Early Tooth Growth

Your child’s teeth began forming even before they were born. Their primary teeth should start appearing around 6 months of age and by age 3, they should have all of their primary teeth. Though each child’s development is different, below is a general guideline of when you can expect their teeth to appear.

  • 4-10 months: lower central incisors (the 2 bottom middle teeth)
  • 8-12 months: upper central incisors (the 2 top middle teeth)
  • 9-16 months: upper & lower lateral incisors (the teeth on either side of the 2 middle teeth)
  • 13-23 months: upper & lower first molars and canines
  • 23-33 months: upper & lower second molars

Your child will likely start losing their primary teeth around age 6. Their permanent teeth will grow in their place soon after. Additional molars will also come in as your child enters adolescence.

  • 6-7 years: lower central incisors and upper & lower first molars
  • 7-8 years: upper central incisors and lower lateral incisors
  • 8-9 years: upper lateral incisors
  • 9-10 years: lower canines
  • 10-12 years: upper & lower first and second premolars and upper canines
  • 12-13 years: upper & lower second molars
  • 17-21 years: upper & lower third molars

Establishing Good Habits

Perinatal Care

Even before your child is born, you can set the foundation for good oral care. Pregnant mothers should take care of their own oral health to help increase the health of the baby. There is an association between mothers with oral disease and low birth weight and/or preterm birth.

Tooth Brushing

It’s important to help children establish good brushing habits early on. While they are still babies, wipe their gums with a soft cloth and water after each feeding. As teeth start to emerge, use a soft toothbrush to clean the teeth and gums daily. For toddlers, choose a soft toothbrush and a toothpaste designed specifically for children. Make sure you choose a toothpaste that is recommended by the American Dental Association and that is free from harsh abrasives which can wear away your child’s developing tooth enamel. For children age 2 and younger, use only a smear of toothpaste, about the size of a grain of rice. For children aged 2 to 5, use a pea-sized amount of toothpaste. Don’t let your child swallow the toothpaste. If your child is too young to spit out the toothpaste, use fluoride-free toothpaste to avoid them ingesting too much fluoride. For the first few years, you should help your child brush their teeth. Make sure they brush their teeth at least twice a day. Use gentle, circular motions and make sure to clean all the teeth, the gums, and the tongue. Even after your child is old enough to brush their teeth on their own, you should supervise the brushing until about age 7.


Flossing is an important part of tooth care because it removes plaque that a toothbrush can’t reach, including between the teeth and under the gumline. You should start flossing your child’s teeth when they have two teeth that are touching. Floss your child’s teeth daily until they can do it alone.

Eating a Good Diet

Your child’s teeth need the nutrients from a well-balanced diet in order to grow and stay healthy. Make sure that your child eats a variety of foods and eats more whole fruits, vegetables, and grains instead of sugary or fatty foods. Be careful with snacks; not only do sugary snacks lead to the formation of cavities, but the more frequently they snack the more likely they are to have tooth decay. Hard candy, mints, and other foods that stay in the mouth for a long time can also increase tooth decay because it gives bacteria more time to build up acid that can damage teeth.

Avoiding Bad Habits

Baby Bottle Tooth Decay

Infants and young children can have a much higher risk of tooth decay if they frequently are put to bed (for a nap or for the night) with a bottle containing juice or milk. The sugars pool around the infant’s teeth as they sleep, letting bacteria produce acids that wear away at the tooth enamel. To prevent this, avoid putting your child to bed with a bottle of anything other than water and wipe their gums and teeth with a damp washcloth or pad of gauze after each feeding.

Sippy Cup

Sippy cups should only be used for a short time to help infants transition from a bottle to a regular cup. Do not let your child carry around a sippy cup full of anything other than water during the day. Juice, milk, or other liquids with sugar can quickly grow bacteria that increases the chance of cavities.

Thumb sucking

Many young children suck on their thumbs, fingers, or pacifiers to help them feel secure and relax. Most children stop sucking their thumbs by the age of 3 or 4. However, if they continue sucking their thumb too long, it can interfere with the growth and alignment of their teeth. Children should stop sucking their thumb or any pacifier before their permanent teeth are ready to come in. If your dentist has expressed concern that the thumb sucking will cause a problem with your child’s teeth, there are a few things you can do to help them stop. One is to address the root cause of the thumb sucking. Since children often suck their thumbs when they feel insecure or need comfort, helping them feel more secure or finding comfort in other ways can help replace the need for thumb sucking. You can also reward your child when they go for a certain amount of time without sucking their thumb. If the habit is subconscious, you may want to help your child remember not to suck their thumb by bandaging their thumb or using another reminder.

Download Our Thumb Sucker Chart

Chewing on Objects

Many children put toys, pencils, and everything they can find into their mouths. This should be discouraged because it introduces harmful bacteria into their mouth which can increase the chance that they will get sick. It can also lead to teeth grinding.

Teeth Grinding

Many children grind their teeth at night due to stress or inner ear pressure. Most of the time this does not cause a major problem and children outgrow it between the ages of 9 and 12. However, in some cases, the grinding can wear down the child’s teeth. In this case, your dentist may recommend they wear a night guard to protect the teeth.

