Between the ages of six and 12 years, many changes occur in your child’s mouth, along with their normal growth and development. These years cover the transition from all primary teeth to a dentition that is all permanent teeth. During this period, the dental appearance of your child will change significantly, and not all stages are pretty, due to gaps from missing teeth and the perception that the new adult-size permanent teeth are out of proportion to other characteristics of the face. Routine check-ups are important during these years so that any incorrect tooth positions or jaw relationships can be evaluated and orthodontic treatment considered.
In this stage of growth, good oral hygiene cannot be emphasized too strongly. It is important for the primary teeth to stay healthy until they are naturally exfoliated, and the permanent teeth need good care to last a lifetime.
About preventing tooth decay
How to reduce sugar in your child’s meals and snacks
About toothbrushing and between teeth cleaning
How frequently to visit the dentist
Your child’s dentist if you are worried about your child’s dental health or the color of their teeth
Your child’s dentist if your child is taking fluoride supplements or any prescription medicines such as antibiotics
Your child’s dentist if your child is about to start playing contact sports
Supervise your child’s toothbrushing and between-teeth cleaning
Take your child for dental check-ups as frequently as your dentist or pediatrician advises.
Make sure your child wears a mouthguard that is well fitting every time they play a contact sport.
Brush twice a day with fluoride toothpaste for at least 2 minutes.
Floss or carry out interdental cleaning at least once per day.
Regular dental visits are the best way to keep your child’s dental development on track and healthy.
Too many acidic foods and drinks may result in acid erosion.
Avoid sugary snacks and drinks between meals.
Cavities occur as a result of tooth decay, also known as dental caries. Tooth decay is the destruction of the tooth structure, and if untreated, it can lead to severe pain, infection, and the probable extraction of the tooth.
Tooth decay happens when foods containing sugars are eaten too frequently. The bacteria in the dental plaque feed on the sugars and produce acids as waste products. The acid dissolves the minerals out of the tooth, and if allowed to continue, will create a cavity. On the protective side, saliva bathes the teeth in a solution of calcium and other minerals that help heal the tooth through the process of remineralization. Fluoride also helps to prevent tooth decay, as it makes the enamel stronger and more resistant to acid, encourages the minerals to return to the tooth, and slows down the acid production in the bacteria.
One of the first signs of tooth decay is the appearance of white spots, typically near the gum line. At this stage, the process can be reversed and a cavity avoided.
To prevent dental decay, it is important to:
- Avoid frequent or excessive consumption of sugary foods and drinks.
- Brush teeth with a high-quality toothbrush at least twice a day, and clean between the teeth with floss or interdental brushes at least once a day to reduce the amount of dental plaque.
- Use a fluoride toothpaste.
- Have regular dental check-ups as advised by your dentist or pediatric dentist.
Cavities are caused by the bacteria in dental plaque feeding on sugar in foods and drinks. Sugar causes the bacteria to produce harmful acids, which then dissolve minerals, like calcium, out of the tooth.
There are three key actions you can do:
- REDUCE SUGAR: Avoid sugary snacks and drinks between meals.
- TOOTHBRUSHING TWICE A DAY: Teeth should be brushed for at least two minutes twice a day with a fluoride toothpaste.
- BETWEEN-TEETH CLEANING should start once the child’s teeth fit closely alongside one another. Use either interdental brushes, flossers specially designed for children, or dental floss.
Ask your dentist if sealants or topical fluoride treatments may be necessary to protect your child’s teeth from tooth decay.
Figure: Early stage tooth decay may occur either in the grooves on the biting surfaces or just above the gumline, between the teeth and out of sight. The first sign may be white spots near the gum line.
Figure: As decay advances through the tooth it spreads into dentin and toward the nerve.
Fluoride is a naturally occurring salt of the element fluorine and is a mineral that is found in all oceans, lakes, and rivers. Research in the nineteen thirties and forties suggested that natural water supplies that contained small amounts of fluoride were associated with communities that had fewer cavities. Further extensive scientific study ensued in the United States, Canada, and the United Kingdom, and led to the addition of fluoride to municipal drinking water supplies (fluoridation) to reduce dental decay. In 1945, Grand Rapids, MI, became the world’s first city to adjust the level of fluoride in its water supply. Today, approximately 72% of the US population that is served by public water systems receive the benefit of optimally fluoridated water, which has been shown to reduce tooth decay by 20–40%.
