Oral Health and Pregnancy
Maintaining good oral health during pregnancy might be the last thing on your mind as you deal with food cravings and morning sickness. However, it’s important to look after your teeth and the ADA has developed a fact sheet with tips and advice to help you maintain good oral health during your pregnancy.
You are the most influential role model in the development of your child’s good oral health behaviours. Maintaining your own good oral health reduces the risk of tooth decay in your child.
Visiting the Dentist
If you’re planning on becoming pregnant it’s important to visit your dentist and have a check-up. Routine dental treatment is safe during pregnancy.
If you are already pregnant, don’t avoid visiting the dentist. It’s important to check that your teeth and gums are healthy. Ensure you advise your dentist that you are pregnant when scheduling your appointment. Your dentist may recommend a dental check-up during your second trimester. That’s because morning sickness has usually subsided in most women.
The appearance of primary teeth is commonly called ‘teething’. Many babies experience some discomfort during teething. Most babies are irritable when new teeth break through their gums. Signs and symptoms of teething can include:
- Frequent crying and crankiness
- A mild fever
- Reddened cheeks and drooling
- Loss of or reduced appetite
- Mild diarrhoea
- Sucking or gnawing on toys
- Pulling the ear on the same side as the erupting tooth
It is extremely important not to ignore symptoms such as fever and diarrhoea in your child. If these symptoms occur, seek medical advice to eliminate other reasons for the symptoms. To help relieve the discomfort of teething, here are some recommendations from the ADA:
- Wash your hands and gently rub your baby’s gums with a clean finger
- Give your baby a teething ring or wet washcloth to bite. Teething rings can be chilled in the refrigerator before being used to help manage discomfort associated with teething (do not put teething rings in the freezer)
- Give your baby non-sweetened rusks to chew on
Signs and symptoms may appear and disappear over several days. Ask your dentist or pharmacist for advice before using any pain relief specifically created for babies and toddlers. Never give aspirin to a baby or young child.
Brushing Baby Teeth
Even before your baby’s teeth appear, you should gently wipe their gums with a moistened soft cloth once a day. Once your baby’s primary teeth start to appear, you should use a toothbrush specially designed for babies, with a small head and soft, rounded bristles to gently massage their teeth and gums. Up to the age of 18 months, your baby’s teeth should be brushed with plain water, once a day after the last feed in the evening.
Tooth brushing for your baby can be done more easily with them lying on a bed or change table. The time taken to brush can be increased slowly until the baby is able to tolerate a two minute brushing as a toddler.
Once your toddler has become accustomed to brushing and during their third year, introduce brushing teeth twice a day in the morning after their breakfast and in the evening just before bed.
There are special low-fluoride toothpastes that have been developed for young children. These can be introduced from around the age of 18 months – read the directions on the toothpaste for age suitability. Only a smear of toothpaste is needed, and encourage your child to spit out the excess toothpaste.
If your child isn’t able to spit out after brushing. continue using a smear of low fluoride toothpaste and wipe their mouth with a washer or tissue. It’s really important to keep brushing their teeth and there is variability in the age at which children learn to spit out.
Store all toothpastes out of your child’s reach. Some small children love the taste of toothpaste and will eat it if given the chance. Consuming toothpaste can cause dental fluorosis, which is why you need to keep toothpaste out of reach of young children.
If you do not have access to fluoridated drinking water then it may be necessary to vary this advice. Consult with your local oral health professional regarding your specific individual needs.
Some two year-olds are ready for a ride in the dental chair while some three year-olds are still only able to cope with a “knee-to-knee” examination. Individual variations must be taken into account and this can be done through observation during the consultation phase of the appointment.
The One Year-Old Dental Check
In order for an intervention to be successful, it must be both timely and relevant. The avoidance of early childhood caries and the difficulties associated with its management are dependant upon the provision of information that will allow for behavioral modification early enough in the life of the child. The one year-old visit to the dentist is focused on oral health risk assessment through a structured consultation with parents and the provision of age appropriate individualized preventive information. A ‘knee-to-knee’ examination (pictured right) can be performed in either the dental clinic or a consultation room, but is not the main objective of the visit. Time spent in discussion with parents allows the child time to become accustomed to the environment as well as to the clinician, and may allow for an easier examination. White coats, masks and gloves are generally dispensed with for such a non-invasive examination, but hand-washing procedures are strictly observed. A child visiting his/her medical practitioner for an ENT examination will be approached in much the same way.
