All About Teeth

The Growing Smile

First Tooth: Typically, the first baby tooth appears around the time your little one is six months old, an it’s usually one of the lower front teeth.

First Checkup: Shortly after your baby’s first teeth have erupted, somewhere between 6-12 months old. This is the time to ask your dentist about the best oral hygiene practices for your baby (and yourself!) and discuss the use of pacifiers and other oral habits (thumb sucking, etc.), and any teething issues if appropriate.

First Complete Smile: At around 3 years old, your child will probably have a complete set of 20 baby teeth.

First Cleaning Treatment: Ask your dentist when your child should get his or her first professional cleaning treatment, and also ask about sealant treatments. Cleanings and cavity defense procedures can start anywhere between 2-6 years. Cleanings should then be performed every six months or as indicated by your child’s oral health status.

First Lost Tooth: Baby teeth usually fall out in the same order they came in, so the That means the lower center teeth will usually go first, somewhere around age 6 or 7. But your child may lose his or her first teeth as early as age 4. Typically, a child whose baby teeth came in early will lose them sooner than other children. If your child loses a tooth due to an injury or dental decay, see a dentist. Your child may need a space holder (a small plastic dental appliance) to keep his or her teeth in the correct position until adult teeth come in.

Permanent Teeth Complete: It can take a decade (or more!) for your child baby teeth to be replaced by adult teeth. The American Dental Association offers a great chart to track the progress of adult teeth appearances in your child’s mouth, along with a timetable that tells you when to expect each tooth.

Braces: Orthodontic treatment, if needed, normally begins between ages 10 and 14. Some dentists may start treatment earlier, depending on your child’s needs.

Wisdom teeth: These “third molars” typically come in somewhere between 17-21 years but can erupt much later. During your child’s late adolescence, your dentist will assess the presence, position, and development of wisdom teeth to determine whether they might need to be extracted.

The Importance of Baby Teeth

Just because your child’s primary teeth, often known as “baby teeth,” eventually fall out, that doesn’t mean they’re not important. Primary teeth play an essential role in your son or daughter’s overall health, development, and well-being.

Much like your own permanent teeth, your little one’s primary teeth require professional and at-home dental care. Decay can happen at any age, so it’s time to visit us within six months of your child’s first tooth, and certainly by age one.In addition to checking for tooth decay and other pediatric dental problems, Dr. Al will show you the best ways to start your child on a lifetime of good oral health habits.


Most children have a full set of primary teeth by the time they are three years old. Primary teeth are crucial for many reasons. They:

  • Promote good nutrition through proper chewing
  • Assist in speech development
  • Build self-esteem by providing a beautiful smile
  • Provide a path for permanent teeth to follow when they are ready to emerge
  • When healthy, enable the child to pay attention and learn in school without the distraction of dental pain


Primary teeth can get cavities, just like adult teeth. In addition to the pain caused by a cavity, young children can develop dental infections.

Primary tooth decay is a serious, infectious, and transmissible disease that can spread quickly and lead to infection or abscess without proper precautions. This can be especially harmful to children in proper care is not given in a timely manner. I

f a tooth becomes infected and needs to be extracted, Dr. Al may recommend inserting a space maintainer. If the space is not preserved, other teeth may drift, which can cause difficult-to-treat crowding and orthodontic problems when permanent teeth arrive.

The most important aspect of taking care of your child’s primary teeth is the example you help to set. Early on, your youngster should develop the habit of brushing and flossing that will carry into adulthood. Healthy teeth also lead to easier dental visits, which teach your son or daughter that there is nothing to be afraid of at the dentist.

Dental Care For Your Baby

Congratulations on the arrival of your baby! Are you prepared for the arrival of your little one’s first tooth? Follow these guidelines and your son or daughter will be on the way to a lifetime of healthy smiles!


Even before your infant’s first tooth appears, the gums can benefit from your careful attention. After breast- or bottle-feeding, wrap one finger with a clean, damp washcloth or piece of gauze and gently rub it across your baby’s gum tissue.

