As with every milestone your baby makes, seeing him cut his first tooth is an exciting one. Most babies get their first teeth at around six months, although some babies can get their baby teeth as early as three months[1]. The first teeth to appear are usually the two bottom front teeth, also known as the Central Incisors. These are followed about one to two months later by four top front teeth – two Central Incisors and two Lateral Incisors which are the teeth that appear on either side of the two top front teeth. When the four upper teeth have emerged, the two bottom Lateral Incisors will appear about a month later.

The next teeth to follow would be the Premolars and Molars with their flat surfaces for grinding food and then finally the Eyeteeth or Canines – the pointy teeth on both sides of the Incisors.

And by the time they are three years old, most children would have developed all 20 of their baby teeth or primary teeth.

Why Some Children are Born with Teeth

In rare cases, some babies are born with one or two teeth present in the mouth at birth or have a tooth emerge within the first 30 days of life. The former is called Natal Teeth while the latter is known as Neonatal Teeth. These teeth are usually loose, badly formed and are removed as they may interfere with feeding or pose a choking hazard. There is no known cause except that it may be hereditary. The phenomenon occurs in all cultures across the world and is actually an ancient one which dates as far back as 59BC[2] when it was first recorded!

From Baby Teeth to Permanent Teeth

Actually, when a child is born, his set of primary teeth are already present under the gums. The first buds of primary teeth start developing in the unborn child’s jaws as early as around the sixth week of pregnancy[3]. Next, the hard tissue surrounding the teeth is formed at around three to four months of foetal gestation. After that, the teeth will only erupt through the gums when the child is around six months old. Finally, these teeth will fall out beginning at around the age of six when they are replaced by permanent or adult teeth. These permanent teeth began developing in the jaws at birth after the child is born.

This is why nutrition is so important for the development of healthy teeth and gums. The seven essential vitamins and minerals required[4] are Calcium, Vitamin D, Vitamin C, Potassium, Phosphorus, Vitamin K and Vitamin A. The right foods should be eaten throughout a child’s developmental years as nutrient deficiency can exert a wide range of detrimental effects on the teeth. Some examples include delayed tooth eruption, reduced teeth size (microdontia) and decreased enamel formation (enamel hypoplasia)[5]. {More about nutrition later}.

The arrival of permanent teeth[6] begins with the Molars at the age six or seven. This will be followed by the upper and lower Central and Lateral Incisors between the ages of six to eight, the Canine teeth between nine and 13 years, the second set of Molars and Premolars between the ages of nine and 13 and the final and third set of Molars between the ages of 17 and 21. Finally the child growing into adolescence and then into adulthood will have 32 permanent teeth – 16 at the top and 16 at the bottom.

Why Teeth Care is Important from Day One

While it is true that your child’s baby or primary teeth will eventually fall out after a short amount of time, you may ask why it is important to take care of them. The answer is: primary teeth play a greater role in the child’s development and future wellbeing than you may think they do and these are the number of ways[7] they lay the foundation for their lifelong health.

• They reserve space for the permanent teeth to come in
• They help give a healthy start to the permanent teeth because tooth decay and infections and abscesses in primary teeth can cause dark spots or discolouration on the permanent teeth developing beneath them.
• They give the face its normal appearance
• They aid in the development of clear speech
• They help attain good nutrition for the child as missing or decayed teeth make it difficult or painful to chew causing children to reject food
• They promote self-confidence because children with good teeth smile and speak with the self-confidence they need for positive, social interactions.

It is crucial to take good care of primary teeth as they emerge as cavities can develop as soon as your baby has teeth. Dental caries (tooth decay or dental cavities) can lead to gum disease and infections that can spread to the head and neck causing fever, pain and severe swelling. Children with tooth decay do not do well in school because the pain interferes with sleep and rest, concentration and behaviour. Moreover, missing primary teeth cause malalignment and crowding of erupting adult teeth as the child grows up. In Malaysia[8], 98.1% of children aged five to six, and 44.6% of children aged between seven and 11 years old have been found to have dental caries.

How to Maintain Good Health in Primary Teeth

One of the best ways to maintain your child’s oral health is to establish a dental hygiene routine early on.