Contact us to book your child’s one year-old dental check!
Learning to Brush
From around the age of four to five children should begin to learn how to brush and care for their own teeth. Children do not have the skills to properly clean their own teeth until around eight years of age, so until then, tooth brushing should be a combined effort by you and your child. The teeth should be brushed in the morning and at night.
Choose a position where you can easily see your child’s mouth. For example, sit your child on your lap or stand behind your child with their head tilted back slightly.
Move the toothbrush gently in small circles to clean the front surfaces of your child’s teeth. To reach inner surfaces, tilt the toothbrush. Avoid side-to-side scrubbing, which can damage your child’s teeth and gums. Brush the biting and grinding surfaces of back teeth with a firm back and forth motion, and be sure to clean every surface of every tooth.
In total, you should aim to brush for about two minutes. It will take time for your child to allow you to clean their teeth for that length of time, however it’s important that their teeth are brushed twice a day, working up to two minutes as they get older.
Replace toothbrushes every three months or when bristles appear frayed. Frayed bristles are not effective at removing plaque and may scratch your child’s gums.
Did you know?
Plaque-disclosing tablets or drops (available from your dentist or pharmacist) contain food dye that turns plaque pink or red. Using these can be a fun way to help you and your child to see if the brushing technique you are using removes plaque from every tooth surface.
Learning to Floss
When your child is about two and a half years old, you can try introducing them to flossing their teeth. Flossing helps remove decay causing bacteria from between their teeth and keeps their gums healthy. It will take time for your child to get used to having their teeth flossed, however, ideally their teeth should be flossed twice a week in areas where the teeth are touching.
Slide the floss between your child’s teeth and gently work it up and down, against the surfaces of each tooth. Do not snap the floss down between the teeth as the floss may hurt their gums. After flossing, have your child rinse with water, then brush (or if you prefer, brush then floss) your child’s teeth.
If you find flossing your child’s teeth difficult, ask your dentist to show you how to do it. Floss holders are available, which can make flossing easier for some children.
Fluoridated water has the right amount of fluoride to help prevent caries when combined with fluoride toothpaste at the appropriate concentration for the age of the child. Bottled water has variable amounts of fluoride and many have zero fluoride. Boiling of water does not remove fluoride. The majority of water filters do not remove fluoride from water but reverse osmosis water filters have the ability to remove fluoride from water. If parents do not have access to fluoridated water then a fluoride inventory should be conducted and the appropriate prescription for fluoride supplements given to the parents. This advice must be given on an individual basis by an informed oral health professional as each situation will display local variations.
Did you know that as soon as your baby develops their first tooth, they are at risk of dental decay, which is known as Early Childhood Caries (ECC)? The following tips can help prevent ECC in your child:
If your baby has teeth, it’s best to avoid settling them to sleep overnight with a breastfeed or bottle of milk, sweetened flavoured milk, cordial, soft drink or fruit juice. Bacteria feed on the sugar in these drinks and form plaque acids on teeth, which eat into the tooth surface and cause decay.
- Encourage your baby to learn to drink from a toddler cup from 12 months of age
- Don’t allow your child to take a bottle of milk or other sugary drinks to bed. When they are older, it is fine to place a glass of water on their bedside table in case they get thirsty overnight
- If your baby needs to suck on something to settle them to sleep, offer a dummy rather than a bottle
- If your baby has a breastfeed or bottle of milk before bed, gently wipe down their teeth with a moistened cloth before putting them to sleep
- Breast and bottle feeding regularly throughout the day or night once a child is over 12 months can contribute to ECC. Speak with your maternal and/or child health care adviser if your baby still needs an overnight feed
- Avoid giving your baby or toddler frequent snacks – three meals and two snacks per day is ideal to meet dietary needs
- If your baby suffers from a dry mouth (lack of saliva) and is a mouth breather, they are at greater risk of ECC. Speak with your maternal and/or child health care adviser or dentist if you think your baby may suffer from a dry mouth
- Good oral hygiene begins at birth. Click on the link below from the Australian Dental Association’s (ADA)website. This is a fact sheet on oral hygiene for babies and toddlers for guidelines on cleaning your baby’s gums and teeth
More information: ADA Oral Hygiene Factsheet
The normal number of baby teeth is 20 and these are all lost to make way for the permanent (adult) teeth. The normal number of adult teeth is 32; this includes four wisdom (third molar) teeth. The transition to the permanent dentition starts at around six years of age and continues until around 12 years of age. It generally occurs in two stages. First the upper and lower front incisor (8) teeth are lost and replaced with permanent incisors and the four six year old molars erupt behind the baby molars. This is usually completed by eight years of age. In the second stage the remaining baby (12) teeth are lost and replaced by 12 adult teeth, eight premolars and four second molars.