Fluoride is also formulated into most toothpaste. It, too, has been studied extensively and shown to reduce cavities by about 25%. It is now added to some mouthrinses, milk, and table salt in different parts of the world, and dentists and dental hygienists apply higher concentration gels and varnishes to the teeth of children and adults at high risk of developing cavities. National and international health agencies and dental associations throughout the world have endorsed the safety and effectiveness of fluoride. The US Centers for Disease Control and Prevention has listed water fluoridation as one of the ten great public health achievements of the 20th century.
Fluoride prevents cavities by strengthening the mineral crystals in the tooth’s enamel. The enamel is made stronger and harder when fluoride is incorporated and thus the tooth becomes more resistant to the acid attack that causes cavities. Fluoride also encourages the enamel to repair itself by attracting any calcium that may have been dissolved by acid or is naturally present in the saliva to bind to the enamel and thus strengthen it—a process known as remineralization. Fluoride also affects the bacteria that produce the acid that causes cavities by interfering with bacterial acid production.
Tooth erosion, also known as acid erosion, occurs when the tooth enamel is worn away by acids in many everyday foods, such as fruits and vegetables, sodas, sports drinks, fruit juices (and even wine). Tooth erosion is becoming more common in children, particularly those on a “healthy” diet containing many fruits and vegetables. The acid softens the enamel surface, and the saliva will naturally re-harden it in about an hour. During this time, the softened enamel can be easily be rubbed away by toothbrushing, chewing foods, swishing liquids around the mouth, and even the roughness of the tongue. As the enamel is worn away, the natural shape, texture, and appearance of the tooth gradually change. Once lost, the enamel cannot be replaced.
Figure: Left image shows teeth recently emerged into the mouth fully covered with dental enamel that is shiny and white; Right image is moderate erosion with sensitive and dull yellow dentin exposed, as enamel is lost.
More rarely, enamel can also be eroded by regurgitation of stomach acids.
To reduce the risk of acid erosion, follow these tips:
- Avoid frequent snacking.
- Try to have foods and drinks that contain acids as part of a meal rather than a frequent snack.
- Consider brushing before meals when the enamel is at its hardest; or wait at least half an hour after consuming any acid-containing foods or beverages before brushing.
- Finishing meals with calcium rich foods and drinks is good (milk, yogurt, and cheese).
- Ask your dentist or dental hygienist if your child is at risk of tooth erosion and follow their recommendations.
- If erosion is occurring as a result of regurgitation of stomach acids, consult a physician for investigation of the cause, and also consult your dentist to address the tooth erosion.
Your child’s dental health is very important. Between ages 6 and 12 years, the permanent teeth are erupting into the mouth, and they need care to help them last a lifetime. It is important to select a brush that your child will be happy to use. Consider the following to select the ideal brush:
- The brush head should be small enough to easily get in all the areas of the child’s mouth.
- The handle should be easy to grip firmly.
- The bristles should be soft or ultra-soft, flexible, and packed together tightly.
- Cartoon characters and other themes may help generate the child’s interest in using the brush.
- Toothbrushes with built-in timers, such as light or music, help the child adopt the correct length of time for each brushing episode (at least two minutes, twice a day).
- The toothbrush should be made by a leading manufacturer of oral hygiene aids. GUM® has a wide variety of kids’ oral care products including age-appropriate toothbrushes and a fluoride toothpaste.
Toothbrushes should not be shared, should be rinsed clean after each use, and allowed to dry naturally. Toothbrushes should be replaced every three months or more often if the bristles become worn or splayed. Also, replace toothbrushes after upper respiratory tract illnesses, such as cough, colds, and influenza.
The frequency of dental visits should be determined in consultation with your dentist or pediatric dentist. Typically, a child in this age group should be seen every six months, but the dentist can advise more accurately based on the child’s growth and development and risk of developing dental disease, especially new cavities.
Between these years, the mouth and face go through extensive growth and development. Abnormal bites, or malocclusion, are first noticed in this age group. Your dentist or pediatric dentist will monitor the situation, and if concerned, may recommend a consultation with an orthodontist, who is a dentist with specialist training. Orthodontics is the specialized area of dentistry that diagnoses and corrects crooked and misplaced teeth and can improve both the appearance of the mouth and face and the function of the jaws.
Loss of the baby teeth starts around 6–7 years old and will continue until age 12–14 years. Usually, the first baby teeth to be lost will start to get wobbly around 6–7 years and will then fall out. The baby or primary teeth are important to eat, speak, smile, and most importantly, hold and maintain the spaces for the adult teeth.
