Your Oral Health

The Canadian Dental Association recommends parents schedule their child’s first dental visit within six months of the eruption of the first tooth or by their first birthday.

Without proper dental care, cavities can begin to form as soon as baby teeth appear, around six to 10 months of age. Read Teething, Oral hygiene – brushing and flossing, and Early childhood caries (ECC) to learn more.

Purpose of the first dental visit:

• Learn how to care for your child’s teeth
• Have any oral health questions answered
• Find and treat dental problems early

Parents should not wait for an emergency to schedule their child’s first visit. Early, regular visits can help prevent cavities or early childhood caries.

At the first dental visit

The first dental visit is a short appointment.

The dentist or dental hygienist will:

• Check your child’s teeth for cavities and other dental problems
• Check that their jaws and teeth are developing properly
• Apply fluoride varnish depending on your child’s cavity risk
• Show you how to care for your child’s teeth
• Set up the next appointment before you leave and more

Oral health screening can be provided by a York Region Public Health registered dental hygienist at one of convenient clinic locations. Parents and guardians may call 1-877-464-9675 ext. 74388 to schedule an appointment or to speak with a registered dental hygienist for more information about the first dental visit.

When babies are born, they have a partially developed set of primary (baby) teeth under the gums waiting to erupt. They are important for eating, smiling, talking and holding space for adult teeth. The first primary tooth will start to erupt at six to ten months of age. This process is called teething and will end at two to three years of age. Babies may drool excessively, have red cheeks, swollen gums, difficulty sleeping, be cranky or irritable and want to put everything in their mouths while teething. Do not confuse teething with illness. Keep in mind that fever, rashes and diarrhea are not symptoms of teething. If a baby has any of these symptoms, or remains cranky and irritable, ensure the baby receives medical attention.

Easing the discomfort of teething will help make the baby more comfortable. Babies massage their own gums by chewing on hard, smooth objects. Give them a teething ring, or a clean, wet, chilled cloth to chew on.

Avoid using:

• Teething biscuits and wafers  
• Teething or numbing gels

At the end of the eruption process, a child will have 20 primary teeth.  

The primary teeth will start to naturally fall out at six years of age. Some of the primary molars will remain until 12 years of age. Keep in mind that all of these ages are guidelines only and children develop at their own pace.

Good dental habits, such as a healthy diet, cleaning the gums and brushing the teeth twice a day, combined with regular dental visits, help prevent tooth decay and promote good general health. Use an age and size-appropriate toothbrush. Do not use a finger brush as it can be a choking hazard.

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

Tooth decay and gum disease are caused by a sticky film called plaque, which constantly forms on teeth and gums. Removal of this plaque with proper brushing and flossing on a daily basis is important in preventing dental disease. Establishing good dental hygiene practices early on can help develop positive, lifelong dental habits and a healthy smile.

Videos with helpful brushing and flossing teeth at different ages:

• Cleaning Baby’s Mouth
• Brushing for 1 to 8 years
• Brushing for 9 years and up 

Tips

• Use a toothbrush that is the correct size for the child’s mouth
• Do not let children share toothbrushes – the bacteria that causes dental decay can be spread from person to person
• Store toothbrushes where they do not come in to contact with other brushes and are allowed to air dry
• Children model what they observe – set a good example

A cavity (tooth decay) is a hole in the surface of a tooth. It starts off small, but gets larger over time if left untreated. Cavities begin to form when our teeth are attacked by acid. Acid develops when sugar from our food mixes with the plaque (bacteria) in our mouth. The acid breaks down the hard outer layer of the tooth called enamel, resulting in tooth decay.

The Ontario Association of Public Health Dentistry

Early childhood caries (ECC) is a disease of the primary teeth. It is defined as one or more cavities (dental decay) in the upper front teeth of children three years of age or younger. Dental decay in the primary teeth is one of the most common diseases of childhood.

Decay is a result of the frequent or prolonged exposure to acid and sugar on the teeth. Whether the sugar is natural or refined, it does the same damage. Sugars found in food and drink, mix with dental plaque in the mouth to form acid. The acid attacks the hard outer layer of the tooth’s surface called enamel and over time will create a cavity. The damage the sugar can do depends on how long it stays in the mouth and how often it is consumed.

In the early stages of ECC, the tooth can have a chalky appearance that cannot be removed with toothbrushing. As the disease progresses, these areas can turn brown. In severe cases the teeth will have dark brown spots and appear to have large holes or spaces between the teeth.

Tooth decay in children can be extensive and may need to be treated in the hospital while the child is sedated with a general anesthetic. Treatment is both financially and emotionally costly. If left untreated, the child may experience pain and infection that can interfere with their ability to eat, drink, sleep, play and development.

