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Oral Health

About Teeth

The Growing Years: From Birth to Six

People usually think of a newborn baby as having no teeth. But the 20 primary teeth that will erupt during the first three years already are present at birth in the baby’s jawbones. At birth, most of the crowns of the baby’s teeth are almost complete, and the chewing surfaces of the permanent molars have begun forming.

Primary teeth are important in normal development-for chewing, speaking, and appearance. In addition, the primary teeth hold the space in the jaws for the permanent teeth. Both primary and permanent teeth help give the face its shape and form.

A baby’s front four teeth usually erupt first, typically at about six months of age, although some children don’t have their first tooth until 12 or 14 months. Most children have a full set of 20 primary teeth by the time they are three years old. As your child grows, the jaws also grow, making room for the permanent teeth that will begin to erupt at about age six. We call these teeth the “six-year molars”. They will get another set of “12-year molars” at around age 12. At the same time, the roots of the primary teeth begin to be absorbed by the tissues around them, and the permanent teeth under them begin to erupt. Your child’s 1st and 2nd primary molars will be replaced by the permanent bicuspids. Typically, children have the majority of their permanent teeth by 12 to 14 years of age. The remaining four permanent molars, often called “wisdom teeth, “erupt around age 21 to complete the set of 32 permanent teeth.

The Transition Years: From Six to 12

As children develop, their jaws and faces continue to change. The transition from baby teeth to adult teeth is gradual. By the time they reach adulthood, most children will progress from their 20 primary teeth to 32 permanent (adult) teeth. All the while, the jaw gradually expands to make room for the additional 12 teeth.

At about age six, maybe earlier, children begin to lose their front teeth on top and bottom. During the next six or so years, permanent teeth gradually will replace the primary teeth. It is important to remember that there is a huge range of what is considered to be normal so your child may develop dentally on a different level than his or her friends.

The first permanent molars usually erupt between ages five and six. For that reason, they are often called the six-year molars. They are among the “extra” permanent teeth in that they don’t replace an existing baby tooth. These important adult teeth are often mistaken for baby teeth. However, they are permanent and must be cared for properly if they are to last throughout the child’s lifetime. The six-year molars are especially important because they help determine the shape of the lower face. They also affect the position and health of other permanent teeth.

Dental Health

Caring for Baby’s Teeth While Still in Mom’s Belly?

Importance of a Balanced Diet

A balanced diet is critical for the proper development of an unborn child. Teeth begin to form in the second month of pregnancy and to harden between the third and sixth months of pregnancy. A balanced diet that provides adequate amounts of vitamins A, C and D, protein, calcium and phosphorous helps develop healthy teeth. Inadequate nutrition, on the other hand, may result in poorly-formed tooth enamel that may make a child more likely to develop cavities once the teeth have erupted.

Keeping Mama’s Teeth & Gums Healthy

A mother’s decay-causing bacteria can be transmitted to her child, so it is important to have maternal teeth free of decay before the birth. Pregnant women may have the desire to eat more frequently between meals. While this is normal, frequent snacking can be an invitation to tooth decay. The decay process begins with plaque, an invisible, sticky layer of harmful bacteria that constantly forms on teeth. The bacteria convert sugar and starches that remain in the mouth to an acid that attacks tooth enamel. Brushing your teeth twice a day and cleaning between teeth daily with floss can reduce the risk of decay.

Plaque that is not removed can irritate the gums, making them red, tender, and likely to bleed easily. This condition is called gingivitis and can lead to more serious periodontal disease that affects the gums and bone that anchor teeth in place. During pregnancy, a woman’s hormone levels rise considerably. Gingivitis, especially common during the second to eighth months of pregnancy, may cause red, puffy or tender gums that tend to bleed when brushed. This sensitivity is an exaggerated response to plaque and is caused by an increased level of progesterone. Poor periodontal health in the mother may lead to adverse pregnancy outcomes like premature delivery and low birth weight of the baby. Mothers should see a dentist regularly throughout pregnancy. The dentist may recommend more frequent cleanings during the second trimester or early third trimester to help avoid problems.