This practice both clears your little one’s mouth of any fragments of food and begins the process for building good daily oral care habits.


When that first tooth makes an entrance, it’s time to upgrade to a baby toothbrush. There are usually two options: a long-handled brush that you and your baby can hold at the same time, or a finger-puppet-like brush that fits over the tip of your pointer finger. In each case, the bristles are soft and few.

At this stage, toothpaste isn’t necessary; just dip the brush in water before brushing. If your little one doesn’t react well to the introduction of a toothbrush, don’t give up.

Switch back to a damp washcloth for a few months and try the toothbrush again. During the teething process, your youngster will want to chew on just about anything, and a baby toothbrush with a teether can become a favorite toy during this period.


When a few more teeth appear, you can start using toothpaste with your child’s brush. At this stage, use only a tiny amount of fluoridated toothpaste (the size of a grain of rice). Always encourage your child to rinse and spit out toothpaste after brushing. Children naturally want to swallow the paste after brushing, but swallowing too much fluoride toothpaste can be tough on your stomach, and too much of anything is rarely a good thing. Teamwork makes the dream work, so help brush your child’s teeth until he or she is ready to take on that responsibility, which usually happens by age six or seven.


Don’t give your baby any sort of sweetened liquids such as flavored drinks or soda. Even the sugars present in fruit juice, formula, and milk (this goes for breast milk as well) can cause decay, so regular teeth and gum cleaning is vital.

Also, make sure your infant never goes to bed with a bottle; sugary liquids in prolonged contact with teeth are a guarantee for early-childhood decay, also called baby-bottle caries.


It’s recommended that you bring your child in for a visit within six months of the first tooth’s eruption – usually around his or her first birthday. Since decay can occur in even the smallest of teeth, the earlier your son or daughter visits us, the more likely he or she is to avoid problems.

We’ll look for any signs of early problems with your baby’s oral heath, and check in with you about the best way to care for your little one’s teeth. Remember that preparing for each dental visit with a positive attitude goes a long way toward making a youngster comfortable with regular checkups.


As part of the natural learning process, little ones are expert mimics, and you can take advantage of this talent. Brush and floss daily while your child is watching, and he or she will intuit at an early age the importance of your good habits.

As soon as your child shows interest, offer a toothbrush of his or her own and encourage your toddler to “brush” with you. (You’ll find toothbrushes with chunky, short handles that are easy to grip.) Most children don’t have the dexterity necessary to clean their own teeth thoroughly until they’re about six or seven, so you’ll have to do that part of the job.

Try different tactics to make brushing fun: flavored toothpaste, a toothbrush with a favorite character on it, or singing songs about brushing. The primary goal is to instill healthy oral habits at an early age to set up your son or daughter for a lifetime of healthy, cavity-free teeth!

Gum Disease in Children

Gum disease, also known as gingivitis or periodontal disease, is an infection that occurs in the gums, deep tissues, and bones that support the teeth. It can affect children if proper oral health practices aren’t followed. If the disease is not treated, gum disease can ultimately lead to tooth loss.


Your child’s mouth naturally produces a sticky substance called plaque. Without adequate brushing and flossing, plaque builds up on the teeth.

The bacteria in plaque produce poisons, or toxins, which irritate the gums and cause infection. As an infection increases in severity, it breaks down the bones and tissues that hold your youngster’s teeth in place.


The initial stage of gum disease, known as gingivitis, is the mildest form of gum disease and is common in children.

During this stage, the gums become swollen and red, and may bleed after brushing or flossing. Gingivitis is frequently painless, so your little one might not mention it is a bother. With professional treatment and daily attention to oral hygiene, gingivitis can be reversed before it progresses.

Untreated gingivitis may develop into periodontitis — the more extreme form of gum disease.

Aggressive periodontitis can affect your child even if he or she is otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults. It mainly affects the first molars and incisors, and is characterized by the severe loss of jaw bone.

Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and tartar. Eventually it can cause the teeth to become loose.


Because gum disease can exist without pain or discomfort, it’s vital to be aware of the possible warning signs that may indicate a problem.

