Brushing to Brilliance

By Dr Josh Liu 2019-05-30 14:25:57

Puresmile's U.S. trained dentist Dr. Josh Liu gives useful tips on some common issues with your children's teeth

Parents across Shanghai will all eventually face some type of dental scenario for their children, whether its from teething, losing teeth, having an accident, or getting their first cavity. As a recent dad himself, Dr. Josh understands those struggles and is here to help you with some advice.

Q. When do the first teeth start to emerge?

A. The first pair of primary (baby) teeth that emerge are the lower front teeth (central incisors). They tend to emerge when your baby is around 6 months old, but it may be a bit earlier as well and even as late as 10-12 months. It can take a few years until all the 20 baby teeth (deciduous teeth) are fully developed. The first permanent tooth to develop on the other hand is the lower 1st molars. This usually occurs around the age of 6, hence their name “six year molars”. Keep in mind; girls’ teeth tend to emerge sooner than boys when it comes to time ranges of emergence.

Q. How can I help my child through the teething stage?

A. There are available products such as "teethers" which can be chewed on to relieve swelling and pain of the gums. The child can chew on these teethers and it will help stimulate the gums and relieve the discomfort during the teething stage. They come in different shapes, colors, sizes, and scents. Most teething toys also tend to work better when frozen or given to your child cold. A mild fever may also develop if your child is teething, so make sure to keep an eye on him or her. Rubbing your child’s gums with a clean finger or a moist gauze helps sometimes too. Most importantly, if you do give your child an ointment, make sure it is natural and free of benzocaine and lidocaine. In very rare instances, these topical anesthetics can cause a condition called methemoglobinemia, which can be life threatening and parents have been advised by the FDA to avoid them as a teething remedy.

Q. What causes tooth decay?

A.The ultimate cause of tooth decay is the breakdown of enamel by the acids produced by the bacteria inside our mouths. In order for these bacteria to produce acids, it needs to feed on sugar, hence why sugary drinks and candy tend to lead to cavities. Our enamel is constantly going through a process of remineralization and demineralization. Good oral hygiene and use of fluoridated products leads to our teeth remineralizing and becoming stronger, while bad oral hygiene, diet, and plaque leads to our teeth to become weaker and demineralized.

The main culprit is the plaque accumulating on your teeth. This plaque consists of bacteria and its by products. This plaque then will keep producing acids, until a cavity or a hole in your tooth forms. If the cavity is left untreated, it can lead to the tooth dying or being completely destroyed. Therefore, it is crucial to practice good oral hygiene habits to remove the plaque and reinforce your teeth.

A few other things to keep in mind is that not just the obvious sugary candies and drinks cause cavities. Fruits, breads, pastas, rice, etc are all carbohydrates, and are broken down to simple sugars that the bacteria can use to create acids, thus just avoiding candy and soft drinks is not enough to prevent cavities. Lastly, cavities tend to be unnoticeable or have no symptoms until it is too late. Usually when you begin to “feel” a cavity, it means it is near the nerve, or already there, so be sure to see your dentist regularly for check ups and cleanings.

Q.If my child gets a cavity in a baby tooth, should it still be filled?

A. Absolutely! Cavities are full with bacteria, and cavities are contagious – the more bacteria and more cavities left in someone’s mouth, the more teeth that will become decayed. Also baby teeth have nerves and blood vessels just like adult teeth. If it progresses far enough, it can cause severe pain, dental infections, and even spread into other areas. It can also affect the growth of the permanent tooth, as the infection will travel down the root of the baby teeth to the developing permanent tooth under it.

Furthermore, new research that was just released in April 2019 in the Journal of the American Medical Association found a link in childhood gum disease and cavities with adult heart disease, where 46% of people developed thickened arteries that had cavities as kids, creating a correlation of poor oral health leading to health issues decades later. The only exception to filling a baby tooth with a cavity is if it is close to coming out on its own.

Q. What should I do if my child knocks out a permanent tooth?

A. When a tooth has been knocked out or avulsed, handle the tooth very carefully!

It is best to hold the tooth on the crown portion and try not to touch the root (the portion of the tooth underneath the gums). The root contains the nerves, blood vessels and supporting tissue and can be easily damaged.

If the tooth is dirty, rinse it with milk or water. Remember to keep the tooth moist.

The first option would be to place the tooth in a glass of milk. If milk is unavailable, place the tooth in your child’s mouth, between the cheek and gum. If this may be difficult for a young child to do, you can have the child spit into a cup. Place the tooth in the cup with the saliva.

The least favorable option would be to place the tooth in a cup of water. The goal is to never let the tooth dry out and stay vital as long as possible.

There are also over the counter solutions you can buy that help keep the tooth moist, like Save-A-Tooth.

Seek emergency dental treatment soon as possible.

The dentist will do all the necessary procedures to clean the tooth socket and the avulsed tooth. A root canal treatment may be necessary depending on the circumstances. Then your dentist would reposition the tooth in the correct position. The tooth is best to be placed back into the socket within an hour. The tooth vitality diminishes as time progresses.

Usually your dentist will also use a splint to hold the tooth in place for a certain duration and periodic dental check ups would be required to examine the progress and make sure the tooth is healing normally.

Q. I noticed a space between my child's two upper front teeth. Is this cause for concern?

A. Depending on the child’s age, this can be a cause for concern. Between the ages of 7-12, when the permanent upper canines have yet to erupt, there would usually be spaces in the front teeth. We call this the "Ugly duckling stage". These spaces would usually resolve by the time the permanent canines erupt at around 11-12. Otherwise, if these spaces persist after the permanent canines erupt, then consulting with a dentist or orthodontist would be advised.


Dr Josh Liu

General, Cosmetic, and Implant Dentistry.

Dr. Josh has a wide range of experience treating patients of all ages and of all dental conditions. He obtained his Doctor of Dental Surgery (DDS) and Advanced Education in General Dentistry (AEGD) in the USA, and currently works for Puresmile, whom offer exemplary dental care in a family-friendly and comfortable environment.

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