First Visit

Is it time?

The American Academy of Pediatric Dentistry recommends the first visit to the dentist be 6 months after the first tooth erupts. This is typically at about a year of age. This visit will include going over dental and medical history, including family history. Dr. Dunne will complete a thorough oral exam to assess growth and development, oral hygiene, injuries, cavities and/or other problems. We will review fluoride exposure, bottle & breast feeding and talk about diet. We can assess your child’s risk of developing tooth decay and provide information regarding oral development, teething, pacifier or finger/thumb sucking habits & injury prevention. By starting visits at an early age, you will help your child build a lifetime of good dental habits.

What should I expect?

When you arrive for your child’s first visit, please be prepared with your insurance cards if applicable and health information regarding your child. We will ask you to fill out several forms on our touch screen computer that will allow us to begin your child’s dental treatment.

Your initial visit will last approximately 30 to 45 minutes. Oral hygiene instructions will be provided along with suggestions to help you care for your child’s teeth. If your child is over the age of 2 1/2, we will also most likely clean your child’s teeth on this visit. Our number one goal is to make every trip to the dentist positive. If we are not able to complete everything on the first visit, we’ll try again in 6 months. We have found that if a younger child comes with an older sibling or family member they tend to do better with the new experience.

It is important to remember that we will never push your child to do anything they don’t want to do. If the appointment isn’t working, we stop & just try another day.

Brushing & Flossing

Cleaning your baby’s teeth

Begin cleaning the baby’s mouth during the first few days after birth. After every feeding, wipe the baby’s gums either with a clean, wet gauze pad or with a washcloth or towel. This removes plaque and residual food and helps children become accustomed to having their mouth checked.

When your infant’s teeth begin to erupt, it is important to clean them regularly. You may continue to use a gauze pad or cloth to clean the incisors after feedings until the back teeth (molars) begin to erupt (usually around 12 months of age). Once a molar appears, brush all teeth gently with a child’s size soft toothbrush & water. Position your child so you can see into the mouth easily; you might want to sit, resting your baby’s head in your lap.

Cleaning your child’s teeth

When your child can predictably spit and not swallow toothpaste, begin brushing the teeth with a pea-sized amount of fluoride toothpaste. We really don’t recommend using a fluoridated toothpaste before the child is three years old. Check your child’s toothbrush often and replace it when it is worn. Bent or frayed bristles will not remove plaque effectively. Begin using floss when adjacent teeth are touching. Flossing is important to prevent cavities from developing between teeth. We recommend the Dino-flossers or the Reach Access to help make flossing more fun and easier on you as a parent!

Brush and floss your child’s teeth until he or she is at least six years old. By age six or seven, children should be able to brush their own teeth twice a day, with supervision, until about age 10 or 11, to make sure they are doing a thorough job. However, each child is different. Typically we say that when a child is able to write in cursive they have the dexterity to brush properly on their own.

Choose a child-size toothbrush for ease of use. The variety of colors and designs can provide extra fun and motivation to keep children brushing. There are also powered or mechanical brushes available for children, we sell the Crest Spin Brush in our office for $6.00. For some children, this makes brushing more fun, so they are more willing to sit for the recommended 2 minutes of brushing. If your tweener or teenage child is struggling with brushing a Sonicare might be in order. We highly recommend this brush, every staff member we have uses one and would never go back to the old standby toothbrush. Sonicares really take you to the next level of brushing with its dynamic cleaning action. They guarantee their product and the new FlexCare has been clinically proven to help reduce gingivitis.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching how to brush, you may wish to stand behind the child and hold the brush to be certain that brushing is done properly.

Floss once a day

If the back molars are touching, it is time to floss! Flossing removes plaque between the teeth where a toothbrush can’t reach.

Because flossing is a difficult skill to master, you should floss your child’s teeth until he or she can do it alone. Show your child how to hold the floss and gently clean between teeth. At about age 10 or 11, your child should be able to floss between teeth under your supervision. We can check at the 6 month cleaning appointments if your child may be ready to floss on their own.