Some children do not develop a full set of permanent teeth. The most commonly missing teeth are the upper lateral incisors, second premolars and third molars (wisdom teeth). Most children who have missing teeth will only have one or two missing teeth. Children who have more than this number missing may have a special genetic condition called ectodermal dysplasia.
Supernumerary Teeth (Extra Teeth)
Teeth are usually lost symmetrically in pairs and if one side is lagging behind then it is best to investigate with your dentist early rather than later. Occasionally an extra (supernumerary) tooth may be blocking the eruption path of the adult tooth causing a problem with both the loss of the baby tooth and the alignment and proper development of the adult tooth. This problem is best dealt with earlier rather than later and is most common in the upper incisor area.
Thumb sucking is a natural reflex in babies and young children. Most children lose interest in thumb sucking and dummies at two to four years of age.
Children who continue to suck their thumb or fingers after their permanent teeth have appeared risk developing crooked teeth, particularly if the sucking is forceful or frequent. Also, speech defects may arise, especially with ‘s’ and ‘th’ sounds.
Gently encourage your child to give up thumb sucking. See your dentist for advice if your child cannot stop thumb sucking by the end of their first year at school. In rare cases, referral to a child psychologist may be helpful.
Sometimes baby teeth just hang around for too long. They become loose then tighten again as the emerging adult tooth becomes increasingly deflected from an ideal position in the dental arch. Some baby teeth just seem to be hanging by a thread making eating and brushing very difficult and painful. Plaque can build up around the gum line of both the baby tooth and the emerging adult tooth placing it at risk of early decay or at least mineral loss. The gums may bleed excessively on brushing causing distress.
Patience is the first course of action as many of these baby teeth will eventually be lost naturally. If pain and gum infection become a problem so that eating and brushing are an ordeal then removal of the tooth may be necessary. If the baby tooth has become quite tight again and the adult tooth is deflected from an ideal position then it may be necessary to remove the baby tooth. Some children suffer from this problem repeatedly while others will have an isolated problem with only one or two teeth affected. The most common position is in the lower two central incisors. The next most common is the upper two central incisors.
The loose baby tooth can sometimes be removed by applying some topical anaesthetic gel to the gum line around the tooth. The gel is flavored and after three to five minutes causes the gum to become ‘numb’ or ‘frozen’. It is then possible to pinch the tooth away with some light pressure and a piece of gauze. Parents may be able to do this for their child by using a preparation like ‘bonjela’ to ‘numb’ the gum first. If the tooth does not come away easily it may be quite painful for the child if you persist. Dentists are generally quite experienced at determining whether or not local anaesthetic will be necessary.
A firm baby tooth may require the use of local anaesthetic. Topical anaesthetic is first applied for three to five minutes and then an injection of local anaesthetic is used to totally ‘numb’ or ‘freeze’ the area. The injection can be quite painful for a second or two and it is best to warn the child that it may be a little painful or uncomfortable similar to a ‘mozzie’ bite or pinch. Some children may not feel anything at all.
Children respond well to a kind approach and firm instructions such as remaining very still and opening wide. They understand the importance of being safe and minimizing the discomfort. Your dentist has developed a sensitive and positive approach to the use of local anaesthetic and is very experienced in safe and reliable injection techniques. It is best to keep the answers to your child’s questions brief and simple. If you are unsure about the precise nature of the procedure then it is best to tell your child to ask their dentist for information on the day of the procedure.
It is not usually necessary to use any other form of sedation or pain relief for this type of simple procedure. Post operative pain management is usually unnecessary. Although the gums bleed profusely with the loss of a tooth it is usually short lived and settles best with some pressure by biting on a pad of clean gauze as supplied by your dentist.
