Everyday-care-article | Blue Cross and Blue Shield of Michigan

Children and Pre-teens

By age three or four, infants and toddlers should have seen a pediatric dentist several times, and all of their baby (primary) teeth should have come in. More changes follow as your child progresses through ages 3-12. Baby teeth start falling out, and adult (permanent) teeth begin to take their place around age six. By age 13, most permanent teeth have erupted. All the while, your child's jawbones are developing and changing.

Throughout this same period, your child is learning to take more responsibility for themselves. It's important not only to teach your child proper oral health habits from an early age but to ensure your child is following through every single day. While many things are best learned through failure, oral health is not one of them. Once decay or periodontal disease sets in, your child will suffer the consequences for a lifetime. So it's best to help them get it right from the start.

Care at home

Young children and older children have differing needs, but some oral health habits are necessary at any age.

Brushing for two minutes at least twice a day with fluoride toothpaste. Until your child can brush all of their teeth reliably and effectively on their own (usually around age six), you should monitor their progress or brush their teeth for them. Younger children don't realize it's important to brush every tooth and often lack the dexterity to do so. When you are confident they can do it on their own, you should still supervise your child's brushing. This ensures they use the right amount of toothpaste (about the size of a pea) and do not swallow it.

Keep toothbrushes separated from others to prevent the spread of bacteria and viruses.
Floss at least once a day. If they are not ready to do it themselves, do it for them. Floss picks are often easier to use on young children than string floss. Flossing is extremely important as children approach their teen years. By that time, most of their permanent teeth have erupted, and the spaces between them begin to close, making them inaccessible to toothbrush bristles.
Encourage children undergoing orthodontic treatment to use a power toothbrush and floss properly to avoid white spots that can form on teeth when braces are removed.
Limit or avoid sugary foods and drinks. Sugary foods, candy (especially sticky gummy candy, gummy vitamins, or fruit leather), juice, and sports drinks can erode enamel and cause cavities. If your kids eat or drink sugary products, have them rinse their mouth with water or brush their teeth to help wash away the sugar. The same goes for sweetened liquid medicines. Sugar is a magnet for bacteria that can cause bad breath and promote tooth decay.
Ensure that your child wears a properly fitted mouthguard during sports or activities to protect their teeth from injuries.

Care at the dentist

It is important your child becomes and remains comfortable with visits to the dentist. This is a great way to help ensure a lifetime of good oral health habits.

During a regular dental visit for your child, you can expect the dentist or hygienist to:

Examine your child's mouth for proper growth and development.
Look for oral injuries, tooth decay, signs of grinding or clenching, or other problems. If tooth decay is present, teeth are misaligned, or there are signs of tooth wear, your dentist may recommend other treatments your child may need such as fillings, orthodontics, or occlusal guards.
Let you know if your child is at higher risk of developing tooth decay. If so, the dentist will advise you on the extra steps needed to protect your child's teeth. Some risk factors include:
- Other family members with cavities.
- Eating and drinking sugary substances, especially between meals and without rinsing or brushing afterward.
- Wearing braces or orthodontic appliances.
- Special health care needs.
Clean your child's teeth and provide you with tips for daily care.
Discuss fluoride or other preventive treatment options (sealants, space maintainers).
Discuss pacifier use or finger and thumb-sucking habits in younger children.
For older children, the dentist or hygienist may take necessary X-ray images to help identify tooth decay, periodontal disease, or other issues that cannot be seen visually. The images will also help the dentist provide an update on the status of your pre-teen's wisdom teeth.
Talk about how to prevent mouth injuries during sports or activities and what to do in a dental emergency.
Schedule the next visit.

Other considerations

Personal choices

As your child nears their teen years, they may become curious about certain behaviors or appearances. You and your child's dentist need to explain the oral health risks associated with:

Medication

Prolonged use of inhalers for conditions such as asthma can contribute to dry mouth (xerostomia), tooth decay, periodontal disease (periodontitis), enamel erosion, thrush (oral candidiasis), mouth sores, and bad breath (halitosis). Your dentist can recommend ways to help offset these effects and prevent worsening problems.
Acne medications have been known to permanently darken developing permanent teeth. This is important to note for younger children who are prescribed acne medication before their permanent teeth have erupted.

Sports or activities

Certain sports and recreational activities, especially those that involve physical contact, involve oral health risks. The most important thing you can do for your child is to ensure they wear a properly fitted mouthguard, face mask, or cage. Talk to their dentist about the best protection based on their activities.

Sleep apnea

Up to 4% of children between ages two and eight have sleep apnea,¹, which significantly increases your child's oral health risks, primarily from dry mouth. They are typically the result of enlarged tonsils or adenoids that constrict the airway. Research has shown that children with sleep disorders were three times more likely to develop tooth decay and deeper gum pockets that can lead to periodontal disease. They also had more tooth sensitivity or pain, gum bleeding, and mouth sores than children without sleep apnea.² Children with sleep disorders may also develop a habit of positioning their tongues forward in their mouths, causing the upper front teeth to tip outward. This can result in the need for orthodontic treatment and may also affect their speech development.

Vaping and e-cigarettes

Vaping devices and e-cigarettes can be just as harmful to oral tissue and lungs as regular cigarettes, and their use has risen dramatically. In fact, vaping use increased from 0.6% to 10.5% among U.S. middle school students between 2011 and 2018.³ If you suspect your child may be using tobacco or vaping products, tell their dentist so they can support your efforts to explain the dangers of continued use.

Routine Care