Focus on Fluoride

Cavities used to be a fact of life. But during the past few decades, tooth decay has been dramatically reduced. The key reason: fluoride. Fluoride is a mineral that occurs naturally in all water sources, including the oceans. Research has shown that fluoride not only prevents cavities, it also helps repair the early stages of tooth decay even before the decay is visible.

During childhood, when teeth still are forming, fluoride works by making tooth enamel more resistant to the acid that causes tooth decay. After teeth erupt, the benefits are just as great. Fluoride helps repair, or remineralize, areas where the acid attacks have already begun. Fluoride is obtained in two forms: topical and systemic. Topical fluorides may be found in toothpastes, mouth rinses and fluoride applied in the dental office. Systemic fluorides are those that are swallowed. They include fluoridated water and dietary fluoride supplements in the form of tablets or drops. The maximum reduction in tooth decay is achieved when fluoride is available both topically and systemically.

Water fluoridation provides both topical and systemic benefits for preventing tooth decay. Community water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal prevention of tooth decay. THERE IS NO FLUORIDE IN OUR WATER SUPPLY HERE IN LANE COUNTY. Children who regularly drink bottled water, well water or unflouridated tap water may be missing the benefits of fluoride.

Common Problems

Sucking Habits

Sucking is a natural reflex and infants and young children may suck on thumbs, fingers, pacifiers and other objects. It may make them feel safe and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with tooth alignment and the proper growth of the mouth. The frequency, duration, and intensity of a habit will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Usually 80% of children with thumb or finger habits stop by the time permanent teeth erupt. Dr. Dunne recommends making a calendar or chart for a 14 day period. If your child can stop the habit for 14 days in a row and can bring Dr. Dunne this chart showing they did it, he will give them a special prize!

Here are some tips to help your child get through thumb sucking:

  • Instead of scolding children for thumb sucking, praise them when they are not.
  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
  • Children who are sucking for comfort will feel less of a need when their parents provide comfort.
  • Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.


Malocclusion, or bad bite, is a condition in which the teeth are crowded, crooked or out of alignment, or the jaws don’t meet properly. This condition may become particularly noticeable between the ages of six and 12, when the permanent teeth are erupting. This “bad bite” may be inherited or result from events in the child’s development.

Every child should receive an orthodontic evaluation by age seven. Early examination and treatment may help prevent or reduce the severity of malocclusions in the permanent teeth. An early evaluation allows the orthodontist to determine when any recommended treatment should begin. The developing occlusion should be monitored throughout eruption. Starting treatment or preventative care at the best time may reduce the overall treatment time and result in the best outcome.

Dr. Dunne will work with your orthodontist to try and prevent the development of malocclusions, when possible. Some preventative orthodontic treatment may be started when the primary teeth are still in place. Often effective preventative treatment is done during a child’s growth period. Different types of orthodontic appliances, including some that are removable, are used to prevent and treat malocclusions.

Orthodontic treatment may be divided into distinct stages or it may be continuous over a period of many months or more. The starting age, the duration of treatment, the type of appliances used, the outcome of the treatment, and the cost of treatment depend upon the nature and the severity of the malocclusion being treated. In most cases, the cooperation of the patient-practicing good oral hygiene and maintaining scheduled appointments for cleanings and exams-are major factors in the success of orthodontic treatment.

Obstructive Airways and Sleep Apnea

Our ability to breathe directly affects our health and well-being. Our ability to fight infection is directly influenced by our ability to clean bad cells out of our bodies and provide oxygen to our living cells. The lymph system is the body’s way of removing old, bad cells. Since there is no pump for the lymph system, our bodies must use breathing and muscle movement to clean up our body’s old, dead cells.

An interesting study was done to see the effect of oxygen on cells and it was found that cells that were given oxygen, after 1 year, were normal and cells that were deprived of oxygen had malignant growths after that year. It is a known fact that oxygen affects the quality of life of the body’s cells. Fully oxygenating your system is a top priority. Presently, one in 3 Americans gets cancer, however, only one in 21 athletes gets cancer. Athletes oxygenate better than the average person and athletes stimulate their bodies’ immune system by stimulating the movement of lymph fluid. So we can see that good breathing and exercise are crucial to health and to life.