  • Gums appear red or swollen
  • Gums feel tender Gums bleed easily during brushing or flossing
  • Gums recede or pull away from the teeth Persistent bad breath
  • Loose teeth
  • Any change in the way teeth come together in the biting position

If you suspect that your little one may be suffering from gingivitis or periodontitis, make an appointment with us immediately. We can diagnose the problem, determine how far the disease has progressed, and recommend an appropriate treatment.

Baby Bottle Tooth Decay

Also known as early childhood caries, baby bottle tooth decay refers to tooth decay in infants and toddlers. Your child needs strong, healthy primary teeth to chew food properly and learn to speak, so preventing baby bottle tooth decay is vital.


There are many risk factors when it comes to children’s tooth decay. A common cause is the frequent and prolonged exposure of teeth to sugary drinks, including milk, formula, and fruit juice.

Giving your child a sugary drink at nap or night-time can be especially harmful, because the flow of saliva decreases during sleep. Bacteria in the mouth thrive on sugar and produce acids that attack the teeth.

Tooth decay can also be caused by bacteria passed from you to your baby through saliva by the sharing of spoons, testing foods before feeding them to your little one, and cleaning off a pacifier in your mouth instead of with water. These germs can start a process that causes cavities even before your baby’s primary teeth emerge, so it’s crucial to avoid sharing saliva with your baby from the start.

If your infant or toddler does not receive an adequate amount of fluoride internally through water, especially if he or she drinks bottled water, there can also be an increased risk for tooth decay. Dr. Al may prescribe fluoride supplements to help prevent tooth decay.


The good news about baby bottle tooth decay is that it’s preventable!

  • Wipe your baby’s gums with a clean gauze pad or washcloth after each feeding.
  • Begin brushing your child’s teeth, without toothpaste, when the first tooth comes in.
  • Clean and massage gums in areas without teeth. Place only formula, milk, or breast milk in bottles. Avoid filling a bottle with liquids like sugar water, juice, or soft drinks.
  • Never allow your child to fall asleep with a bottle that contains anything but water.
  • Never dip a pacifier in anything sweet, like sugar water or honey.
  • Schedule an appointment with our office by your child’s first birthday or when the first teeth begin to emerge.

Remember, healthy little smiles grow up to be healthy big smiles!

Teeth Grinding

Teeth grinding, or bruxism, refers to excessive grinding of the teeth and/or excessive clenching of the jaw, and is common in children. The first indication is the noise created by your child grinding teeth during sleep. Or you may notice wear (teeth getting shorter) in your little one’s dentition.

Although teeth grinding is often the result of stress in adults, the same is not always true with children. If your youngster’s teeth grinding is not the result of stress, other possible causes include irritation in the mouth, inner ear pressure, allergies, and misaligned teeth.

The good news is that, because your child’s teeth and jaws change and grow so quickly, teeth grinding is not usually a damaging habit that requires treatment. Most outgrow it by adolescence. However, if excessive wearing of the teeth continues in the permanent dentition phase, Dr. Al may recommend wearing a night guard.

If you’re concerned about your child’s teeth grinding, ask us about the potential causes and, if necessary, the potential solutions.

Thumb Sucking

Along with favorite blankets, teddy bears, and nap time, thumb sucking can be one of the most comforting aspects of childhood. According to a recent report, between 75% and 95% of infants suck their thumb, so chances are there’s a thumb sucker (or a former thumb sucker) in your family. Is this cause for worry?

In most cases, the answer is no. However, it’s worthwhile to pay attention to your child’s habits in case his or her behavior has the potential to affect overall oral health.


Most children begin sucking their thumbs or fingers from a very young age; many even start inside the womb. Sucking is a natural reflex for an infant and it serves an important purpose.

It often provides a sense of security and contentment for a young one. It can also be relaxing, which is why many children suck their thumb as they fall asleep.

According to the American Dental Association, most children stop thumb sucking on their own between the ages of two and four. They simply grow out of a habit that is no longer useful to them.

