Molar Power

Media item: article

Date published: 4 December 2012

This page records the media item. The original article is the property of its publisher and is not reproduced here.

The archive preserves the headline and the date. What follows is general information on the first permanent molars — the most consequential teeth in a child's mouth, and the ones almost nobody notices arriving.

The teeth nobody sees come through

The first permanent molars arrive at around age six, behind the baby teeth, with nothing falling out first.

No wobble. No tooth fairy. No announcement. The sequence up to that point is set out in The order of baby teeth, and what happens when the front ones start going in My child has a loose tooth.

The consequence is that enormous numbers of parents never realise a permanent tooth has arrived, and assume for years that the back teeth are still temporary and therefore not worth worrying about. They are not temporary. They are meant to last eighty years, and they are the teeth most often lost first.

How much decay Australian children are carrying by that age is measured. The Australian Dental Association's Consumer Survey of 25,000 people reports that 34% of children aged 5 to 6 have experienced decay in their primary teeth, and 27% of those aged 5 to 10 have untreated decay in primary teeth — those figures describe the baby teeth, not the new molars, but they describe the mouth the new molars are erupting into, and the bacterial load that greets them. The ADA's Children and Young People Oral Health Tracker adds that 10.8 in every 1,000 children aged 5 to 9 are hospitalised for potentially preventable dental problems, rising to 14.3 per 1,000 for Indigenous children, and that only 56% of children visit a dentist before age 5.

They are also the teeth that set the bite. The way the upper and lower first molars meet establishes the relationship the rest of the permanent teeth are arranged around. Losing one early has effects that run through the whole dentition — neighbouring teeth drift, the opposing tooth over-erupts, and what would have been a filling becomes an orthodontic problem. See Why do teeth shift? and What is malocclusion of the teeth?

So: at around age six, look in the back of your child's mouth. If there is a large tooth behind the last baby molar, it is permanent.

Why the biting surface is the vulnerable part

Molars have fissures — deep, narrow grooves across the biting surface, formed where the developing cusps met.

Some fissures are narrower than a toothbrush bristle. Food and bacteria go in; the bristle does not. That is why the biting surfaces of newly erupted molars are the commonest site of decay in children, and why decay there is not a reflection of lazy brushing. See How does tooth decay develop? and The stages of dental decay.

And a newly erupted tooth is at its most vulnerable. Enamel continues to mature for a period after eruption, so the first couple of years after a molar arrives are the highest-risk window of its life — which is precisely when it is hardest for a six-year-old to clean, because it is at the very back and they cannot reach it. See Kids' teeth cleaning tips and Which toothbrushes do dentists recommend?

Fissure sealants

A thin resin coating flowed into the grooves and set hard, sealing them so bacteria cannot get in. The two articles on this are The role of fissure sealants in children's teeth and Who is a suitable candidate for dental sealants?.

No drilling, and normally no anaesthetic. The tooth is cleaned, prepared, the sealant flowed in and cured with a light. It takes minutes, and most children manage it without difficulty.
They are among the best-evidenced preventive measures in dentistry. The evidence that sealants reduce decay in the biting surfaces of permanent molars in children is strong and long-standing.
Timing matters. Soon after eruption, while the tooth is at highest risk.
They need checking. Sealants wear and can partially lose their seal; a sealant that has partly failed can be worse than none, because it hides what is underneath. They are inspected at recall and topped up as needed — see How often should I go to the dentist?
They are covered by the Child Dental Benefits Schedule for eligible children — Services Australia sets the benefit at up to $1,158 for each eligible child over two consecutive calendar years for basic dental services, with the cap indexed on 1 January each year; the child must be eligible for Medicare and the family in receipt of a qualifying payment. And the schedule is significantly under-claimed. The ADA names exactly that among the contributors to child tooth decay in its survey findings: parents ‘not accessing government-funded free dental entitlements'. See Child Dental Benefit Schedule and how the scheme operates.

If your child has newly erupted molars, this is the single most useful thing to ask about.

Molar incisor hypomineralisation

Worth knowing about because it is common, frequently missed, and the explanation for a great deal of unexplained trouble. The article on this is My child has chalky teeth — now what?

MIH is a developmental defect in which the enamel of the first permanent molars — and often the permanent front teeth — forms with too little mineral. The enamel is soft, porous and structurally weak. See Enamel is the hardest substance in the body — so why do teeth break?

What it looks like: creamy-white, yellow or brown patches, sharply demarcated from the surrounding normal enamel — see What causes white spots on teeth?. On front teeth it is a cosmetic concern; on molars it is a functional one.

It is worth distinguishing from dental fluorosis, which also produces white marking but has a different cause and a defined window. The NHMRC describes fluorosis as occurring only while teeth are developing inside the jawbone, ‘usually from birth to six or eight years of age', appearing ‘as white lines or areas on the surface of both primary and permanent teeth' and identified after the teeth erupt — which is why the public health advice for young children is to ‘use only a small pea-sized amount' of toothpaste and to ‘encourage children not to swallow toothpaste'. MIH's demarcated creamy, yellow or brown patches are a different picture, and the two are not treated the same way.