ECC is preventable. Prevention must start early because the decay process can begin as soon as a tooth erupts. Regular dental care can prevent tooth decay and other dental problems that can lead to disease in later life.

Lift the lip

Children should have their teeth checked once a month by parents or guardians. The purpose is to check for signs of ECC. If detected early it is much easier to treat. Parents may consult with a dentist or registered dental hygienist on how to lift a child’s top lip.

Tips

• Be aware of Early Childhood Caries (ECC) (one or more cavities in the upper front teeth of children three years of age or younger) and what it looks like so it can be prevented or identified at an early stage
• Parents should lift their child’s upper lip regularly to check for early signs of tooth decay; hands should always be washed before and after touching the lip
• Parents should have their children’s teeth checked regularly by a dental health professional starting at one year of age
• Any dental concern should be mentioned to a dental health professional as soon as possible

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

Sucking is a natural way for babies to feel secure; some even suck their thumb in the womb. It helps comfort small children, but prolonged use of pacifiers or thumb sucking can affect teeth, jaw shape, and speech. A child’s need to suck usually decreases around age two. The earlier the habit stops, the lower the risk of dental issues. If it continues beyond age three, consult a dental professional.

Baby bottle use should end by 18 months. Children can start drinking from an open cup at six months with help and should use one exclusively by 12 months. Never use a bottle as a pacifier or allow continuous sipping throughout the day.

Safe use of pacifiers

Always

• Check daily for cracks or tears
• Wash after each use
• Ensure baby’s needs are met before offering
• Respect the child’s choice - don’t force it

Never

• Clean by putting it in your mouth
• Dip in sugar, honey or syrup
• Tie around the neck
• Use to replace feeding or force into the mouth

Breaking the Habit

• Offer comfort alternatives like hugs or toys
• Praise when not sucking
• Gradually reduce sucking time
• Consult a dentist if habit persists beyond age three (or six for thumb sucking)

Tips

• Do not let children sleep with bottles of milk or juice
• If needed at night, fill with water only
• Report dental concerns promptly

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

The sippy cup was developed for children transitioning from a bottle to a regular cup. Children can learn to drink from an open cup as early as six months of age, with help from a caregiver. A link has been established between sippy cups and early childhood caries.

It’s not the cup itself that is responsible for tooth decay, but the type of liquid within. When sippy cups are filled with milk, juice and sugary liquids, children’s teeth are bathed in sugar every time they sip from the cup, throughout the day and sometimes even at nap and sleeping times.

Outside of meal and snack times, offering only water in the cup is recommended. This will allow children to quench their thirst and prevent the constant sugar intake.

By 18 months of age, children should be drinking from a cup without a lid and should be encouraged to stop using a sippy cup.

Tips

• Provide only water in sippy cups outside of meal and snack times; limit juice and milk to meal and snack times
• Use sippy cups as a transitional step, not a long-term solution
• Disassemble and properly clean sippy cups at least once a day to prevent the growth of microorganisms such as bacteria, viruses and fungus that can cause illness

Eating a variety of nutritious foods by following Canada’s Food Guide is good for our general and oral health. A diet that contains many sugary snacks can lead to dental decay or cavities.

When choosing snacks that are good for teeth, there are three things to consider:

1. How much sugar is in the food?
   Learn about food labels and sugar. Check front of the package labelling to see when a product is high in sugar. 
2. How sticky is the food?
   If food sticks to the teeth, it means the sugar in the food is in contact with the tooth for a longer period of time. This can happen with foods such as fruit leather, chewy fruit snacks and raisins.
3. How frequently is the food being eaten?
   The number of times children are eating and drinking throughout the day plays a part in the decay process. It is important to limit food and drinks that may contain sugar to meal and snack times so the exposure to sugars is reduced.

Making healthy diet and food choices at a young age will foster better food choices later in life. Examples of healthy snacks for good oral health include fruits, vegetables, cheese, whole grain crackers, unsweetened cereals, whole grain muffins, eggs, hummus and plain yogurt.

Refer to the fact sheet in Dental Health Resources: "Oral Health for Babies and Children."

For more information about feeding babies and young children, visit york.ca/feedingkids

• Fluoride is a mineral found naturally in our environment and has been proven to prevent tooth decay
• Fluoride can be found in food, drinking water, toothpaste and in fluoride treatments
• Fluoride strengthens tooth surfaces, prevents dental decay and reduces tooth sensitivity

Recommendations for the use of fluoridated toothpaste:

• Children under three years of age should use only water or a rice grain-sized amount of non-fluoridated toothpaste unless otherwise advised by their oral health professional
• Children three years of age and older should use a green pea-sized amount of fluoridated toothpaste if they are able to spit
• Teach children to spit out the toothpaste and to rinse well after brushing

Refer to the fact sheet in Dental Health Resources: "Fluoride Information."