• From birth: Clean your baby’s mouth and gums[9] with a soft damp cloth or gauze after each feeding or at least twice a day. This is crucial for future oral health.
• First Tooth: Clean your child’s first tooth or teeth with a soft baby toothbrush and water[10] after each feeding or at least twice a day. As soon as a child has a tooth, plaque can begin building on the surface of the tooth causing decay. This is especially so when he has begun weaning and eating pureed food. While brushing his teeth, softly run the bristles over your baby’s gums and tongue too to loosen accumulated bacteria in the mouth.
• 12 Months: Take your child for their first dental[11] visit. A visit to the dentist can be fun and fruitful if the child’s first experience is not a traumatic one involving emergency tooth extraction and pain. This is to avoid giving the child a negative perception of dentistry and dental visits.
• 24 Months: The CDC[12] recommends that children begin using fluoride at the age of two. Children can begin using low fluoride children’s toothpaste at this time. At this age, children can be taught to spit out the toothpaste, not swallow it, and rinse the mouth. Only a small amount of toothpaste such as the size of a pea, is required on the toothbrush.
• 30 Months: Begin flossing between any teeth that touch
• Three to Five Years: Children learn at different paces. By age three to five years[13], children can begin to develop the skill of holding the toothbrush and brushing their teeth by themselves. Be sure to follow up to make sure all surfaces have been cleaned.
• Six Years: By six years of age[14], most children would have learnt how to spit and rinse their mouths thoroughly and not swallow the toothpaste. They can begin changing to adult toothpaste by this time because adult toothpaste has higher amounts of fluoride, protection and cleaning power. It is also at this time that the first adult or permanent teeth begin to arrive.

*Fluoride is a naturally occurring mineral that helps strengthens the teeth’s enamel. It can be a powerful tool in stopping and even reversing tooth decay. However, it mustn’t be ingested in large amounts by children under the age of eight. This is why it is important they know how to spit out their toothpaste and rinse their mouths. Excessive consumption of fluoride can cause dental fluorosis – which is a condition that discolours the enamel. This is why children’s toothpaste are formulated with lower amounts of fluoride or none at all to prevent this. There are some trusted toothpaste brands in Malaysia that do not contain fluoride but other alternative ingredients. There is some debate on the use of fluoride for children but the choice is ultimately yours on which type you prefer for your child.

• Eight Years: By eight years of age, children would have developed the fine motor skills needed to brush and floss their own teeth unsupervised[15]. But do keep up with their regular dental check-ups.

Additional Tips for Keeping Your Child’s Teeth Healthy

• No bottles in bed: Putting your child to sleep with a bottle allows the sugars found in milk to linger on teeth, setting the stage for tooth decay. In fact, many doctors and dentists refer to early cavities as baby bottle tooth decay[16]).
• Never share saliva: Tooth decay-causing bacteria as well as infections can easily move from mouth to mouth. Never share saliva. For example, you should avoid putting a pacifier or bottle teat in your mouth and then giving it to your child, or tasting your child’s food before offering him a bite from the same spoon. Also, do not group feed a gathering of children (such as siblings, cousins or childcare/nursery mates) using the same spoon. Avoid storing your child’s toothbrush[17] in the same container as other family members.
• Do not dip pacifiers into honey or sugar: It is often tempting to soothe a fussy child with a pacifier, more so when it is dipped in sugar or honey. However, this will expose the teeth to sugars for long periods.
• Limit use of pacifiers: Children should stop using the pacifier by 24 months of age. Prolonged use can cause children to have buck teeth[18] (protruding front teeth), crossbites (when upper teeth fit behind the lower teeth), maligned teeth (teeth that angle outwards) and misshaping of the roof of the mouth.
• Introduce a cup around your child's first birthday: Teaching a child to drink from a cup can help prevent tooth decay. You can begin moving your child to a lidded or Sippy cup by the time he is 12 months old.
• Skip the sugary drinks: Fruit juice and sweetened drinks aren't good for your child's teeth and in fact, they are not recommended for children under 12 months. If you must give sweetened drinks when he is older, limit the intake to 4oz a day and have them diluted to half-water-half-juice.
• Limit sticky fruits and treats: Some foods can cling to a child's teeth, giving bad bacteria plenty of sugar to feast on. Sticky foods that promote tooth decay include raisins, gummy candies, fruit roll-ups and snack bars with honey or molasses. Try to limit these foods in your child's diet and have them brush or rinse with plain water after eating them.
• Make water the family drink of choice: Plain, boiled water is the healthiest drink for your child's teeth. Drinking plenty of water cleanses your child's mouth, and helps maintain saliva flow, which also washes away decay-causing bacteria.
• Promote healthy eating: What your child eats can significantly impact their dental health. Encourage them to consume a balanced and wholesome diet that will give them bright, sunny smiles throughout their lives.

