, “Dr. Bonnick, we are in a mad rush to get them to school. We are always running late; the kids hold us up. Do you have kids? Doesn’t everyone make their kids brush their teeth when they get up? Could their breath smell bad? We don t have time to brush after breakfast because we are rushing to get to school.”

I then asked, “When they get to school, do they brush?”

She replied, “They can’t brush in school. The teachers won’t allow them to brush in school. Aren’t they supposed to brush when they first get up?”

My response was that they should brush after eating to remove leftover food so the bacteria can starve. The rule is after any meal, snack, or drink (except water), all of us should brush our teeth.

This parent required her kids to brush twice a day — once when waking up and once before going to bed. By not brushing after meals, they wear plaque on their teeth for the rest of the day until bedtime. This is a prime scenario for cavities and gum disease to develop.

The parent mentioned that her school would not let their kids brush their teeth after lunch. She asked, “Would you give me a note for the teacher?”

“Absolutely, “ I replied. “If you have the children brush when they wake up, have them brush again after breakfast, and if they brush after lunch, they’ll be on their way to better oral health.” 

How Bacteria Grows On Your Child’s Teeth

It is incredible how many well-intentioned parents and teachers will tell the children to brush their teeth two times per day. The proper way to care for teeth and preserve them from the destruction of cavities is to brush within twenty minutes after each meal, drink, or snack.

As a dental student, I remember researching my senior project at the University of Maryland Dental School with a biochemistry professor. My job was to grow Streptococcus mutants (the most important bacteria to the creation of cavities in teeth) and study their adherence to smooth surfaces in different concentrations of sucrose similar to concentrations found in nature.

The goal was to determine how these bacteria stick to the smooth part of teeth and enable other bacteria to stick to the tooth surface. I obtained sugar cane juice from the government agency that quarantined it and found the sucrose concentration to be around 20 percent. I made up samples of 20 percent,10 percent, 5 percent, and 2.5 percent sucrose by diluting the sample with distilled water and used control samples of the same concentrations drawn up with pure sucrose(cane sugar) and distilled water.

My hypothesis assumed that adherence of the bacteria would be less with the natural juice than with pure sucrose. This unpublished study gave us two results: the bacteria had similar results to adherence between the pure sucrose and sugar cane juice, but surprisingly, the bacteria in the sample showed more adherences in the sample at 2.5 percent than at 20 percent (The bacteria glued themselves to a smooth surface easier at a lower concentration of sugar.).

The application of this knowledge to the mouth shows us that the bacteria’s activity is not that high at higher sugar concentrations. Still, as sugar in the mouth becomes more diluted with time, it promotes more adherences of Streptococcus mutants. So if you had fruit or some juice with sucrose and you did not brush right away, the lower concentration of sucrose (dilution) would make the bacteria more active (with time, bacteria sticks to teeth better) and cause more holes in your teeth.

Many parents are health-conscious, and sometimes it works to the detriment of their children. Some refuse to have their children drink fluoridated water, and instead, they use bottled or filtered water. These children not only lose the benefit of the hardening properties of fluoride when their teeth are developing, but they should use topical fluoride more often at a time when they are more likely to have dental cavities.

Care of Your Child’s Permanent Teeth

At approximately six years of age, the first permanent teeth start appearing in the mouth, and it is essential to have them sealed to protect them from cavities when children are not very good at cleaning their teeth. Baby teeth are often partially covered with gum tissue, and because it hurts to brush, some children neglect the proper cleansing of the area.

The first large back tooth is called the first molar. The first molar is one of the most important teeth for stabilizing the bite, and it usually appears when the child is six years old. It is the most important back tooth, and it represents the sweet spot for chewing.

The first molar is the tooth that is most often filled, extracted, or in need of root canal treatment because it is one of the first permanent teeth that appears in the child s mouth. Loss of the first molar is a common reason for posterior bite collapse (back teeth don t fit together well, so the bite is not as efficient as it could be). If it is lost, immediate replacement with an implant is of extreme importance.

The bone grows with the adult teeth’ eruption, and because of this continually growing as a child continues to grow, it is not a good idea to place an implant in the growing patient. Until the end of the growth spurt, bone development could change the relationship of the crown of the tooth with the developing bone.

Suppose a first molar or any primary tooth is lost early. In that case, have your child evaluated for a space maintainer (a device to maintain the space for an erupting tooth, prosthesis, or implant).

The mixed dentition stage is a confusing time for most parents. The primary teeth are being lost as permanent teeth are erupting into place, and the child is going through a growth spurt. Puberty gingivitis is common as hormonal changes, as well as poor flossing habits (non-flossing) by children, promote excessive plaque buildup.

Lack of flossing leads to more cavities between the teeth, so teeth sealed on top can still have cavities through the sides. Root canal treatments, as well as large fillings, are common during this time.

Your orthodontist will begin treatments during this transitional time for many reasons. Growth spurts can be used to correct malocclusions, and loss of teeth allows the orthodontist to move teeth into more ideal positions.

Levels of Occlusion

There are generally three classifications of occlusion (the way teeth come together). 

Class one occlusion is one in which the relationship between the upper and lower teeth is ideal. The upper teeth should be on the lower teeth cheek side, and the teeth relate correctly.

Class two occlusion is a relationship where the upper jaw and teeth stick out too far from the lower teeth, and the connection is one of a protruding upper jaw.

In a class three occlusion, the lower teeth stick out ahead of the upper teeth and give the appearance of a strong jaw. 

• An overjet is not an abnormal condition. When the distance between the upper and lower front teeth is so far apart, it makes incising (biting) difficult or stresses the lower jaw to move extremely forward to touch the upper jaw. Overbites should be treated.
• An overbite is the measurement of the upper front teeth closure over the lower. When an overbite is extreme, the lower teeth sometimes hit the upper gum near the mouth’s roof. Severe overbites should be corrected.
• A crossbite can exist with one or more teeth when the upper teeth relationship is on the lower teeth tongue side. A slight overlap (degree) may not be harmful, but your dentist can determine whether it should be evaluated or not. A crossbite left untreated could result in facial deformities and improper development of one or both jawbones.

During the mixed dentition stage, the primary challenge is to get the child to brush after every meal and floss once or twice per day. The environment and parents attitudes set the tone for early-adulthood habits and determine how much it will cost for dental care in the future.