Why it matters:

The enamel can crumble away under normal chewing forces, sometimes shortly after eruption. Where a molar needs full coverage, see Dental crowns for children: silver or white?
It decays rapidly, because the surface is porous.
It is often extremely sensitive — to cold, to brushing, sometimes to air. A child who suddenly resists brushing may have a tooth that genuinely hurts to brush, and pushing harder makes matters worse. See What to do if you suffer from sensitive teeth and How do I get my child to brush their teeth?
Local anaesthetic can be less effective in affected teeth, which means treatment is harder and a child's experience of it worse. This is a well-recognised cause of dental anxiety established in childhood — and the Australian data on where that leads is stark: in the National Dental Telephone Interview Survey (n = 6,112 aged 16 and over), 11.9% of adults reported being ‘very' afraid of the dentist, and 43.9% of those had last attended more than two years earlier, against 29.1% of people with no fear. See Combating dental anxiety in children and Dental Anxiety.
Restorations bond less reliably to hypomineralised enamel and fail more often — see How long do dental fillings last?

The cause is not established. It appears to relate to disturbances during enamel formation in early childhood, and it is not caused by anything a parent did or failed to do. That is worth saying plainly, because parents commonly assume it is.

What helps: early diagnosis, high-fluoride and desensitising products — see The benefits of fluoride — sealing or restoring affected surfaces before they break down, shorter recall intervals, and — for severely affected molars — planned extraction at the right stage of development so the second molar drifts forward into the space. That timing decision is one to make with a paediatric dentist or orthodontist, and it is time-sensitive. See When should I take my child to an orthodontist? and Children's Braces and Invisalign.

See Paediatric Dentists and Should my child see a specialist paediatric dentist?

What parents can actually do

Look for the six-year molars, and know they are permanent.
Brush them yourself, or closely supervise, until at least seven or eight. The rule of thumb is that a child cannot brush effectively until they can tie their own shoelaces — manual dexterity, not maturity. The archive's item on that daily fight is Stop brushing battles.
Angle the brush to reach the very back, which is where a child's brushing never gets.
Fluoride toothpaste twice daily, spit don't rinse — see Selecting a toothpaste: fluoride or non-fluoride. The WHO names toothbrushing with fluoride toothpaste at 1000–1500 ppm as one of the three things whose absence allows caries to develop, alongside continued high intake of free sugars and failure to remove plaque. The ADA's own list of main oral hygiene strategies is similarly plain: ‘brushing for two minutes twice a day; using an age-appropriate fluoride toothpaste; clean between teeth once a day using floss or interdental brushes; and visit a dental professional for regular check-ups and professional cleaning.'
Ask about fissure sealants as soon as the molars are through.
Reduce the frequency of sugar, which matters more than the total amount — see How does sugar affect your dental health? and Protecting your child from dental disease. The ADA's policy on diet and caries treats ‘the form, frequency, timing and total amount of sugar intake' as all significant, with special emphasis on snacking on sugary drinks and sugar-rich foods of limited nutritional value. The gap between knowing and doing is measured in the same ADA survey: 85% of parents are aware that soft drinks, energy drinks and fruit juice lead to decay, yet 26% of children have fruit juice every day and 37% have two to five soft drinks a week. The WHO's threshold for the total is free sugars below 10% of energy intake, ideally below 5%.
Mention any patches, sensitivity, or sudden resistance to brushing. If your child has not yet had a first visit, see First visit to the dentist and When should a child first visit the dentist? The ADA's advice is that the first visit should be when the first tooth comes through, or by one year of age, and at least every 12 months after that.

Common questions

There is a chalky mark on the new molar and it does not hurt. What happens if we wait?

The window for the cheap, simple version of the treatment closes — and that is the whole argument for looking now rather than at the next sore tooth.

The ADA puts the trade-off in one sentence: ‘tooth decay, if picked up early, can be controlled fairly simply (for example with fluoride applications) before they become established and cause trouble. Leaving it till the teeth hurt or break down means simpler interventions are unlikely to work and more complex treatment may be needed.’

On a newly erupted molar that matters more than on most teeth, for two reasons already covered above: the enamel is still maturing, so the first years are the highest-risk ones; and a chalky mark may not be decay at all but hypomineralisation, which is porous, breaks under chewing forces and is harder to anaesthetise once it does. Either way the useful interventions — a fluoride application, a sealant, a shorter recall interval — are quick, do not involve a drill, and are covered for eligible children under the CDBS.

The thing not to do is wait for pain. On these teeth, pain generally means the problem has reached the pulp, and by then the choice is a much larger one. Why do I need a filling?

The back molars are through. Do we need to floss now?

Yes — and this is almost exactly the point at which most families are not doing it, which is the wrong way round.

The ADA's 2025 consumer survey found that 76% of children never floss themselves, nor have their parents do it, and that among families who had started, 61% introduced it between the ages of six and 13. So the habit typically arrives after the six-year molars, at the very time those teeth are at their most vulnerable.