However, some children continue sucking beyond the preschool years (although studies show that the older a child gets, the lower the chances are of continuing the habit). If your son or daughter is still sucking when the permanent teeth start to appear, it may be time to take action to break the habit.


First, take note of how your child sucks his or her thumb. If the sucking is passive, with the thumb gently resting inside the mouth, it is less likely to cause damage.

If, on the other hand, the thumb sucking is aggressive, and may be placing pressure on the mouth or teeth, the habit may cause problems with tooth alignment and proper mouth growth. Extended sucking affects both the teeth and the shape of the face and may lead to a need for orthodontic treatment. If at any time you suspect your child’s thumb sucking may be affecting his or her oral health, please give us a call and schedule a visit. We can help you assess the situation.


Should you need to help your youngster end the habit, follow these guidelines:

  • Always, always, always be supportive and positive. Instead of punishing your child for thumb sucking, give praise when he or she doesn’t do it.
  • Put a band-aid on your child’s thumb or a sock over the hand at night. Let your little one know this is not a punishment, but rather a way to help remember to avoid sucking.
  • Start a progress chart and let your child put a sticker up every day that he or she doesn’t suck. If your little one makes it through a week without sucking, he or she gets to choose a prize. When the whole month is full, reward your child with something great (a toy or new video game); by then the habit should be over. Making your youngster an active participant in treatment will increase the willingness to break the habit.
  • If you notice your child sucking when he or she is anxious, work on alleviating the anxiety rather than focusing on the thumb sucking. Take note of the times your child tends to suck (long car rides, while watching movies) and create diversions during these occasions.
  • Explain clearly what might happen to the teeth if he or she keeps thumb sucking.

Whatever your method, always remember that your little one needs your support and understanding during the process of breaking the habit of thumb sucking.

Tethered Oral Tissues (TOTs)

TOTs (Tethered Oral Tissues) includes restriction of the lingual frenum also known as ankyloglossia, but can also be a restriction of the frena of the lips and cheeks, by a band of tissue. There are seven frena in the oral cavity that can be impacted by TOTs.

Tongue-tie is a birth defect that occurs when the strip of skin (lingual frenum) that connects a baby’s tongue to the floor of the mouth restricts the movement of the tongue. Typically, this strip of skin separates before birth, which allows the tongue free range of motion.

Tongue-tie is a common condition that, if assessed and addressed quickly, will not hinder a child’s development. If left untreated, however, tongue-tie can result in other conditions including malnourishment, speech difficulty, or poor oral hygiene.


  • Restriction of the tongue’s movement, making it harder to breastfeed
  • Difficulty lifting the tongue up or moving it from side to side
  • Difficulty sticking the tongue out
  • The tongue looks notched or heart-shaped when stuck out


The treatment of tongue-tie for infants is a simple surgical procedure called a frenotomy. Dr. Al examines the lingual frenulum, then uses sterile scissors or laser to snip it free.

Stitches are usually not necessary. Since there are few nerve endings or blood vessels in the lingual frenulum, only a local anesthetic is used.

Frenotomy for tongue-tie in older children and adults is similar to that for infants, although it is usually done under general anesthesia and may involve stitches. Speech therapy may also be necessary.

Moving Teeth


The palatal expander “expands” (or widens) your upper jaw by putting gentle pressure on your upper molars each time an adjustment is made. When you achieve the desired expansion, you will wear the appliance for several months to solidify the expansion and to prevent regression.


You can also download these instructions in a printable PDF document.

Step 1

In a well-lit area, tip the patient’s head back.

Step 2

Place the key in the hole until it is firmly in place.

Step 3

Push the key toward the back of the mouth. You will notice the fender will rotate and the new hole will appear. The rotation stops when the key meets the back of the expander.

Step 4

Press back and down toward the tongue to remove the key. The next hole for insertion of the key should now be visible

Pediatric Dentistry FAQs


All dental specialists (pediatric dentists, orthodontists, oral surgeons, and others) begin by completing dental school, then continue their education with several years of additional specialized training. During training in the field of pediatric dentistry, Dr. Yamoah gained extensive knowledge and experience in treating infants, children, and adolescents.

