Children's Dentistry

The first visit and check-ups

• The first visit. The first teeth usually come through at around 6 months, but it is also normal for them to come earlier or later. The American Academy of Pediatric Dentistry also advises the first visit before 12 months of age³; it gives this recommendation no evidence grade.
• The check-up interval. The UK's national guideline sets the shortest interval between check-ups at 3 months and, for under-18s, the longest interval at 12 months⁴. The interval is set with the dentist, according to your child's level of disease and risk. There is no "every 6 months" rule for everyone.

Who this page is for

• Parents whose baby's first tooth has come through or is about to
• Parents who have noticed a mark, decay, pain or a knock on their child's teeth
• Parents whose child has been offered fissure sealants, fluoride or a filling
• Parents with questions about thumb sucking, dummies or front teeth that stick out

When to look at another page

• Bite problems and braces. The treatment plan is made after an orthodontic assessment; see the braces treatment page.
• Children with special needs. You can read how treatment is planned on the dental treatment for people with disabilities page.
• Adults. For root canal treatment, fillings or gum disease in adults, see the relevant treatment pages.

Children's dentists and the specialist title

Children's dental treatment can be carried out by dentists. A dentist is authorised to carry out the professional work² of diagnosing and treating diseases of the teeth and gums. The title "specialist in paediatric dentistry" (çocuk diş hekimliği uzmanı) is different. Only a dentist who holds a specialist certificate issued and registered by the Ministry of Health⁵ may use it. The usual route to this certificate is the national specialty entrance exam (DUS), specialty training, a thesis and a final exam. In the surgery, an approved copy of the dentist's practising certificate is displayed where patients can see it⁶.

Children have 20 baby teeth. Baby teeth usually start to come through at around 6 months⁷. In some babies they start before 4 months, in others after 12 months. In most children, all the baby teeth are through by the age of 2 to 3⁸.

Adults have 32 permanent teeth, including four wisdom teeth. These teeth have usually come through by the age of 21⁷.

In some children, one or more permanent teeth never form. Leaving wisdom teeth aside, in pooled studies 6.4% of people were missing at least one permanent tooth from birth⁹. The teeth most often missing are the second premolars in the lower jaw and the lateral incisors in the upper jaw. Most cases are mild. It is often an X-ray that shows it.

Under 3

Teeth are brushed twice a day as soon as the first tooth comes through, once just before bed. A parent or carer does the brushing. The UK's National Health Service (NHS) advises a toothpaste with at least 1,000 ppm fluoride, only a smear on the brush¹. The point of using a small amount is to limit the risk¹⁰ of marks on the teeth called fluorosis. Fluoride-free toothpaste is not recommended.

Ages 3 to 6

Use a pea-sized amount¹ of toothpaste with 1,000 to 1,500 ppm fluoride. Teeth are brushed twice a day. A parent does the brushing or helps the child. When your child starts brushing their own teeth, stay with them and watch.

Age 7 and over

The European Academy of Paediatric Dentistry advises parents to help with or supervise brushing until at least 7 years of age¹¹. After this age, children can usually brush their own teeth. At this age the NHS still advises keeping an eye on your child and using a toothpaste with 1,350 to 1,500 ppm fluoride¹.

At every age

• Spit, don't rinse. After brushing, the toothpaste is spat out, and the mouth is not rinsed with water¹. This way the fluoride left on the teeth is not diluted¹².
• Cut down on sugar. When sugar makes up less than 10% of daily energy, tooth decay is less common¹³. This is moderate-quality evidence from cohort studies.
• Any extra benefit from xylitol is uncertain. In children, a fluoride toothpaste with 10% xylitol was compared with a fluoride toothpaste alone over 2.5 to 3 years. It may have reduced decay by 13% (4,216 children)¹⁴. But this estimate rests on two studies by the same authors in the same population, and the quality of the evidence is low. Studies of other xylitol products are small and stand alone.

The options below are ordered by the state of the tooth: first monitoring and prevention, then repair such as a filling.

• Monitoring and care at home. Tooth decay can be stopped at an early stage, and even reversed¹⁵. The basis for this is the right fluoride toothpaste for your child's age and less sugar. The dentist watches for change at check-ups.
• Fluoride varnish. A dentist can apply a fluoride varnish¹⁶ to stop early decay. Varnish is also used to prevent new decay. The UK's national prevention guidance gives fluoride varnish twice a year for all children¹² from the age of 3 as a strong recommendation. Your dentist plans what your child needs according to their risk of decay.
• Fissure sealants. The pits and grooves on the biting surface of the permanent back teeth (molars) are covered with a thin resin. In 7 studies covering 1,548 children aged 5 to 10, after 24 months decay was clearly less common in teeth that had a sealant¹⁷. The quality of the evidence is moderate. The UK guidance recommends sealants for children whose risk of decay is a concern¹².
• Silver diamine fluoride (SDF). A liquid painted onto the decay to stop it; the tooth does not need drilling. After one application, the share of decay that stopped has been reported at between 47% and 90%¹⁸. The rate varies with the size and position of the decay. The treated decay usually turns permanently black.
• Fillings. Once a hole (cavity) has formed in the tooth, a filling will probably be needed¹⁶.
• Pulp (nerve) treatment or extraction of a baby tooth. If decay has reached the nerve, pulp treatment or extraction is discussed for baby teeth too. The choice depends on the state of the nerve. A crown may also be needed to protect the treated tooth. After an extraction, a space maintainer may be needed to keep the gap open. We do not give figures for the results of these treatments on this page; ask your dentist.

Children who cannot cope with treatment

Some children cannot cope with treatment because of fear or their age. In this case, splitting treatment into several short appointments, sedation or general anaesthetic may be discussed. This page does not cover who sedation and general anaesthetic suit in children, their risks, or the setting they should be done in. The conscious sedation page is for adults. Ask your dentist whether these options suit your child, what the risks are and where it would be done.