The period of time when there are both baby and permanent teeth, from 6–14 years is a time of changing appearances, as there are some small baby teeth mixed with some permanent teeth that look very large in proportion to the size of a child’s face. During this transitional phase of a mixed dentition, children may have an awkward appearance due to two different types of teeth. Routine examinations by the dentist will enable proper monitoring of the child’s dental growth and appearance.
Figure: The tooth fairy will start to visit at approximately 6 years old.
At age 6–7 years, the first permanent teeth begin to appear and are usually the lower first molars at the back of the mouth in the lower jaw. When these teeth appear, it is important to make sure that regular toothbrushing reaches far back to keep these teeth clean and to ensure they receive the fluoride carried in the toothpaste. In some instances, the lower incisors will appear first, replacing the baby incisors. In some instances the new incisors will emerge behind the baby incisors and both sets of teeth may be present for a short period before the baby teeth are lost.
The first permanent teeth usually emerge around 6-7 years. The permanent teeth that are first to emerge are the first molars and the lower central incisors, followed by the upper central incisors. Most permanent teeth have emerged by age 14 years.
Figure: The first permanent teeth emerge around 6-7 years old. At this age there is a ‘mixed dentition’ of both primary and permanent teeth.
Figure: Between the ages of 8-10 years, upper lateral incisors, upper first premolars and lower canines emerge filling gaps after normal loss of primary teeth.
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Figure: Between the ages of 10-14 years all the remaining permanent teeth emerge, except for the third molars or wisdom teeth. During these years the teeth may look crowded until they settle into their final positions.
Figure: Between the ages of 17-21 the third molars or wisdom teeth may emerge. Not everyone has wisdom teeth, and not all wisdom teeth emerge fully into the mouth. Many wisdom teeth become ‘impacted’ due to insufficient space in the jaws.
Upper Permanent Teeth Development Chart
|Upper Teeth||When tooth emerges|
|First molar||6 to 7 years|
|Central incisor||7 to 8 years|
|Lateral incisor||8 to 9 years|
|First premolar (first bicuspid)||10 to 11 years|
|Second premolar (second bicuspid)||10 to 12 years|
|Canine (cuspid)||11 to 12 years|
|Second molar||12 to 13 years|
|Third molar (wisdom teeth)||17 to 21 years|
Lower Permanent Teeth Development Chart
|Lower Teeth||When tooth emerges|
|First molar||6 to 7 years|
|Central incisor||6 to 7 years|
|Lateral incisor||7 to 8 years|
|Canine (cuspid)||9 to 10 years|
|First premolar (first bicuspid)||10 to 12 years|
|Second premolar (second bicuspid)||11 to 12 years|
|Second molar||11 to 13 years|
|Third molar (wisdom tooth)||17 to 21 years|
Third molars or wisdom teeth emerge between the ages of 17 and 21. Not everyone has wisdom teeth and of those who do, some do not have all four. As wisdom teeth are the last to emerge into the mouth, there may not be enough space left for them, in which case they may be “impacted,” meaning there is no room for them to take their proper position. Impacted wisdom teeth may need to be removed from the jaw by a simple surgical procedure.
From six years old, a child can use the same amount as an adult—no more than a one-inch strip. Toothbrushing with fluoride toothpaste should be performed at least twice a day.
Figure: For children 6–12 years, apply fluoride toothpaste no longer than a 1-inch strip.
A small amount of fluoride is very good for teeth, strengthening the enamel, and protecting against tooth decay. Too much fluoride can be harmful; all fluoride sources should be kept out of the reach of children. Your dentist, pediatric dentist, or pediatrician can provide recommendations tailored to the needs of your child.
Most dental professionals recommend that toothbrushes be replaced every three months. It may be necessary to replace the brush more frequently if the bristles begin to look bent or splayed out or the brush-head looks worn.
Toothbrushes should not be shared, and should be rinsed clean of all toothpaste and left in the open air to dry after each use. Some dental professionals recommend that toothbrushes should be replaced after you or family members have had a cold or flu.
Figure: Note the difference between a new brush and one that is worn and with the bristles splayed out, which should be replaced.
Dental sealants are thin plastic coatings that are applied to the chewing surfaces of the back teeth to seal the grooves (fissures and pits on the surface). Most decay in children and teens occurs on these areas of the teeth. Ask your child’s dentist about the need for sealants to prevent decay. Not all children will need them. However, the risk of decay can change as the child grows, and sealants may be needed if the risk of decay increases. Sealants will provide protection for 5–10 years. They do not replace fluoride for cavity protection. Sealants work in those areas where fluoride is not as effective. Their purpose is to keep germs and food particles out of the areas on the biting surfaces, where particles can easily become trapped and cannot always be removed by toothbrushing.
