​The structure, diseases, preventive and therapeutic treatments of children’s oral, dental, and lower facial regions fall under the field of “Pedodontics.” Dentists trained in this specialty are called “pedodontists.” In this article, information is provided regarding children’s normal tooth eruption periods and major oral and dental conditions.

When do teeth begin to erupt?

In infants, the first tooth typically begins to erupt around the 6th month. However, delayed or early eruption may often be observed. Late tooth eruption is generally associated with genetic predisposition, but systemic diseases that delay eruption should not be ignored. These include thyroid, parathyroid, and growth hormone deficiencies, which commonly affect overall growth and development.

Newborns already have tooth buds. At birth, all primary tooth buds (germs) and the cusp tips of the first permanent molar (six-year molar) have formed.

Teeth erupting between 4–8 months:

If a slight swelling is observed in the region of the upper incisors, this indicates that the upper right and left lateral incisors are in the process of erupting. The lower and upper central incisors have already erupted. The eruption order is: upper central incisors first, followed by upper lateral incisors, and then lower lateral incisors.

Teeth erupting between 8–11 months:

All upper and lower central and lateral incisors have erupted.

Teeth erupting between 11–15 months:

All upper and lower central and lateral incisors have erupted. Upper lateral primary incisors erupt approximately 12 months before the lower lateral primary incisors. After this, the first primary molars begin to erupt.

Teeth erupting between 15–21 months:

By 18 months of age, the primary canine teeth begin to erupt.

Teeth erupting between 1.5 – 2.5 years:

The second primary molars in the upper and lower jaws have erupted. Root calcification of primary teeth is completed one year after crown eruption. The permanent first molar erupts at age six. The six-year molar erupts behind existing primary teeth. Children and parents often confuse these with primary teeth. Before fully erupting, only the chewing surface may remain visible for months. Food accumulation can cause decay. Sometimes gum inflammation also occurs.

What symptoms occur during tooth eruption in children?

During the eruption of primary teeth, infants may show several general and regional symptoms. These include loss of appetite, weight loss, diarrhea, irritability, increased drooling, itching of the gums, and redness in the gingival region.

There is no specific treatment method to eliminate these symptoms. However, topical dental gels may be used to relieve pain and help the baby feed comfortably. Certain syrups may also be used to reduce itching.

When should the first dental visit take place?

Children should be taken to the dentist for an examination after the eruption of the first tooth. Thereafter, dental check-ups should be repeated every 6 months. The clinical examination performed by the dentist consists of two stages:

Stage 1: Extraoral Examination

In the head-face examination, the size, shape, and proportions of the area are observed. Any swelling, asymmetry, mandibular retrusion or protrusion in children older than six should be assessed. Palpation and inspection of swelling, determination of softness, and lymph node examination should be performed. Afterwards, the temporomandibular joint is examined for pain or sound. In eye-nose-sinus evaluation, conditions such as exophthalmos, blue sclera, eyelid drooping, or nasal obstruction are assessed if present.

Stage 2: Intraoral Examination

This examination includes evaluating the teeth and soft tissues while the mouth is open, as well as observing occlusion when the teeth are closed. The examination begins with inspecting the lips internally and externally. Then the buccal mucosa, frenula, hard palate, pharynx, floor of the mouth, and tongue are examined. Color changes, presence of acute or chronic fistulas, or swelling are noted.

What does the dentist recommend to parents?

Parents are informed about the child's oral and dental health. It is recommended that the child be examined every six months by a pedodontist or dentist.

What should be done if a permanent tooth erupts while the primary tooth is still present?

This is most commonly seen in the lower anterior teeth during intraoral examination. “Ectopic eruption” refers to the abnormal eruption of a tooth. Permanent incisors and canines are more prone to ectopic eruption. This may lead to early root resorption of primary incisors. Early resorption of the posterior roots of the second primary molars is another example of ectopic eruption.

Ectopic eruption generally occurs between 5–8 years of age. If a 7-year-old child has missing primary canines or unerupted permanent molars, ectopic eruption should be suspected.

Ectopic eruption in the lower anterior region usually corrects itself once the primary incisors fall out or are extracted. Various treatment options, from simple wires placed between the teeth to orthodontic appliances, are available for ectopic teeth. Forces are applied to guide the teeth to erupt from the correct position. For this purpose, the child is referred to a pedodontist.

When should tooth-brushing begin?

Dental care beginning in infancy forms the first steps of preventive education and lifelong oral hygiene. The microorganisms responsible for tooth decay—generally known as “Streptococcus Mutans”—are believed to be transmitted from mother to child between 9–36 months. Therefore, the mother's dental health is closely related to the child’s oral health. Oral care in infants should begin with the eruption of the first tooth.

Oral and dental cleaning should be performed by the mother using a clean cloth. Children can begin using a toothbrush at age 1. Considering that children may not be able to rinse their mouth, brushing may be done without toothpaste or using low-fluoride children's toothpaste. Since children cannot perform effective brushing on their own, parents must brush their teeth for them. The tongue surface must also be brushed after brushing the teeth.

During the first examination, the baby's medical and dental history is evaluated. Intraoral examination is performed at the first visit, and the child's susceptibility to caries is assessed. Guidance is provided regarding development, fluoride needs, habits other than normal nutrition (bottle, pacifier, etc.), trauma prevention, oral hygiene, and dietary habits. The first visit to the pedodontist or dentist is important for gaining information that will benefit the child throughout life.

What measures should be taken to prevent tooth decay in children?

The first step in preventing tooth decay is ensuring good oral hygiene. Teeth should be brushed at least 3 times a day for 2 minutes each. Dental floss and mouthwashes may be used after age 5 only upon a dentist’s recommendation. One of the proven effective methods for preventing tooth decay is the application of “fluoride.”​

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