Nutrition for Strong and Healthy Teeth

As can be seen from the above, a child’s teeth are meant to last for the entire duration of their lives. Not only do teeth require a lifetime of good oral hygiene to keep them in good condition, they also require sufficient nutrition to form the foundation of healthy teeth right from the beginning. The most essential nutrients required for dental health are:

1. Calcium: Calcium[19] helps build strong bones and provide structural support. For teeth, this mineral helps harden tooth enamel, and strengthens the jawbone. Calcium can be found in dairy such as milk, cheese and yoghurt.
2. Vitamin D: Vitamin D helps the body regulate and absorb Calcium while boosting bone mineral density. Vitamin D deficiency[20] causes delay of teeth eruption and abnormal calcification of enamel and dentin. Vitamin D is naturally made by the body when exposed to sunlight. It is also found in fatty fish, portabello mushrooms, and foods and drinks fortified with Vitamin D such as milk, orange juice and cereal.
3. Potassium: Potassium[21] improves bone mineral density and works with magnesium to prevent blood from becoming too acidic which can leach calcium from the teeth and jawbones which weakens them. Bananas, tomatoes, lima beans, potatoes, sweet potatoes, avocados and prunes are rich in Potassium.
4. Phosphorous: This mineral is present in bones, teeth and even in DNA. It works with Calcium to create hydroxyapatite – the main structural component of bones and tooth enamel. Without Phosphorus[22], the body cannot use Calcium well and this will result in bone brittleness and teeth that chip easily. Foods high in Phosphorous include sardines, cod, tuna, salmon, shrimp, beef, cheese, soybeans, lentils and pumpkin seeds.
5. Vitamin K2: A miracle vitamin[23] that is essential for strong teeth and bones. It acts as a shield and blocks substances that break down bones while working along with Vitamin D to move Calcium out of soft tissue and blood into teeth and bones. Leafy greens such as Kale, Kai-Lan, Spinach, Broccoli and Parsley are rich in Vitamin K.
6. Vitamin C: Strengthens gums and soft tissue in the mouth and can protect against gingivitis and other gum disease while preventing teeth from loosening. Fruits and vegetables are rich sources of Vitamin C.
7. Vitamin A: Vitamin A[24] contributes to the immune function, vision and saliva. It keeps the mucous membranes healthy and saliva flowing which cleans the teeth and prevents dry mouth. Vitamin A can be found in fish, egg yolks, liver, leafy green vegetables and orange-coloured foods.

Morinaga Chil-kid

All seven of the afore-mentioned vitamins and minerals can be found in Morinaga Chil-kid – a Japanese growing up milk specially formulated for children aged one to seven. Apart from these seven essential nutrients, Morinaga Chil-kid is packed with other essential nutrients including AA+DHA, Nucleotides and dietary fibre Galacto-oligosaccharides (GOS) , and Omega 3&6 LCPs (long-chain polyunsaturated fatty acids), vitamins B1, B6, B12, and E plus minerals such as Zinc, Iron and many more. The formulation is especially suitable for Asian children.

Morinaga Chil-kid uses milk from dairy cows in the Netherlands and is packed in a state-of-the-art plant in the Netherlands where it goes through stringent quality assurance processes and a double inspection in Japan before it is released into the market.

For more information on Morinaga Chil-kid, please visit the website here.