Protecting your child from dental disease — media record, June 2012

Media item: article

Date published: 16 June 2012

Subject: children's oral health

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

Note: the habits and ages that prevent decay are covered at Kids get the brush off, and choosing a practitioner at Picking the right dentist for your child. A separate article on the same subject is at Protecting your child from dental disease. This page covers the conditions themselves — what they look like, and which ones need seeing today.

Teething

First teeth usually appear around six months, with a very wide normal range. Order and appearance of baby teeth sets out the usual sequence, and Baby teething — signs, symptoms and treatments covers the same ground as this section in more detail.

What is normal: irritability, drooling, gum rubbing, disturbed sleep, wanting to chew, mild loss of appetite.

What is not caused by teething: high fever, diarrhoea, vomiting and rashes. This matters, because attributing a genuine illness to teething delays its diagnosis. A febrile, unwell baby needs medical assessment, not a teething gel.

What helps: a chilled (not frozen) teething ring, a clean cool washcloth to chew, gentle gum rubbing with a clean finger, and simple analgesia at the correct dose for the child's weight if genuinely needed.

What to avoid: teething necklaces and amber beads, which present a genuine choking and strangulation risk and have no established benefit. Do not use adult analgesic gels, and do not use products containing benzocaine or salicylate in infants, which regulators have warned about. Never use anything containing alcohol or honey.

An eruption cyst — a bluish swelling over an erupting tooth — looks alarming and almost always resolves without treatment as the tooth comes through.

Natal teeth, present at birth or appearing in the first weeks, are uncommon and should be assessed: some are mobile enough to be an aspiration risk or to interfere with feeding. Later on, the opposite question comes up — should I pull out my child's loose tooth?

Mouth infections and ulcers

Primary herpetic gingivostomatitis

The most severe common mouth problem in young children, and frequently misidentified as teething.

What it looks like: a young child, often between one and three, with fever, very red swollen bleeding gums, multiple small ulcers across the mouth, lips and tongue, refusing to eat or drink, drooling, and miserable. It is the first infection with the herpes simplex virus and it is common.

Why it matters: the risk is dehydration, not the ulcers. A child who will not drink needs medical assessment.

What helps: pain relief at correct doses, cold fluids, ice blocks, soft bland food, and time. It resolves over about a week to ten days. See a GP or dentist; antivirals are sometimes used if started very early.

Hand, foot and mouth disease

Viral, common in childhood, causing mouth ulcers plus spots on hands and feet. Usually mild; again, the concern is fluid intake.

Oral thrush

White patches on the tongue and inside the cheeks that do not wipe away easily (unlike milk residue, which does). Common in babies, and in children using asthma inhalers — rinsing the mouth with water after an inhaler is the simple preventive. Treatable; see a GP or pharmacist.

Recurrent aphthous ulcers

Ordinary mouth ulcers. Painful, self-limiting. The cause of mouth ulcers and their usual treatments covers what helps and what does not.

But: any ulcer that has not healed in three weeks needs examining, at any age — the reason is set out in Oral cancer: signs, risk factors and how your dentist can help.

Geographic tongue

Map-like red patches with white borders that move around over days. Benign, harmless, no treatment needed. Frequently frightening to parents until named.

Dental abscess in a child

This is the one that gets underestimated.

Signs: a pimple-like swelling on the gum near a tooth, facial swelling, a tooth that hurts to bite on, a bad taste, fever. What is a tooth abscess? Should I have it treated? and Why are dental abscesses so painful? describe how one forms.

A baby tooth can abscess just as a permanent tooth can, and infection at the root of a baby tooth sits directly against the developing crown of its permanent successor — which is one of the concrete reasons “they're only baby teeth” is wrong. The stages of dental decay shows how a cavity gets that far, and How do I prevent dental decay? how it is stopped earlier.

Facial swelling in a child is urgent. Swelling that is spreading, that closes the eye, or that comes with difficulty swallowing, difficulty breathing, drooling, a stiff neck or a very unwell child, is a medical emergency — go to a hospital emergency department immediately. Dental infections in children can spread quickly, and Can a dental abscess affect your general health? explains why.

Antibiotics alone do not treat the cause. They may settle an acute swelling; the tooth still needs treating — see I have a toothache. Should I see my GP for antibiotics?

Trauma

Toddlers learning to walk and school-age children in the playground account for most of it. Children's Dental Emergencies and What is considered a dental emergency? set the thresholds.

A knocked-out PERMANENT tooth: hold it by the crown, rinse briefly in milk if dirty, put it straight back in the socket, or store it in milk — saliva or saline if there is no milk, and plain water only as a last resort, because the one real absolute is never to let the tooth dry out — and get to a dentist immediately. Treat it as an emergency and go straight there. (What should I do when a tooth is knocked out?)

A knocked-out BABY tooth: do not put it back. Replanting can damage the permanent tooth forming beneath. See a dentist anyway — My child has a knocked out baby tooth: what do I do?

A discoloured front tooth after a knock — grey or dark — means the tooth may have lost its blood supply. It is not an emergency but it does need assessing.

Any facial injury: check for head injury first. Loss of consciousness, vomiting, drowsiness or confusion needs medical assessment before anything dental.

Habits and development

Thumb, finger and dummy sucking are normal in early childhood and most children stop on their own. Persisting past the arrival of the permanent front teeth can move teeth and change how the jaws develop, and is worth intervening on — see What is malocclusion of the teeth?, Treatment of malocclusion and When should I take my child to see an orthodontist?

