Many children fall over and bump their teeth accidentally. If this happens, take your child and the tooth if it has been knocked out to your dentist for advice as quickly as possible. If you can’t get to your usual dentist, contact the nearest dentist.
Tooth decay and dental erosion are two preventable causes of damage to children's teeth.
Our mouths are full of bacteria that build up on the teeth in a sticky layer called plaque. These bacteria digest some of the sugar in our food and drinks, making acids which weaken the tooth enamel (the hard outer layer of teeth). If acid stays on the tooth surface for a long time, it can cause those areas of the tooth to decay. This can happen if children often have sugary foods or drinks, or don't clean their teeth properly.
If your child has tooth decay that isn't treated by a dentist, it will eventually reach the centre of the tooth and can cause an infection or toothache.
Dental erosion is the gradual wearing away of the enamel on the whole surface of the tooth. It's caused by acid attacking the surfaces of the teeth. These acids usually come from drinks such as fruit juices, fizzy drinks and squashes – even the sugar-free varieties. These drinks are so popular that over half of all five-year-olds in the UK have some dental erosion. Acids can also be produced if your child vomits or has stomach problems.
Dental erosion can cause sensitivity and pain. Although enamel doesn't grow back, dental erosion doesn't usually need treatment. If your child has a seriously eroded tooth, his or her dentist may protect the tooth with a filling.
To reduce your child's risk of tooth decay and dental erosion:
- take your child to the dentist regularly
- don't give your child sugary or acidic foods and drinks often, and if you do then try to only give them at mealtimes
- encourage your child to brush his or her teeth twice a day with at least 1,000ppm fluoride toothpaste
- encourage your child to spit out toothpaste and not rinse with water, as this reduces the effect of the fluoride
- ask your dentist about protective treatments such as fluoride supplements and fissure sealants
You should take your baby when you go for your own dental check-ups, even when he or she is too young to have teeth. This helps your child become familiar with the people and the surroundings at the dental surgery. Your dentist will look in your child's mouth in an informal way. He or she may count how many teeth have erupted and spot any early signs of decay. Quick check-ups like this help to encourage good co-operation with the dentist when your child is older.
Your dentist will recommend check-ups at intervals suitable for your child. He or she may take X-ray images to check for decay. Children may need dental visits more often than adults. This is because milk teeth are smaller and have thinner enamel than permanent teeth, so decay can spread quickly.
Reducing sugar in your child's diet is the best way to prevent tooth decay. However, it's how often your child eats sugar rather than how much that is important. Similarly, it's how often your child has acidic food and drinks rather than the amount that affects dental erosion.
Keep squashes, fizzy drinks, natural fruit juices, sweets and cakes to a minimum, and never more than four times in a day. Don't give your child sugary foods and drinks as snacks between meals or before bedtime. Watch out for hidden sugars in sauces, breakfast cereals and other foods.
Fruit, vegetables, cheese and milk are all healthier snacks because they contain only natural sugars. Remember, however, that as well as natural sugars, fruit contains acids, which can cause decay if eaten in large amounts. You can help to protect your child's teeth against erosion by finishing a meal with an alkaline food such as milk or cheese. This will neutralise the acid in your child's mouth.
Older children can chew sugar-free gum after meals, especially gum containing xylitol, as this helps remove bacteria and prevent tooth decay.
Plain water and plain milk don’t cause tooth decay or erosion. Your child may find it hard to drink plain water or milk if he or she usually has sweet drinks, but most children get used to it over time.
You should start cleaning your child's teeth as soon as they come through the gums. There are special toothbrushes for babies.
Make tooth brushing a regular activity, in the morning and before bedtime, so that it becomes part of your child's daily routine. Don't brush for one hour after eating or drinking anything acidic (such as orange juice). This gives time for the teeth to build up their mineral content.
When your child is about seven, teach him or her how to brush his or her own teeth, using a gentle, circular motion and fluoride toothpaste. You should supervise your child while he or she is learning to brush. Give your child plenty of encouragement and praise. It's a good idea to check how well he or she is getting on every few days.
Disclosing tablets can help. After chewing a tablet for 30 seconds, it stains any plaque a bright colour – usually pink. This can help your child see any areas that have been missed when brushing.
Most toothpaste contains a mineral called fluoride, which strengthens the tooth enamel making it more resistant to decay. Fluoride is also added to the water supply in some of the UK. You can find out if your water is fluoridated by contacting your water supply company.
However, too much fluoride in young children can result in a spotted appearance on their permanent teeth (dental fluorosis).
The amount of fluoride in different brands of toothpaste varies. Children under three should use toothpaste that contains 1,000ppm fluoride. Children over three should use toothpaste that contains between 1,350 and 1,500ppm fluoride.
