A child will ultimately have 20 baby (primary) teeth and, as an adult, 32 permanent teeth divided equally between the upper and lower jaws. In each jaw the baby teeth comprise four incisor teeth at the front, and on each side a single eye tooth followed by two molar teeth towards the back.

Your child will eventually lose these four front incisors and two eye teeth which will be replaced by permanent incisors and eye teeth. The baby molars will be replaced by bicuspids. First, second and third permanent molars will come in behind the bicuspids on each side of the jaws. Permanent third molars are often called wisdom teeth. Your child will use the front and eye teeth for cutting food and back teeth (molars and premolars) for grinding food.

Your child's teeth began developing long before birth - in fact, during the sixth week after conception. By the end of the six month after conception, all of them will have begun to develop.

The Importance Of Diet
Both enamel and dentin contain and require large amounts of calcium for their formation. As a result, a mother and child need dietary calcium which can be obtained in generous amounts from milk and cheese and vitamin D, which helps them use it efficiently. Vitamin A from yellow vegetables and fruits, green vegetables, margarine, butter, eggs and liver is also essential for normal enamel formation. Vitamin C from citrus fruits and juices and vitaminized apple juice is also needed.

Getting Teeth, Losing Teeth
The crown of the baby tooth is formed first, deep in the jaw bone, and is covered by the child's gums. When the root begins to develop the crown pushes through the gum. Incisor, eye teeth and bicuspid teeth have single roots. Molars have two or more roots.

When the permanent teeth develop their roots, they start to move through the jaw bone causing the roots of the baby teeth to be removed. As a result of this loss of root, the baby tooth becomes loose and eventually falls out.

Baby Teeth
As a rule, teeth in the lower jaw arrive ahead of teeth in the upper jaw. Girls often get those first teeth - and also lose their baby teeth - earlier than boys.

The first tooth will start to appear in most babies at 6 to 7 months of age, but some perfectly healthy children won't get their first tooth until they are several months older.

Memo: Late teething is usually a family characteristic and is rarely indicative of disease.

The front teeth erupt first followed by the first baby molars. The eye teeth then fill the gap. The last tooth to appear is the second baby molar. All of the baby teeth are usually in place by age 21/2.

Important: Early and continuing care of baby teeth is important since some of them will be functional for 10 years or more.


Permanent Teeth
The first permanent teeth to erupt are the first permanent molars, often called six-year molars, since this is the approximate age when they appear. They almost always erupt without any symptoms.

These are permanent teeth and will not be replaced, so great care must be taken to immediately include them in regular and routine oral hygiene procedures.

The baby teeth are replaced by their permanent successors as shown in the chart. Sometimes the wisdom teeth may not develop, or they may not erupt because there is not enough room for them in the jaw. If this is the case, these teeth are often extracted.

Memo: The cutting surfaces of both upper and lower front teeth are slightly scalloped. These indentations wear away and disappear within a few years.

Teething
Most children are not disturbed by teething, although they may experience some difficulty when their baby molars are erupting.

Symptoms of teething may include tender and sore gums and drooling.A clean, firm object such as a teething ring for your child to bite on may help the tooth cut through the gum.

Caution: Medications for pain and over-the-counter teething preparations should only be used following consultation with a dentist or physician.

Tooth Decay
Almost all decay can be prevented, although some children are more susceptible than others.

The surfaces of the teeth are sites for continual deposits of plaque. Plaque consists of a combination of bacteria and salivary proteins which stick to the teeth. The bacteria in plaque ferment and produce acids from sugars and starches. These acids are capable of dissolving tooth enamel - and this produces dental decay. The longer plaque is allowed to remain on the teeth and the greater amount of sweets and sugars in the diet (particularly those consumed between meals), the more susceptible the teeth will be to decay.

Important: Children with an established chewing gum habit must be encouraged to chew sugarless gum.