Mouth breathing — sleeping with the mouth open, snoring, waking with a dry mouth. Often nasal obstruction, allergy, or enlarged tonsils and adenoids. This is a medical or ENT matter, and it increases decay risk because the mouth dries out overnight. Worth raising with a GP. See Mouth breathing: the silent habit that's changing your face and your health, Orofacial Myofunctional Therapy and Snoring and Sleep Apnoea.

Tongue tie (ankyloglossia). Genuinely causes feeding difficulty in some infants — and it is also over-diagnosed and over-treated, with concern raised by Australian professional bodies about the rate of division being performed. If it is raised, ask what specific functional problem it is causing, and consider a second opinion including from a lactation consultant.

Delayed eruption, missing teeth, extra teeth and teeth erupting in the wrong place are picked up on examination and sometimes on radiographs long before they are visible. Referral to a paediatric dentist is sometimes the right next step.

When to go today, and when to wait

Today — or to a hospital emergency department:

Soon, but not an emergency:

At the next check-up:

And the money

The Child Dental Benefits Schedule covers examinations, cleans, sealants, fillings, extractions and radiographs for eligible children, capped over two years. It is substantially under-claimed. Check through Services Australia or myGov — how the schedule operates explains the claiming. Victoria also provides public dental services for eligible children.

Related pages: Children’s Dentistry, Children’s Dental Emergencies, Emergency Dentistry, Kids get the brush off, and the rest of the media record.

Common questions

At what point is it too late for the first tooth to appear?

The Australian Dental Association's own guidance puts the usual arrival later than most parents expect: baby teeth "often start to appear around 9 months old", with a normal range of 3 to 12 months, and "if your child does not have any teeth by 12 months of age, it is best to have a check-up with a dentist". That 12-month mark is the threshold worth remembering rather than a precise expected month. Order does not matter — "it is normal for the teeth to arrive in any order", though the middle bottom teeth are often first — and all 20 baby teeth usually arrive by age 3.

Which symptoms should I stop blaming on teething?

More than most families assume, and the lists do not fully agree. The ADA treats drooling, gum rubbing, unusual irritability, mouthing objects and biting as teething symptoms, appearing "as early as 3 months old". But it puts a longer list on the other side of the line — symptoms that "should not be linked to teething straight away" — and that list includes difficulty sleeping and loss of appetite alongside coughing, rashes, diarrhoea, vomiting, seizures and very high fever, with the advice to "see your doctor if your child has these symptoms to rule out other illnesses". Note that this is stricter than the section above, which treats disturbed sleep and mild appetite loss as ordinary. Where the two differ, the safer course is the ADA's: get the child checked rather than assume.

How do I check my child's teeth myself between appointments?

There is a specific technique, and it takes ten seconds. The ADA describes it as lifting the top lip and rolling down the bottom lip to look at the tooth surfaces. What you are looking for is "white, brown, or black spots on the teeth that do not come off" — spots that will not wipe away can be a sign of decay, and are the point at which the problem is still simple to manage. The ADA is clear that this "does not replace a check-up by a dentist", but it is how most early decay in small children is first noticed, because it appears where a parent looking straight at a smiling face cannot see it.

If we do nothing, what is the realistic worst case?

Hospital, and it is not rare. The ADA's Children and Young People Oral Health Tracker reports that 10.8 in every 1,000 children aged 5 to 9 are hospitalised for potentially preventable problems due to dental conditions, rising to 14.3 per 1,000 for Indigenous children, and that only 56% of children see a dentist before age 5. The ADA describes child dental decay as the most common childhood infection in Australia, with a cost to the economy "estimated to be up to $1 billion per year" and a direct relationship to "poor school performance, inadequate nutrition, problems with sleeping and adverse social wellbeing". Its own framing of the escalation is the useful one: decay picked up early "can be controlled fairly simply", while "leaving it till the teeth hurt or break down means simpler interventions are unlikely to work".

Does the bottle at bedtime really matter that much?

It is one of the few habits Australian dental policy names explicitly. The ADA's diet policy asks that parents and carers of infants be discouraged from "sleeping with sweetened pacifiers/dummies, food or bottles with products containing sugar, including milk and fruit juices", and separately lists "sipping drinks, other than water, during interrupted sleep" among the high-risk behaviours for decay and erosion. The reason is mechanical: saliva flow falls during sleep, so the same drink sits on the teeth far longer. The ADA's position is that "the form, frequency, timing and total amount of sugar intake are significant" — frequency and timing, not just quantity. The ADA also advises never dipping a dummy in honey or jam.

Will the Child Dental Benefits Schedule pay for an emergency like a facial swelling?

Partly, and there is one exclusion that catches families out. Services Australia covers up to $1,158 per eligible child over two consecutive calendar years, indexed each 1 January, for check-ups, X-rays, cleaning, fissure sealing, fillings, root canals and extractions — so a tooth treated in a dental surgery is generally within scope. What it does not cover is orthodontic work, cosmetic work, or any dental services in a hospital. If a child is admitted for a spreading infection, or treated under general anaesthesia in a hospital, that episode falls outside the schedule. Ask what the pathway is and what it costs before the day, not on it.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Directions are on Location; enquiries go through Contact Us.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information. It is not a diagnosis or a treatment plan and does not replace assessment of your child by a practitioner. If your child is unwell, see a GP; in an emergency, call 000 or go to a hospital emergency department. Child oral health figures are quoted as published by the Australian Dental Association; Child Dental Benefits Schedule eligibility and caps are set by Services Australia and change. Third-party published content is not reproduced.

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