Teeth development in children

The development of deciduous teeth begins while the baby is in the womb. At about 5 weeks' gestation, the first buds of the deciduous teeth develop in the baby's jaws. At birth, the baby has all their deciduous teeth (10 in the upper jaw, 10 in the lower jaw) and some permanent teeth developing in the jaws. Deciduous teeth are also known as baby teeth, milk teeth, first teeth, or primary teeth.

Types of teeth

The names of the different types of teeth are:

• Incisors – the front teeth located in the upper and lower jaws. Each incisor has a thin cutting edge. The upper and lower incisors come together like a pair of scissors to cut the food.
• Canines – the pointy teeth on both sides of the incisors in the upper and lower jaws; used to tear food.
• Premolars – which have flat surfaces to crush food.
• Molars – these are larger than premolars towards the back of the mouth, with broad, flat surfaces that grind food.

Teething

'Eruption' refers to the tooth breaking through the gum line. In babies, this process is called teething. The time for each tooth to erupt differs from child to child. For example, one child may have their first tooth erupt when they are only a few months old, while another may not have a tooth erupt until they are 12 months old or more.

Although the exact timing may differ, the order of tooth development is more consistent. The lower incisor teeth are the first to erupt followed by the upper incisors and then the first deciduous molars. The average child has their 20 deciduous teeth by the age of 3 years.

Managing the teething process

Babies’ immune systems start to change when they are around 6 months old. Along with the tendency to put things in their mouths, this makes them more prone to illnesses. Symptoms of common childhood illnesses such as changes in sleep and eating patterns, fussiness, rash, drooling, runny nose and diarrhoea are often linked to teething. Symptoms related to teething usually last around 48 hours. If your child has these symptoms, for a longer period, it is important to speak to your child’s doctor to check other causes such as bacterial, viral or middle ear infections.

Sometimes, you may see a blue-grey bubble on the gum where the tooth is about to appear. This is called an eruption cyst and usually goes away when the tooth erupts. During this time, it is important to provide your child with additional support to keep them comfortable.

Some tips include:

• Massage – gently massage the gum with clean fingers or a soft, wet cloth.
• Chilled (not frozen) teething rings or rusks – pressure from a cold object can relieve discomfort from teething. Do not sterilise plastic teething rings in boiling water or dishwater, unless specified by the manufacturer. Be sure to check product information before buying teething rings. Avoid the ones that use a plastic softener called 'diisononyl phthalate'.
• Unsweetened teething rusks or sugar-free teething biscuits – these can be given to infants over 6 months who have started eating solids.
• Pain-relieving medications – paracetamol works well for infants. Ibuprofen may also help, but it is not as well tolerated in infants.
• Dry the drool – the skin around the mouth, particularly the chin area, can become irritated. Gently wipe this away with a soft cloth throughout the day.

Some treatments are not recommended. These include:

• Teething necklaces – amber is believed by some people to release healing oil on contact with warm skin. The oil is thought to be soothing or help to reduce pain. Although amber teething strings or necklaces are designed to be worn around the neck, wrist or ankle, they have been incorrectly used to chew on. The ACCC has issued a product safety statement about amber teething necklaces, warning of possible choking and strangulation hazards. Parents are asked to consider other less risky ways of providing relief from teething.
• Teething gels – common teething gels contain 8.7–9.0% of the ingredient choline salicylate. Salicylate is related to aspirin. The use of aspirin for children younger than 16 is not recommended because in some children it has been known to cause Reye's syndrome – a rare but potentially lethal condition that can cause liver and brain damage. Teething gels also contain numbing medication like lignocaine and benzocaine. These medications are difficult to measure in teething gels potentially leading to ingestion of a toxic dose which can be fatal. The general advice is that it is a risk not worth taking when there are other things available.

Research also suggests that teething gels may not relieve teething pain, rather the act of massaging it into the gum is what helps.

Caring for baby teeth

Caring for deciduous teeth is as important as caring for permanent teeth. They allow children to chew food comfortably and speak properly, while reserving the spaces in the jaws for future adult teeth.

Tooth decay in baby teeth

Tooth decay is preventable. The risk of developing dental decay can be significantly reduced by good oral hygiene habits and a healthy diet from a young age.

Decayed baby teeth need to be treated by a dental practitioner. In some cases, specialist treatment in a hospital under a general anaesthetic is needed. If neglected, decayed baby teeth can lead to mouth pain, dental abscesses (a boil or swelling resulting from infected teeth), and problems with the surrounding teeth. Severe decay in baby teeth can affect eating and sleep, which can slow growth.

If a baby molar is lost too early due to severe decay, adjacent baby teeth may drift into the gap and create spacing problems for the adult tooth when it comes through.

Loss of baby teeth

From the age of about 6 years, deciduous teeth start to become 'wobbly' and fall out to make way for adult teeth. It is perfectly normal for a child to lose their first tooth up to 2 years earlier or later than 6 years of age. Girls generally lose teeth earlier than boys. The first tooth to fall out is usually located in the front of the lower jaw.

Losing deciduous teeth can be unsettling and uncomfortable for young children.

Suggestions for parents include:

• Reassure your child that losing baby teeth is a natural process and new adult teeth will come in their place. It's normal for gums to be tender and bleed a little, although some children experience little or no discomfort while losing their teeth.
• Use cold packs or over-the-counter anti-inflammatory or pain-relieving medication to help relieve loose tooth pain. Ask your dentist or pharmacist for recommendations on appropriate medication for your child.
• Make use of the Tooth Fairy. This myth has lasted a long time with good reason! The idea of getting some money or another reward in exchange for a tooth might soften the idea of tooth loss for your child.

Permanent teeth

Permanent teeth are also known as adult teeth or secondary teeth. The permanent teeth start to develop in the jaws around birth and continue into childhood. By about 21 years of age, the average person can have 32 permanent teeth,16 in the upper jaw and 16 in the lower jaw. The third molar teeth – commonly called wisdom teeth – do not develop or commonly do not erupt, so some people only have 28 permanent teeth.

At about the age of 6 years, the first permanent molar teeth erupt. These 4 molars (2 in each jaw) come out behind the child's baby teeth. Other permanent teeth, such as the incisors, canines, and premolars, erupt into the spaces left by the deciduous teeth that have exfoliated (fallen out/lost).

As with deciduous teeth, the timing for when the permanent teeth come through can differ. Generally, the order and rough timeline for each type of permanent tooth is:

• First molars – between 6 and 7 years.
• Central incisors – between 6 and 8 years.
• Lateral incisors – between 7 and 8 years.
• Canine teeth – between 9 and 13 years.
• Premolars – between 9 and 13 years.
• Second molars – between 11 and 13 years.
• Third molars (wisdom teeth) – between the ages of 17 and 21 years, if at all.

Mouthguards protect children's teeth

Mouthguards help protect teeth and prevent dental injuries, particularly when playing and training for contact sports. All children playing contact sports should wear a custom-fitted mouthguard, even primary school-age children. Custom-fitted mouthguards are comfortable, allow speech and do not restrict breathing. Learn more about mouthguards.

Where to get help

• Your dentist
• Australian Dental Association ‘Find a Dentist’ or Tel. (03) 8825 4600
• Dental Health Services Victoria Tel. (03) 9341 1000 or 1800 833 039 outside Melbourne metro - provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people.
• Maternal and Child Health Line (24 hours) Tel. 13 22 29
• NURSE-ON-CALL (24 hours, 7 days) Tel. 1300 60 60 24 – for expert health information and advice
• Royal Children's Hospital (Dentistry) Tel. (03) 9345 5344