Tongue Piercing

As your child enters their teenage years, they may begin trying to establish their individuality by making their own choices in clothes and accessories. Many teenagers want to get a piercing and some want to pierce their tongue, lip, or cheek. However, these oral piercings can cause serious dental problems, including cracked teeth, nerve damage, receding gums, scar tissue, and infections. So encourage your teenager to express their individuality in another way.


Tobacco in any form can cause serious health and dental problems. Teach your child about the dangers of tobacco while they are young and as they become teenagers, help them understand why it is important to avoid cigarettes, chew tobacco, and other forms of tobacco. Tobacco can lead to discolored teeth, bad breath, heart and lung problems, and cancer.

Childhood Dental Treatments

Caring for Primary Teeth

It is essential to take good care of your child’s primary teeth (sometimes called baby teeth). Neglecting cavities or other problems in these teeth can lead to problems in their gums and permanent teeth. Though your child will lose these teeth as they grow, primary teeth play important roles in your child’s oral health. Primary teeth:

  • establish proper patterns of chewing and eating;
  • provide space for permanent teeth;
  • allow for correct development of the jaw bones and muscles; and
  • affect the development of speech.

First Dentist Visit

It is important that you help your child establish a good attitude toward visiting the dentist from the very beginning. Before their first visit, tell them what to expect and explain that the dentist and assistants are there to help. Listen to your child’s concerns and help them understand that they don’t need to be afraid of anything that happens at the dentist. Keep your descriptions simple and avoid using words that may scare them, including mentions of needles, pulling, or other painful procedures. Discourage older siblings from teasing the child about the dentist.

Regular Dentist Visits

You should take your child to the dentist every 6 months, starting at their first birthday. These regular visits will help keep your child’s teeth strong and help you identify early signs of trouble. Here are some tips to help make your visits to the dentist as easy as possible:

  • Dental visits are part of growing up. You shouldn’t offer rewards or indicate in any way that there is anything to fear.
  • The less “fuss” the better. It’s best to tell your child about a dental visit the day of the appointment.
  • If you child wants more information about the dentist, explain to them that the doctor will look at his/her teeth to make sure they are healthy.
  • Make sure that your child is well rested the day of the appointment.
  • Don’t threaten a visit to the dentist as a form a punishment for bad behavior.


A sealant is clear or translucent plastic that is applied to a child’s back teeth that prevents food, plaque, and acid from getting in the cracks and areas of the teeth that are prone to decay.


The right amount of fluoride can help strengthen teeth and protect against cavities. However, too much fluoride can lead to discoloration of the teeth. Make sure your child does not swallow the toothpaste. If they are too young to spit it out, use a toothpaste that does not contain fluoride. Also make sure you are aware of other sources of fluoride before giving your child additional fluoride treatments. Many cities add fluoride to their drinking water and some foods contain fluoride, including infant formula, dry cereals, baby foods, and white grape juice.


Dental radiographs not only detect cavities, but also show progress of teeth growth and help alert your dentist of bone diseases and other problems. They let your child’s dentist see patterns and symptoms that are not visible in a physical examination. By finding and treating potential problems early, you can save money and avoid unnecessary procedures later. Your child’s dentist may recommend x-rays once or twice per year, depending on their risk factors for tooth decay and other problems. The amount of radiation from a dental x-ray is small and your child will be protected by a lead apron and other protective measures.

Pulp Therapy

Pulp therapy is also called “children’s root canal,” “nerve treatment,” “pulpotomy,” or “pulpectomy.” The pulp of a tooth is the inner core that contains nerves, blood vessels, and connective tissue. When a child has a severe cavity or a tooth injury, pulp therapy can be used to remove the damaged pulp and seal the tooth to prevent further problems. A pulpotomy removes the diseased pulp within the crown (top) of the tooth and uses an agent to prevent bacterial growth and calm the nerve tissue. The tooth is then capped with a crown. A pulpectomy is a more extensive treatment that removes all the pulp tissue from both the crown and the root. The canals are then cleansed and filled before being capped.

Dental Emergencies


If your child has a sore tooth, gently clean the area. Use floss to clear out any food that may be stuck in or near the tooth. Have them rinse their mouth with warm water or warm salt water. Do not apply heat to the gum or tooth. If your child’s cheek or face is swollen, apply a cold compress and contact us immediately. If the pain persists for more than a day, please contact us for additional treatment options.


If your child has bitten their tongue, lip, or cheek has been cut in their mouth, apply firm but gentle pressure with a clean cloth or gauze to stop the bleeding. Apply ice to the area to reduce swelling and relieve pain. If the bleeding does not stop, call a doctor or take your child to an instacare or emergency room.

Knocked Out Tooth

If your child’s baby tooth has been knocked out, it does not usually cause problems or require treatment. Contact your pediatric dentist during regular business hours. If your child has had a permanent tooth knocked out, see a Seattle pediatric dentist immediately! If possible, find and save the tooth. Hold it by the crown, not the root. Rinse the tooth with water, but do not clean with soap. If the tooth is not cracked or damaged, try to put it back in the original socket and have your child hold it in place by biting on gauze. If you cannot put the tooth back in its socket, put it in a cup containing the patient’s saliva or milk.

Chips and Fractures

If your child has chipped or cracked a tooth, contact their dentist immediately. If you do not take any action, the tooth could become infected and require extensive dental treatment. Rinse your child’s mouth thoroughly with water. If fragments have broken off, save them and bring them with you to the dentist.