The trigger the ADA gives is not an age but a physical event: ‘once a child has two or more baby teeth side-by-side, dentists recommend parents floss daily.’ Two touching surfaces is the point a toothbrush stops reaching. When the first permanent molar erupts behind the last baby molar, it creates exactly that kind of contact at the back of the mouth — the hardest place for a child to reach and the easiest for a parent to forget.

Practically: you do it, not them. The same dexterity limit that applies to brushing applies more strongly to floss. Floss picks or holders are a reasonable compromise if conventional floss is a fight; so are interdental brushes where the spaces are wide enough. Is flossing really that important?

What does the Child Dental Benefits Schedule actually cover, and why do so many families miss it?

It covers more than people assume, and the reasons it goes unclaimed are administrative rather than clinical.

The covered list includes the things this page is about. Services Australia lists ‘check-ups, X-rays, cleaning, fissure sealing, fillings, root canals, extractions’. What it does not cover: ‘orthodontic dental work, cosmetic dental work, any dental services in a hospital.’ It also warns that ‘There are some restrictions for basic dental services. You should check with your dentist if there are any item or time restrictions before starting your service’ — worth asking before a course of treatment rather than after.

You do not apply for it. ‘You don't need to apply or register for CDBS. If your child is eligible we'll send you a letter.’ Eligibility requires the child to be ‘eligible for Medicare’, to be ‘0 to 17 years old for at least one day that calendar year’, and for you or them to ‘get an eligible payment at least once that calendar year’. A letter that was never opened is a benefit never used.

And an unused balance is lost, not banked. The cap is up to $1,158 per eligible child across two consecutive calendar years, and ‘If you don't use the full amount within the 2 calendar years, you can't use the remaining funds.’ The two-year period starts in the calendar year the child both becomes eligible and has their first service, so a family that books late in year two can forfeit most of it. Services Australia also notes these services ‘don't count towards the threshold’ of the Medicare Safety Net or the Extended Medicare Safety Net.

If you are not sure whether your child is covered, the balance can be checked directly with Services Australia — and it is worth checking each January, because the cap is indexed. Child Dental Benefit Schedule.

Is fruit juice better than soft drink?

For teeth, not meaningfully — and the ADA is unusually pointed about why parents believe otherwise.

Its survey finding is that while parents understand fruit juice contains sugar, ‘they think juices have health benefits. This is promoted in the advertising and labelling of these products, aimed purposely to mislead parents. The truth is that they offer little nutritional benefit — kids are better off having a piece of fresh fruit rather than drinking shop-bought juice.’

The chemistry supports that. The World Health Organization's definition of free sugars — the thing to be limited — expressly includes ‘sugars naturally present in honey, syrups and fruit juices’. Juice also brings its own acid, which erodes enamel directly, and it is usually sipped, which is the worst possible pattern: frequency of exposure matters more than the amount in the glass.

The numbers have moved slightly since the figures quoted in the body of this page, and both are the ADA's own. Its 2024 release gave 85% of parents aware, 26% of children having fruit juice daily and 37% having two to five soft drinks a week. Its 2025 release gives 87% aware (‘which is 11% more parents than in 2017’), 27% having fruit juice every day and 38% between 2 and 5 times a week, with soft drinks at 38% two to five times a week and 24% up to twice a week. The ADA's own summary of the trend is the useful part: ‘while parental knowledge of the harm from sugary drinks has increased, the proportion of children consuming them up to five times a week has only declined by 6% since 2018.’ Knowing has improved; behaviour has barely shifted.

Water and plain milk are the drinks that do not participate in this. How does your diet affect your teeth?

My child is frightened of the dentist after a bad experience. How do we get past that?

By changing what the appointments are for, and by saying out loud that the fear exists.

The ADA identifies the mechanism plainly: ‘A first dental visit for a tooth ache may create a negative first experience. We don't want that to be your child's introduction to the dentist.’ In its survey, 33% of first visits were for pain or a problem — so for a third of children, the introduction to dentistry was a bad day. Where hypomineralised molars are involved the odds are worse again, because local anaesthetic works less reliably in that enamel, so a child may have been in genuine discomfort during what an adult was told would be painless.

What breaks the cycle is a run of appointments where nothing is done. The ADA describes early visits as helping ‘introduce the infant to the sights, sounds and sensations of the dentist’, and notes that ‘it's unusual for much to be done at the first few visits’. The same approach works for a frightened older child: a look, a count, a ride in the chair, a fluoride application, and home. Ask for a short appointment with nothing planned, and say in advance what went wrong last time so it can be worked around rather than repeated.

The reason this is worth the effort is what happens if it is not addressed. The Australian survey data quoted above is blunt about the adult version: of adults who described themselves as ‘very’ afraid, 43.9% had last attended more than two years earlier, against 29.1% of people with no fear — and avoidance is what turns small problems into large ones. Combating dental anxiety in children and Dental Anxiety.

Practical details

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This page records a published article and its date, with general information. Eruption timings vary widely between children. It is not a diagnosis or a treatment plan. Individual experience of any procedure varies. CDBS caps, covered items and eligibility are set by Services Australia and change; the cap is indexed each January, so confirm the current figure and your child's balance with them. Third-party published content is not reproduced.

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