Importance of Baby Teeth

I can’t tell you how many times I’m surprised when parents question the validity of getting dental treatment on ‘baby’ teeth. Where it is true that the primary (baby) teeth are temporary and will all fall out, it takes six years from the point of the first primary tooth from being lost (at around the age of six ) to the last primary molar from exfoliating (at around the age of twelve). So aside from the obvious importance for eating, appearance and speech , the baby teeth are essential  to help guide the permanent teeth, which are developing under the primary teeth, into their correct location.

In fact, primary teeth are so important that some of us (pediatric dentists) have spent an additional two years, after completing a grueling four years of dental school, to study ‘baby’ teeth. Permanent and primary teeth are actually very different from each other and differ in many ways other than just size.

Firstly, they form at varying stages in a child’s life. The primary teeth start to form at the beginning of life, starting at six weeks of gestation and completely form by the start of the second trimester. The permanent teeth,  on the other hand, start to develop after the child’s first birthday and continue to develop as the child grows.

Secondly, the anatomical makeup of permanent teeth and primary teeth are quite different from each other as well. Primary teeth are whiter in color and have much thinner enamel since they are meant to last for a limited period of time. Permanent teeth are a darker shade in color than primary teeth and have much thicker enamel since they are meant to last the natural life span of a child.

Many times parents are unaware that the permanent molars erupt behind the primary teeth. There are twenty baby teeth that will exfoliate and be replaced by permanent teeth. All permanent molars develop once in a lifetime and erupt at very specific times, hence the not so inspired names; six year molar, twelve year molar and wisdom teeth. The numerical number indicating the year in which the molar usually erupts with the  exception of wisdom teeth . They can erupt as early as fourteen years of age or not at all if they are impacted.

Due to the fact that primary teeth have thinner enamel, restoring decayed teeth in a timely manner is very important. The Academy of Pediatric Dentistry recommends the first dental visit be either by the first birthday or the eruption of the first primary tooth. This may seem rather silly to many parents but this appointment is geared more to discuss oral health care and to ensure the proper development of teeth with the the parents. Many things are discussed including but not limited to when to start brushing the baby teeth, which toothpaste to use and when to start weaning the baby off the baby bottle and (if applicable) the pacifier.

Decay can happen at a very early age and can spread rapidly. One such condition that I have unfortunately seen quite a few times in my career is Baby Bottle Syndrome. This condition can happen to infants who sleep with the baby bottle or nurse on demand throughtout  the night. It’s a very tragic thing to tell young parents that their baby’s front teeth are non restorable and have to be extracted at the age of two. This can all be prevented with guidance. Many times the pediatrician will suggest children be seen by age three for their first dental check up. Unfortunately,  by this time many children have already developed decayed teeth. Therefore, this first dental visit is vital to educating parents/caregivers and establishing a routine that will hopefully follow thru throughout life.

Once decay starts on a primary tooth, it can spread rather quickly into the pulp chamber of the tooth. This is when a child can get pain that can lead to swelling and infection . At this point, to protect the permanent tooth bud that is forming underneath, extraction becomes the only option. Premature loss of a baby tooth requires a space maintainer to ‘hold’ space until the new permanent tooth erupts. Sometimes it may take many years before that happens. Correct spacing helps ensure the proper jaw development . Crowded or crooked teeth will be the direct result of space loss due to premature loss of primary teeth. Ironically when the decay is small, teeth are asymptomatic to sensitivity or pain many times. Symptoms start when the cavity becomes deep.

There are many ways to protect both the primary and permanent teeth and ensure they grow caries free. First and foremost is good oral hygiene. I usually encourage parents /caregivers to help the child brush their teeth until the age of six.  Non fluoride toothpaste should be used until the child is able to rinse independently, usually by age three, after which fluoridated toothpaste should be used.  Diet and nutrition are also extremely important. A healthy well balanced meal is obviously recommended but if the eating pattern is not monitored then decay can start even in a child that doesn’t eat sweets.

Those children that eat very slowly, hold food in their mouth and/ or are distracted during meals will be more likely to have decay. It actually makes perfect sense when one thinks about the process of chewing. The longer partially digested food is in the child’s mouth, the longer the bacteria, acids and enzymes (whose job it is to breakdown food) are exposed to the enamel in the oral cavity. The more likely it is for decay to start. Meal times should be closely monitored  and water should be given in between meals. Drinking water is a healthy habit and a natural way for keeping teeth clean.

Lastly, routine dental checkups are strongly recommended. Preventive therapy is highly effective. One such treatment is the application of sealants. Sealants are the armor we place on the biting surfaces of molars to help prevent the start of decay. It is routinely placed on permanent  molars  but are very  important to be placed on primary molars as well. Sealants are noninvasive and very simple to apply.  Understandably,  dental visits can be stressful and at times frightening  for children as well as many adults.  It’s important to bear in mind, the better the oral health is maintained, the easier the dental visits become.