Dental decay can be prevented in several ways:
1 Brush and floss to remove plaque.
2 Eliminate between-meal sugar snacks.
3 Use fluorides to strengthen tooth enamel.
4 See your dentist regularly.
5 Avoid nursing bottle decay; don't let your baby go to sleep with a bottle of milk, formula, juice or any sweet liquid. Clean your baby's gums and teeth at least once a day.
6 Ask your dentist about pit and fissure sealants.

Brushing And Flossing
Oral cleansing may begin even before your baby's teeth start to erupt. Wipe the gums with a clean piece of gauze after each bottle or breast feeding. This not only cleans the mouth, but it accustoms your baby to oral cleaning procedures at an early age.

The change from gauze to a toothbrush should take place from 12 to 18 months of age.

Fluoridated toothpaste is not recommended for children under 3, and then, only a small pea-sized amount of fluoride-containing toothpaste should be used. Show your child how to spit out and not swallow toothpaste.

Encourage your child to brush as soon as it can be managed, but you should supervise and help until the necessary manual dexterity is acquired. Brushing should be carried out as soon after eating as possible.

Memo: The best type of toothbrush is has soft, rounded bristles, and a thicker handle that small hands can grasp more easily. It should have a small head with a straight edge at the top, two or three tufts wide and four to six tufts long.

Brushing should involve both teeth and gums. The brush stroke should sweep the gums and the teeth in the direction that the teeth grow. Scrubbing sideways simply shoves food debris between the teeth.

The biting surfaces of the molars should be thoroughly scrubbed since food debris can get caught in the pits and fissures on their surface. The mouth always should be rinsed with water after brushing - and the water spat out.

After the brushing routine is comfortable for your child, flossing where two teeth touch is a useful method of removing plaque from these areas. It is recommended that parents perform flossing procedures, as flossing too hard can cause damage to the gums.

Children who eat lunch at school may not have an opportunity to brush their teeth. Finishing the meal with a detergent food, such as an apple, celery or carrots, and then rinsing with water and swallowing is recommended.

Sugar Snacks
The sugar in sweets such as cookies, cakes and candies can cause tooth decay. Sticky candies such as toffee or caramel, raisins and some cakes remain in the mouth longer and are a cause for concern. The more frequently these snacks are eaten, the greater the likelihood of tooth decay. Substitute snacks which contain no sugar, such as popcorn, cheese, vegetables, pretzels and fresh fruits.

Sweets should only be given at meal time when after-meal tooth brushing can take place.

Fluorides
Fluoride works in two ways. It can be incorporated into tooth enamel while the tooth is developing deep in the jaw bone, such as through fluoridated water, or by topical application to the erupted tooth crown, such as with fluoridated toothpaste.
Sources of fluoride include:
1 Municipal water supplies.
2 Toothpastes.
3 Dentist-applied topical fluoride on your child's semi-annual visit.
4 Dentist-prescribed supplements.
5 Over-the-counter vitamin preparations.
6 Fruit juices and soft drinks, depending upon where they were bottled.

The swallowing of too much fluoride by young children during tooth development is not a good practice because too much may cause white or brown flecked spots on the enamel. Even if your local water supply is not fluoridated, your child may be getting adequate amounts of fluoride from other sources.

Caution:

• The Canadian Dental Association recommends that no fluoride supplements be given to children under the age of six and that supplements then be started only for children who exhibit a high risk of developing decay.
• Fluoride supplements may be prescribed for children who exhibit a high risk for developing decay, but only in consultation with a dentist.
• Avoid fluoride containing vitamin supplements for children under the age of six.
• Keep all fluoride containing toothpastes out of the reach of your child, particularly the children's low fluoride formulas because they taste good - adult formulated toothpastes are less likely to be eaten and swallowed.
  

For most children, fluoridated municipal water, fluoride toothpaste and biannual dentist-applied topical fluorides are probably adequate for decay prevention. If your water supply is not fluoridated, a fluoride-containing rinse may be used provided your child is old enough to spit it out and not swallow it.