The steps below are for a check-up or a first examination. Your dentist decides how long the examination takes and which steps are needed according to your child's age and situation.

Young children can often sit on a parent's lap during the examination. Before the visit, talk to your child about it in a calm way that does not frighten them.

Risks and limits

• SDF leaves a permanent black colour on the tooth. Decay treated with SDF usually turns black and hard¹⁸. This is a side effect, not the aim of treatment. The guide recommends getting consent about this before it is applied.
• Too much toothpaste can raise the risk of fluorosis. The point of putting only a smear of toothpaste on the brush for under-3s is to limit the risk of marks on the teeth. Do not use more than the recommended amount.
• Fissure sealants do not prevent all decay. The result above comes only from a review of the biting surfaces of permanent back teeth. Baby teeth were outside its scope. Sealants do not last for life¹⁷; they are checked at check-ups.
• An examination by eye cannot catch every early decay. A review covering 67 studies worked through a situation in which 28% of surfaces had decay. On that basis, for every 1,000 tooth surfaces, 40 early enamel lesions would be missed and 163 sound surfaces wrongly called decayed¹⁹. Most of these studies were done in a laboratory, and the certainty of the evidence is low. This result does not directly measure how well a child's examination works; but it is a reason not to judge a mark from a photograph. The dentist decides whether an X-ray is needed from what the examination shows.
• Sedation and general anaesthetic. This page does not cover their risks in children. Before deciding, ask your dentist for the risks and safety measures in writing.

Benefits

• Decay picked up at an early stage can often be stopped without drilling.
• Fissure sealants reduce decay on the biting surface of the permanent back teeth.
• Regular check-ups can help identify conditions such as missing teeth or bite problems early.

A long-lasting thumb, finger or dummy sucking habit is linked with bite problems, and the risk rises the longer it goes on²⁰. But this is not the only cause of bite problems; genes, injuries and losing teeth early or late can also play a part.

In children whose upper front teeth stick out noticeably (an increased overjet), these teeth are more likely to be injured. In children with an overjet greater than 5 mm, the odds ratio for injury was about 2.43 in children with a mix of baby and permanent teeth or with permanent teeth only, and about 1.81 in 12-year-olds²¹. An odds ratio is not a measure of risk; it does not mean "injured twice as often". These are associations from observational studies.

Treatment started early, between the ages of 7 and 11, with a functional appliance reduced new injuries to the front teeth. Of every 100 children in the group that waited until adolescence, 30 reported a new injury²², compared with 19 in the early-treatment group. This result rests on 332 children, and the quality of the evidence is moderate. The same review showed no other advantage²² of early treatment: when treatment ended, the results of the two groups were similar. Early treatment happens in two phases; it does not mean braces will not be needed later. Details are on the braces treatment page.

Some children have black marks along the gum line, in the form of a row of dots or a line. These marks are a deposit formed by bacteria²³. Decay has been found less often²⁴ in children with these marks. But this is an association, and it does not show that the stain protects the teeth.

Not every dark mark on a tooth is of this kind. Decay, and decay that has been stopped with SDF, can also look dark. A mark needs to be assessed at an examination, not from a photograph. For more, see our article on a black dot on a tooth.

• If your child had a local anaesthetic, they may bite their lip, cheek or tongue until it wears off. Keep an eye on them during this time and hold off eating until the numbness has gone.
• It is expected that decay treated with SDF darkens. Ask your dentist how long the colour lasts and whether it can later be covered with a filling.
• Fissure sealants and fillings are checked at check-ups. If you notice that a sealant or filling has broken or come out, book an appointment without waiting for the next check-up.
• Daily care stays the same after treatment: brushing twice a day with the right amount of fluoride toothpaste for your child's age, once just before bed.

Contact a dentist if any of the following happens:

• Toothache, or discomfort when eating
• A change of colour, a mark or a hole in a tooth
• A pimple-like swelling or discharge on the gum
• A thumb or dummy sucking habit that continues, or front teeth that stick out
• A permanent tooth that has not come through long after the baby tooth fell out

If you think your child has an abscess, see a dentist without delay, even if there is no fever or swelling. A dental abscess does not go away on its own and needs urgent dental treatment²⁵. If your child has swelling in the face or jaw, or a fever together with toothache, get them seen the same day.

A tooth that has had a knock. For a tooth that is broken, loose or knocked out, contact a dentist straight away. This page does not cover how to store a knocked-out tooth or whether it can be put back; call for advice without waiting.

While you wait. Treating an abscess means the dentist draining the pus and removing the cause of the abscess²⁵. Antibiotics do not replace this treatment. Use painkillers as directed on the pack; children under 16 must not be given aspirin²⁵. Rinsing with salt water is not recommended for children²⁶. Clove oil is not recommended²⁷ for under-18s; life-threatening reactions have been reported in children under 2 after swallowing it.

Emergencies. The following need urgent medical help²⁵. Do not wait for a dental appointment; go to an emergency department or call 112:

• Swelling that makes it hard to breathe, speak or swallow
• Swelling that spreads to the eye or the neck
• Swelling or pain in the eye, or sudden problems with sight
• Major swelling inside the mouth
• Difficulty opening the mouth

This page carries no prices. The plan is prepared for your child after an examination. The main factors that shape it are:

• Whether only a check-up and prevention are needed, or treatment too
• How many teeth need treatment, and whether each is a baby tooth or a permanent tooth
• The size of the decay, and whether it has reached the nerve of the tooth
• Whether an X-ray is needed
• How many appointments the treatment is split into; whether sedation or general anaesthetic is needed

Ask for it in writing: what the plan you are given includes.