Obstructive airways and sleep apnea deprive our bodies of oxygen and have significant effects. If the airway is obstructed, it changes the posture of the mouth and face and affects the growth of bone. If a child has difficulty breathing at night, it can cause life-altering changes. Poor and restless sleep, or sleep deprivation, leads to daytime tiredness and sleepiness. There is an overall decrease in oxygen levels to the body of 10-15%. This deprivation affects IQ and school performance. It inhibits effects on growth– resulting in obesity, hypertension, and sometimes right ventricular dysfunction and heart enlargement. A child is so tired that he may not awaken to go to the bathroom and frequently wets the bed. Mouth-breathing causes the mouth to be dry and the child develops halitosis. It can also cause bruxism or grinding of teeth in their sleep.

Airway obstruction is called OSAS by the American Academy of Pediatrics and a great deal of research has been done to help diagnose and treat obstruction of airway and breathing difficulty. An extensive study of research done between the years 1966-2000 of children aged 2-18 showed that the prevalence of habitual snoring was between 3-12%, and estimates of OSAS was from 0.7-10%. In another study of children ages 3 ½ to11 years old, 35 patients had frequent bed-wetting (enuresis) and after diagnosis of upper airway obstruction and surgical intervention 26 children were completely cured of their bed-wetting immediately. Within 6 months, all children were completely cured of their enuresis.

We are not saying that all nighttime bed-wetting is due to upper airway obstruction and the literature suggests otherwise and we agree. We also do not recommend surgery as a cure for this general problem. However, we do suggest that upper airway obstruction is probably a more common cause to nighttime bed-wetting than was previously recognized.

Upper airway obstruction and sleep apnea can be evaluated at the initial and later cleaning appointments with examination by the doctor. Sometimes it may be necessary to have the child be evaluated by their pediatrician or ear-nose-throat specialist to determine the extent of the problem and any surgical intervention.

Sleep apnea and upper airway obstruction is a relatively common problem and can affect everything from facial growth and crowding of teeth, to head/neck and mouth posture and intelligence.

Emergency Info

Knowing how to handle a dental emergency can mean the difference between saving and losing your child’s tooth. Here are some helpful tips:

Knocked-out tooth Keep tooth moist at all times. Hold the tooth by the crown, and if the tooth is dirty, rinse the root in water. Do not scrub the tooth or remove any attached tissue fragments. The tooth must not be left outside the mouth to dry. If possible, gently insert and hold the tooth in its socket. If it cannot be replaced in the socket, put it in one of the following:

  • Emergency tooth preservation kit
  • Milk
  • Mouth (next to cheek)
  • If none of these is practical, use water (with a pinch of salt, if possible).

Bring your child (and don’t forget the tooth!) to Dr. Dunne’s office as soon as possible-ideally within 15 minutes. However, it may be possible to save the tooth even if it has been outside the mouth for an hour or more. Baby teeth that have been knocked out typically are not replaced because of the potential damage to developing permanent teeth.

Cracked or broken tooth Rinse the mouth with warm water to clean the area. Put cold compresses on the face to keep any swelling down. Take your child to see a dentist right away. If possible, take the broken tooth fragment with you. The dentist may be able to bond the fragment to the tooth.

Jaw possibly broken Apply cold compresses to control swelling. Take your child to Dr. Dunne, urgent care, or the emergency room immediately.

Objects caught between teeth Gently try to remove the object with dental floss. If you’re not successful, visit Dr. Dunne. Do not try to remove the object with a sharp or pointed instrument.

Toothache Rinse the mouth with warm water to clean it out. Gently use dental floss to remove any food caught between the teeth. Do not put aspirin on the aching tooth or gum tissues. Take your child to visit the dentist as soon as possible.

Bitten tongue or lip Clean the area gently with a cloth, and put cold compresses on the area to keep the swelling down. If bleeding is excessive or does not stop in a short period of time, bring your child in to Dr. Dunne’s office or a hospital emergency room.

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