The Canadian Dental Association recommends the following guidelines for children under 6 years of age who use fluoridated toothpastes:

• Brushing with fluoride toothpaste should normally occur twice a day.
• Brushing should be supervised by an adult.
• A pea-sized amount of toothpaste should be dispensed, preferably by the supervising adult.
• Swallowing should be discouraged. (After brushing, spit out, rinse with water, and then spit out the rinse.)
  

Regular Dental Visits
Although most children have all their baby teeth by age 21/2, the first dental visit should be planned within six months of the eruption of the first tooth or one year of age at the latest.
From the age of 3, the best program for your child is twice-yearly dental inspections. Cavities are best repaired in their early stages when damage is minimal. Decay spreads more rapidly when it involves dentin, and if it is allowed to progress, may involve the nerve. As a result, your child may experience considerable pain and an abscess may develop, resulting in extraction of the tooth.
Your dentist may also suggest that two x-rays (called bitewing x-rays) be taken of the molar teeth if these teeth are tight together. These are common sites for decay to start.
At these check-up appointments, your child's teeth will be cleaned and a topical fluoride preparation applied. These procedures will help your child remain cavity-free. Regular preventive dental care by your dentist and home supervision of diets and oral hygiene procedures ensure that many children and adults experience no dental decay in their lifetimes.

Nursing Bottle Decay
Babies on a bottle can develop cavities if sweet juice is given frequently during the day and night. The amount is not as critical as the frequency.

Memo: Children who constantly suck at a bottle of milk, formula, juice or any sweet liquid are bathing their teeth in decay-causing sugary liquids.

The lactose in milk is equally harmful. A bedtime bottle can become a habit for such children which are difficult to break. The flow of saliva which helps wash these liquids off the teeth decreases during sleep, so that decay-causing sugars tend to become concentrated and have the potential to be more damaging.

Important: Never put your child to bed with a bottle containing milk or juices. If your child insists on a bed-time bottle, make sure it contains only water.

Try to wean your child from a bottle as early as is practical. Nursing bottle decay is common, and your children need their baby molar teeth for about 10 years. Breast-fed babies also can get nursing bottle decay if, as toddlers, they consistently fall asleep at the breast with milk in their mouths.

Pit And Fissure Sealents
The biting surfaces of primary and permanent teeth are covered with pits and fissures which are difficult to clean with a toothbrush. Your dentist may suggest sealing these areas with a clear or white plastic material. These materials bond to the tooth surface and make them easier to clean with a toothbrush. Permanent molars are more commonly treated than baby molars.


Thumb Sucking
Thumb sucking is practiced by some 50 percent of children at one year of age. By age 6 only 15 to 20 percent still suck - and by age 9 to 14 it's less than 5 percent. If the habit stops at age 4 or 5 (and before permanent front teeth erupt) there is usually no effect on the alignment of the permanent teeth.
Thumb sucking likely fills an emotional need for some children, especially during late childhood. Intervening before your child is ready to stop often results in an intensification of the habit.

Orthodontic Treatment
Orthodontics is the branch of dentistry which deals with the straightening of crooked teeth. At some stages during tooth eruption, teeth that appear to be crooked will align naturally as other teeth are shed and new ones erupt. Your dentist can tell you whether you need orthodontic intervention.
Some problems can be corrected over a short period of time using simple orthodontic appliances, while others take several years using braces. Some treatment may be appropriate as early as age 5 or you may be advised to wait until all the permanent teeth have erupted.

Mouthguards
When participating in active sports such as hockey, football, boxing, squash and lacrosse, children should wear appropriate mouth guards made or recommended by a dentist. Mouth guards lower the incidence and severity of injuries to teeth, and they act as a buffer against jaw fractures, neck injuries and concussions by absorbing some of the blow. There are three kinds of mouth guards: custom-fitted latex, mouth-formed and stock. They vary in cost, comfort and protection. BCCE
*These suggestions are from the Canadian Dental Association