Use only a smear of toothpaste for children under three. After that, use an amount about the size of a small pea until your child is six.
If there is no fluoride in the water where you live, your dentist may recommend extra fluoride in the form of tablets, drops or mouthwashes. Your dentist may also recommend extra fluoride if your child's teeth are at risk of decay.
Some children have deep fissures (crevices) in their permanent back teeth, which can be difficult to keep clean. These fissures can be sealed with a resin film to protect the surface from decay.
Fissure sealants are quick and painless to apply. The dentist cleans the tooth with a special solution, then washes and dries it. The resin is then painted on to the tooth and hardened with a bright, blue light.
Fissure sealants can last for several years, but your child should visit the dentist regularly to check that they haven't worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.
Is it true that dummies can damage my child's teeth?
Dummies don’t usually cause long-term problems. However, if your child sucks on a dummy for long periods, it could cause problems in the way his or her teeth develop. The pressure of the dummy against the back of the teeth could push the teeth forward. This could mean that your child will need corrective treatment (such as a brace or having teeth removed) when he or she is older.
Many parents use a dummy as a way of comforting their baby, especially when trying to get him or her off to sleep. It's fine for your baby to use a dummy, but only for short periods of time, for example, when settling to sleep. If your child sucks on a dummy for more than six hours a day, it could cause problems in the way the teeth develop. The same is true if your baby sucks his or her thumb or fingers. The pressure of the thumb or the dummy against the back of the teeth could push them forward. This may mean your child will need corrective treatment – like a brace or having teeth removed – when he or she is older. Orthodontic shaped dummies can help reduce the likelihood of damage.
Your child is more likely to have problems with permanent teeth if he or she sucks his or her thumb or finger. This is because the habit usually goes on for longer. The harder your child sucks, the higher the risk of a problem. You should try to stop your child from sucking a dummy or thumb, and it’s best to do this before their permanent teeth erupt. The simplest way of stopping your child using a dummy is to throw it away so that your child can't find it.
If your baby uses a dummy, it's important that you never dip it into fruit syrups, honey, fruit juices or anything containing sugar, particularly at bedtime. Long-term contact between your baby's teeth and sugars or harmful acids can cause decay.
Talk to your dentist if you're worried about your child's use of a dummy or thumb and finger sucking.
I only give my child drinks with no added sugar, but my dentist tells me that these still may contain a lot of sugar and should only be given occasionally – why is this?
When labels say that drinks have no added sugar, it means that sugar hasn't been added as an ingredient. Some drinks, such as fruit juices, have a naturally high sugar content even though no sugar has been added. Drinks containing natural sugars can still damage teeth, and should therefore only be given occasionally. Plain water and milk are the best drinks to keep your child's teeth healthy.
Food and drink labelling can be very confusing. 'No added sugar' usually means that the drink hasn't had sugar added to it as an ingredient. 'Unsweetened' usually means that no sugar or sweetener has been added to the food to make it taste sweet. When drinks are listed as having 'no added sugar' or as being 'unsweetened', it doesn't necessarily mean that they won't contain naturally occurring sugars. Some drinks, such as fruit juices, have a naturally high sugar content even though no sugar has been added.
Check the ingredients lists on 'no added sugar' and 'unsweetened' drinks’ labels. These will tell you the ingredients that have been used, including the types of sweetener and sugar. You can also find information about how much sugar there is in the food in the nutrition panel on the label.
Plain water and milk are the best drinks to keep your child's teeth healthy.
What should I do if my child knocks out one of his or her permanent teeth while playing sport?
If your child knocks out a permanent tooth, you should clean the tooth gently by running it under water or milk. After it's been cleaned, replace it in the tooth socket as soon as possible. Your child should bite down on a clean handkerchief while you take him or her to the nearest dentist or Accident and Emergency department for treatment.
Sometimes a child will knock out a tooth while playing sport. If this happens, hold the tooth without touching the root, and wash it in milk or water. If the tooth is clean and not damaged, put it firmly back into the tooth socket. Then ask your child to bite down on a clean handkerchief. Visit a dentist as quickly as you can, ideally within 30 minutes.
If the tooth is damaged, or if you can't put it back in, ask your child to keep it in his or her cheek. If this is not possible keep it in milk until you get to a dentist.
If your child plays sports such as rugby or hockey that put teeth at risk, you should talk to your dentist about getting a properly fitted rubber mouth guard to protect his or her teeth.
Don't try to replace a milk tooth that has been knocked out as this could damage the permanent tooth underneath. If your child knocks out a milk tooth, your dentist will probably advise you to wait until the permanent tooth comes through.
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