Pediatric dentists enjoy working with children, and bring to each patient our expertise in childhood development and behavior. Because our office is geared toward young visitors, you’ll find our staff, as well as our office design, decorations, and activities, all work together to provide an especially friendly and comfortable environment for children.


We recommend you make an appointment to see the us as soon as your son or daughter gets that first tooth. The American Academy of Pediatric Dentistry recommends that children be seen by six months after their first tooth erupts, or at one year of age, whichever comes first.


We generally recommend scheduling checkups every six months. Depending on the circumstances of your child’s oral health, we may recommend more frequent visits.


The best preparation for your child’s first visit to our office is to maintain a positive attitude. Children pick up on adults’ apprehensions, so if you make negative comments about trips to the dentist, you can be sure your child will anticipate an unpleasant experience and behave accordingly.

Show your youngster the pictures of the office and the All-Star Team on the website and schedule a virtual visit. Let your little one know it’s essential to keep the teeth and gums healthy, and that Dr. Yamoah will help to do that. Remember he is specially trained to handle fears and anxiety, and our staff excels at putting children at ease during treatment.


The first visit is usually short and simple. In most cases, we focus on getting to know your little one and giving you some basic information about dental care. Dr. Yamoah will check your child’s teeth for placement and health, and look for any potential problems with the gums and jaw. If necessary, we may do a bit of cleaning.

We will also answer any questions about how to care for your child’s teeth as they develop, and provide you with materials that contain helpful tips you can refer to at home.


We recommend taking X-rays around the age of two or three. The first set consists of simple pictures of the front upper and lower teeth, which familiarizes the child with the process.

Once the baby teeth in back are touching one another, then regular (at least yearly) X-rays are recommended. Permanent teeth start coming in around age six, and X-rays help us make sure your child’s teeth and jaw are healthy and properly aligned.If your son or daughter is at a high risk of dental problems, we may suggest having X-rays taken at an earlier age.


The first visit to the office can be a challenging and new experience for many children, especially if they have had a negative experience at another dental office. Do not be surprised or embarrassed if your youngster cries; this is a normal and age-appropriate coping skill.

Dr. Al and the All-Star team at Lake Cities Pediatric Dentistry are skilled at connecting with and assessing the level of cooperation of your little ones. Parenting styles vary significantly, so we will do our best to accommodate your preferences.

With regular dental visits, your child’s confidence and comfort will grow, which lays a critical foundation for lifelong dental health. At Lake Cities Pediatric Dentistry, Dr. Al and the All-Star team are specially trained in child development and behavior management. Our goal is to build lasting relationships with our patients from infancy through college, and instill in them the skills and desire to have a lifetime of good oral health!


Certain types of bacteria live in our mouths. When they come into contact with sugary foods left behind on our teeth after eating, acids are produced.These acids attack the enamel on the exterior of the teeth, and eventually eat through the enamel to create holes in the teeth, which we call cavities.


Make sure your son or daughter brushes those teeth at least twice a day with fluoride toothpaste. Daily flossing is also worthwhile, because flossing can reach spots between the teeth that brushing can’t.

Check with Dr. Yamoah about a fluoride supplement, which helps tooth enamel become harder and more resistant to decay. Avoid sugary foods and drinks, limit snacking, and maintain a healthy diet.

Finally, make regular appointments so we can check the health of your youngster’s teeth and perform professional cleanings.


Even before your infant’s first tooth appears, we recommend you clean the gums after feedings with a damp, soft washcloth. As soon as that first tooth appears, you can start using a toothbrush.

Select a toothbrush with soft bristles and a small head. You most likely can find a brush designed for infants at your local drugstore.


Sealants cover the pits and fissures in teeth that are difficult to brush and therefore susceptible to decay. We recommend sealants as a safe, simple way to help your little one avoid cavities, especially for molars, which are hardest to reach.


Even children’s sports involve contact, so we recommend mouth guards for children active in sports. If your little one plays baseball, soccer, or other sports, ask us about having a custom-fitted mouthguard made to protect the teeth, lips, cheeks, and gums.

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