Pediatric Dentistry: An Early Start to a Healthy Smile

The United States will see just shy of 4 million new babies born this year alone, and August/September are the most popular birth months, with October and July rounding out the top four. What this means is somewhere around February the greatest number of baby teeth will be erupting, and teething discomfort and drool will be off the charts! Getting an early start on oral care for infants will help create a favorable oral environment that promotes strong, healthy teeth now and in the future.


Embryonic tooth formation begins with cell changes early in utero and “tooth buds” developing around 8 weeks gestation. Microscopically these buds can be seen in the upper and lower arches, representing each primary tooth. The teeth continue to form while the baby is in the womb, with the initial placement of enamel being laid down during approximately the 3rd or 4th month of pregnancy. Fevers, malnutrition and some medications during the formation of the teeth can affect the health, color and strength of the enamel once the tooth erupts. Calcification of the primary tooth and roots continues not only during the pregnancy but after birth as well, reaching completion by about three years old.


The lower front teeth make their debut generally around 6 months (+/- 3 months) of age and will not be lost until around 6 years old. In all, 20 baby teeth will “bloom” over the next three years. Care for the baby teeth is imperative to avoid decay, abscesses, and tooth pain. The primary teeth aid the child in chewing, eating and speech development, in addition to holding the spaces for the secondary or permanent dentition. If teeth are lost and spaces were too narrow or close, the permanent tooth would have difficulty erupting straight or could be prohibited altogether. If decay is severe enough, it could penetrate through the baby tooth, into the closely following permanent tooth, rendering it decayed before it even erupts! The infection can also affect the formation of the permanent teeth, compromising the health, shape, and color.


Starting around six years of age, 20 baby teeth will be replaced with permanent adult teeth over the next 13 years. An additional three molars in each arch will be added, giving a total of 32 teeth by approximately 18 years of age (this includes the wisdom teeth).
The first permanent molar generally erupts at 6 years old, and that molar will remain in the mouth for life! That could be 60 to 70 plus years! Keeping these teeth cavity free for as long as possible would, therefore, be ideal as they have got to go the distance! The second molars erupt at around 12 years of age, making it evident that the molars not only take the brunt of the chewing forces but for an extended period of time! Wisdom teeth or third molars make an appearance during the late teens if we let them! Often they are removed due to crowding issues or their position in the jaw.

The eruption of teeth usually alternates between the top and bottom jaw. For example, the first two teeth to erupt are the lower front middle teeth called the central incisors. Typically followed the maxillary or upper front middle teeth, also known as the central incisors. Then back to the bottom for the lateral incisors, followed by the upper laterals and so on until approximately 13 years of age when the last eruptions occur with second molars and cuspids (canine teeth). Of course, this is just a guideline, as not everyone fits exactly into this timeline.


Taking care of the primary dentition or baby teeth is important not only for the health and function of the child but also for the health and function of the permanent teeth that follow. Teeth help with speech and facial development. Strong teeth allow for proper chewing which provides an ability to have a healthy diet rich in raw vegetable and fruits. Proper chewing, or mastication, is beneficial for digestion as well, allowing the body to digest and absorb nutrients easier.

A healthy pregnancy with prenatal vitamins affords a baby the best opportunity for strong teeth with uncompromised and uninterrupted enamel placement. Continuing on with a healthy diet for the baby after birth offers the same opportunities for the forming secondary dentition (permanent teeth).

Once eruption occurs, home care habits should start immediately to reduce bacterial accumulation, decay, and sugar exposure produced from the milk diet. Use a washcloth or infant size toothbrush daily to wipe away decay-causing bacteria and milk from the enamel. As more teeth come in, a small child sized toothbrush used by the parent removes lingering bacteria. Flossing the baby’s teeth daily with “flossers” (handheld floss picks) removes bacteria from between the teeth and instills good habits at a young age. Toothpaste introduction is recommended as soon as possible! The American Academy of Pediatric Dentistry recommends a very small smear of paste on a toothbrush in the morning and night of infants/children under 2 years; a pea-sized amount on a brush for 2-5 years of age. Fluoride in the paste helps to reduce decay and is “proven safe and effective”. Fluoride placed by a dental professional is particularly useful for children with a high cavity rate, high sugar diets, orthodontics and medical conditions causing dry mouth (AAPD). Topical fluoride in pastes, gels, and varnishes on the enamel helps to protect erupted teeth by bonding to the surface making it stronger against the production of acids by the bacteria. Fluoride found in drinking water, and vitamins are ingested and incorporated into the enamel during the formation of the permanent dentition.

Baby Bottle Syndrome, also known as nursing/bottle caries is described as severe cavities on the baby teeth due to the prolonged exposure to milk and/or juice from a bottle while the child is sleeping. While the baby sleeps, suckling occurs and/or the liquid leaks into the mouth, pools and remains in contact with the teeth throughout the entire night. Infants and children should not be allowed to sleep with a bottle containing anything other than water, as there is a high risk of extensive decay and erosion of the enamel leading to tooth pain and tooth loss. It is highly recommended that babies and children be put to sleep without a bottle or with water only.

The American Academy of Pediatric Dentistry also recommends the first visit to the dental office after the first tooth appears or no later than the first birthday to evaluate jaw and arch formation and tooth eruption. Visits every 6 months after are also recommended with professional cleanings beginning around 3 years of age or earlier if the child allows. The dental hygienist can introduce the child to the appointment, and all the fun helpers used to make the teeth sparkle like Mr. Thirsty, the mirror, the air and water and the tickling of the electric toothbrush!

Sealants are a clear coating placed on the biting surfaces of the back teeth that flow into the deep grooves and pits where bacteria can hide. This barrier provides protection against the sticky “sugar bugs” and is recommended as the permanent molars erupt. Though sealants can last several years, they can also become worn down or lost over time so replacement may be necessary until the child is through the more cavity prone years. Sealants can be placed on any back tooth that does not already have a cavity or filling, so adults can also consider having them placed. As the ADA states, “prevention is always better than treatment”.

As we enter the height of the “baby season”, remember those little ones are past the budding stage and ready to Bloom! Taking steps to protect their oral health is not only important for them now, but also provides good soil for their adult teeth. Doing the ground work now leads to beautiful flowering smiles in the future!

Fun Facts:

In the US:
Tuesday is the most popular birth day…
Sunday is the slowest day…
September 16th is the most popular birthdate…
December 25th and February 29th the least common dates…

There are approx. 360,000 births per day…
About 115,000 per hour…
An estimated 255 births every minute…
Averaging 4.3 births every second!!!

A Nursery Rhyme: By Mother Goose
“Monday’s Child”
Monday’s child is fair of face,
Tuesday’s child is full of grace,
Wednesday’s child is full of woe,
Thursday’s child has far to go,
Friday’s child is loving and giving,
Saturday’s child works hard for its living,
But the child that is born on the Sabbath Day
Is bonny and blithe, and good and gay.

– By Julia Guerra, RDH, BA

*Facts collected from:,,,, AAPD, ADA,


  1. Very true! Sometimes parents ignore the oral health of a child and that results in a big problem when they grow up. I am going to take good care of my kids because I don’t them to go through painful procedures all their like. I got all the information from a very good dentist Hermosa Beach last week.

  2. I'm 15 and this has truly inspired and helped me to care my teeth the past few days. Bless up.


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