Primary teeth help your child to learn to chew, speak properly and most importantly, these teeth reserve the space in your child’s gums for the eruption of their permanent teeth. Primary teeth start to form in your child’s jawbone before birth. A baby’s first primary tooth usually erupts at about six months of age; however, this can occur as early as birth or as late as your child’s first birthday.
The average child has a full set of 20 primary teeth by the age of two to three years. Your child’s first visit to the dentist should be within six months of the eruption of their first tooth, or by their first birthday.
Diet plays an important role in the health of your child’s teeth, so developing healthy eating habits early in life will help your child form the building blocks for strong and healthy adult teeth.
Dental decay rates in young children are rising, and this is related to changes in what and how some children eat. Fewer children are drinking fluoridated tap water, and more children are consuming sugary, processed foods and drinks.
Good oral hygiene begins at birth, so make your child’s smile count.
Babies and toddlers are at just as much risk of dental decay as an older child or adult, so caring for your baby’s teeth needs to begin at birth. By establishing good oral hygiene habits early, your child will be well equipped to have healthy teeth for life.
If your toddler resists teeth cleaning or struggles to sit still for two minutes, try these suggestions:
- Consider a battery-powered tooth brush, which adds novelty to cleaning their teeth
- Sing nursery rhymes or play a favourite song while you help your child brush their teeth
- Offer a reward every time your toddler allows you to brush for two minutes
- Encourage your child to practise teeth cleaning (under your supervision) to instill good oral hygiene habits in them from an early age. Some toddlers like to be independent so it is a good idea for them to use one toothbrush while you use another one and take turns at brushing
- Make flossing and brushing as much fun as you can to avoid any negative association or resistance. Be sure to talk to your dentist if you need more advice
It is important to set a good example. Children tend to imitate their parents’ behaviours. If oral hygiene and looking after your teeth are important to you, they will be important to your child. Talk to your child about the importance of healthy teeth. A child who understands that teeth have to last a lifetime is more likely to take care of them.
Visit your dentist regularly to maintain your own oral health, which will in turn benefit your child.
What to do if your child chips or knocks out a tooth
When babies are learning to walk they are prone to falls and injuries to their mouth and teeth. Knowing how to administer first aid in case of a dental injury is important. Your child’s primary teeth are just as important as their permanent teeth.
If your child knocks out a primary tooth you should not attempt to put the tooth back in its socket because it may cause damage to the permanent tooth or lead to infection.
If your child knocks out a permanent tooth it is important to put this back into the socket. You should avoid touching the root section of the tooth. If the tooth is dirty, rinse it quickly, preferably with milk, and replace it in the socket. Look at the teeth either side of where the tooth has come from, use the shape and position as a guide. It is important that once you have replaced the tooth that you see a dentist immediately. If you are uncomfortable doing this or you are finidng it too diffuclt the alternative is to put the tooth in milk and see a dentist immediately. The sooner a knocked out tooth is replaced, the better the long-term prognosis for the tooth. Teeth that are replaced within thirty minutes have a good chance of surviving long term, but it is well worth replacing a tooth even if it has been out for a number of hours
It is important to seek urgent dental treatment for your child to check if any pieces of tooth remain in the socket and to ensure no other damage has been done.
To manage bleeding, apply pressure directly to the injured area with a clean cloth or gauze pack. This will help to control the bleeding. To minimise swelling, you can apply ice or cold compresses to your child’s face at the site of the injury. If the injury is severe it may require stitches. Your child may require some age-appropriate pain relieving medication.
With any dental injury, it’s important to always seek professional advice from a dentist, or if a dentist is not available, seek advice from a healthcare professional.
Here are some websites which we recommend:
- American Academy of Paediatric Dentists
- Armidale Private Hospital
- Australian Dental Association
- Australasian Academy of Paediatric Dentists
- Australian and New Zealand Society of Paediatric Dentistry (ANZSPD)
- Children’s Hospital Westmead
- Hunter New England Area Health (HNEAHS)
- North Shore Private Hospital
- Prince of Wales Private Hospital
- St George Private Hospital
- Sydney Dental Hospital
- Sydney ENT and Facial Day Surgery Center
- Tamworth Base Hospital
- VeloCardioFacial Syndrome Site