Figure: The left tooth shows the normal fissure of a tooth before sealing. The right tooth shows the fissure system completely filled with a dental fissure sealant.
Mouth cleaning with a toothbrush alone is not enough. There are many areas between the teeth where the bristles of a toothbrush cannot reach.
Flossing will clean these areas and should be carried out once per day. Flossers are small easy-to-grip handles that are pre-loaded with floss and are ideal for children learning to floss. GUM® Crayola™ Kids’ Flossers are available in various colors and designs and the floss is fluoride coated and grape flavored.
Cleaning between the teeth and other hard to reach areas can also be accomplished with interdental or interproximal brushes where space permits. These are generally much easier to use and are as effective.
What is puberty gingivitis? My child is going through puberty and his/her gums look very red and bleed easily. Could this be puberty gingivitis?
Many changes occur in the body during puberty, and body systems that have worked normally may easily be disturbed during the process of puberty. One such disturbance is in the mouth when the gums react much more aggressively to the presence of dental plaque.
The change in hormone levels in the blood stream affects both the gum tissues themselves and some of the bacteria in the dental plaque, as the hormones can pass through the gums and into the mouth itself, where the bacteria absorb them.
The effect on the gum tissues is to make them more reactive to the presence of the bacteria in the plaque. The effect on the bacteria is to encourage them to release more harmful byproducts. Both these effects show themselves by red and swollen gums that bleed easily.
Though unpleasant, the condition will pass with the conclusion of puberty. However, while the condition exists, it is important that the child work extra diligently to remove plaque on a daily basis, using their normal oral hygiene techniques and aids. Dental advice should be sought to assess the situation, and, if needed, provide a prophylaxis to remove any build-up of plaque. Use of an anti-plaque rinse may be recommended depending upon the severity of the condition.
Figure: In puberty gingivitis, the changes in hormones result in an increased reaction of the body to the dental plaque. Note the redness of the gum tissue, a key sign of inflammation.
Mouthguards, or mouth protectors, help cushion a knock to the teeth and jaws. Many sports increase the risk of injury to the mouth and face. While collision or contact sports have the greatest risk of injury, some non-contact activities, such as gymnastics, also pose a risk. Typically, the mouth can be protected from accidents by wearing a properly constructed and professionally fitted mouthguard. Mouthguards are an essential item of athletic gear that should be used from an early age.
Seek the advice of your dentist, pediatric dentist or pediatrician before your child engages in sports that increase the risk of injury. The most effective mouthguards are professionally-fitted and made at the dental office. However, they tend to be the most expensive. Other types can be purchased in sports stores and drug stores. Although these do not fit as well, they still provide essential protection from permanent injury.
Remember to have the mouthguard examined at each dental check-up visit.
- Rinse it in warm water before and after each use.
- Occasionally brush it with a toothbrush and toothpaste or wash in soapy water.
- Do not place in a dishwasher; the heat will cause distortion.
- Store the mouthguard in a container that has vents, and try to avoid leaving it among sweaty athletic clothing where fungi may easily grow.
Yes, but the best dental filling material is no dental filling at all! All commonly used filling materials are safe, and dental amalgam has been in use for over 150 years. Some concerns are raised from time to time over the safety of dental amalgam fillings, as they contain mercury. The mercury added to the mixture of other metals when the filling is prepared forms a safe and stable material. The American Dental Association, the FDA, the Centers for Disease Control and Prevention, and the World Health Organization all agree that, based on all the scientific evidence available, dental amalgam is a safe and effective filling material.
Dental x-rays (radiographs) are a diagnostic tool and help the dentist detect conditions not always visible to the human eye. They can help detect dental decay and gum disease involving the bone, and they are helpful in monitoring a child’s growth and development. Your dentist will assess the benefit of gaining the additional information the x-rays will provide after reviewing your child’s dental history and examining their mouth, and then will advise whether or not x-rays are needed.
Many x-rays are now digital. Digital x-rays require even smaller levels of radiation and are safer for the environment, as no chemicals are necessary to develop the films.
Dental x-rays require very low levels of radiation exposure, and various protective mechanisms limit exposure to the rest of the body, such as a lead apron and thyroid collar.