Primary Teeth

Human teeth exhibit some of the greatest genetic variability in our bodies. The number, size, shape and time of eruption (when the teeth come in) are all highly variable between individuals. In general, however, children will normally have 20 baby (primary) teeth, the first of those being the lower front teeth erupting at about 6 months of age. Primary teeth serve a number of important functions for your child. They help your child chew and are involved in speech development. Primary teeth also maintain a space in the gum and act as a guide for the permanent tooth to position itself.

Typically, the first teeth to erupt are the front four teeth, beginning as early as 6 months after birth. Babies and toddlers can be irritable when their teeth erupt. Cool teething rings can be a distraction from the soreness. Gum gels offer a temporary numbing of pain. Please call Dr. Atherton if you have any concerns about your child during teething. Most children have all of their primary teeth by age 3 years old. The first primary teeth to loosen and fall out (barring trauma) begins at about age 6 and continues to around age 12 to 14 years old. At this age, most of the 32 permanent teeth have erupted with the exception of the wisdom teeth (3rd molars) which appear in the late teen years.

Brushing for Primary Teeth

Begin brushing your child’s teeth with a little water a soon as the first tooth appears. If you are considering using tooth paste before the child is 2 years of age, ask Dr. Atherton or your physician first.

Parents should supervise tooth brushing, twice daily, and make sure children only use an amount of fluoride tooth paste equal to a grain of rice and avoid swallowing it. Children should be taught to spit out remaining tooth paste.


All active children are at risk for tooth injury. Some extra care can avoid permanent injury to the primary teeth. As toddlers begin to walk consider placing gates for rooms which are not child proof or, moving furniture such as coffee tables, that heads can fall against. Make sure that your child has proper protective gear for an activity such as bicycle helmets and mouth guards. Even under proper supervision, injuries do happen! Please call Dr. Atherton’s office, if your child experiences trauma to the teeth. See Emergencies for more information.

Preventative and Restorative Care

May include some of the procedures listed below:

Prophylaxis involves removing superficial plaque, tarter and stain accumulated over a period of time. This is done by rotating a rubber-cup filled with an abrasive tooth paste against all exposed surfaces of tooth enamel. Tarter which is found below the gum line is removed by the dentist on examination. Kids get to choose what flavor they’d like for the cleaning, and believe it or not, they’re not too bad.

Fluoride is a mineral used to strengthen enamel which has been weakened by acids sitting against the tooth. Acid, if left on enamel, slowly dissolves the tooth surface by pulling minerals off of the tooth. You may even think of it like the tooth getting microscopic potholes across its surface. Over time, this dissolving action can lead to the development of a cavity, or a giant sink-hole. Fluoride basically acts like a plug, filling in those potholes to help prevent the cavity from occurring. Most people are exposed to fluoride in their water, food, and toothpaste, but by itself, it is usually not enough. Our in-office fluoride application makes up for the difference.

X-rays are taken as a diagnostic tool. Cavities which form between the teeth can often only be seen when taking these films. X-rays can also help us determine your child’s risk potential for future cavities. Cavities which grow very quickly tell us your child likely has a combination of many cavity-producing bacteria with a carbohydrate-rich diet.

Sealants are typically placed on molars with deep pits and grooves. These molars are at higher risk for getting cavities because the anatomy of the grooves allows for bacteria and carbohydrates to get packed down into them. Sealing a tooth is analogous to caulking your bathtub, where the grooves are filled in with a hard, white material that leaves the tooth feeling smooth. It is a relatively painless procedure and is recommended according to the anatomy of the tooth, oral hygiene of the child and potential risk factors the child may present at a particular dental examination.

Composite Resin Restorations are the “fillings” which go into the teeth once all of the decay is removed. They are tooth-colored and are bonded to the prepared tooth surface. Silver fillings, or amalgam fillings, are only very rarely used in our office on a case-by-case basis. Different materials have different strengths and weaknesses, and for the overwhelming majority of the time, the tooth-colored fillings are the treatment of choice.

Stainless Steel Crowns Periodically, a molar with a more advanced cavity will require what is called a “full-coverage restoration.”In pediatric dentistry, this is done by adapting and fitting a stainless steel crown to fit over the top of the affected tooth. The crown is completed in a single appointment and is designed to last the lifetime of the tooth. Most baby teeth are out of the mouth by 12 or 13 years of age. Primary teeth with these crowns will fall out normally just like any other primary molar.

Extractions of teeth may be necessary for any number of reasons. Baby teeth that are over-retained, traumatized, abscessed, or potential crowding problems for future adult sometimes need to be removed. Space maintenance may be needed following extractions in some circumstances.

Pulpotomy Cavities which extend all the way into the nerve of the tooth means a direct communication between the bacteria in the cavity and the blood and nerve supply of the tooth. These teeth may or may not have symptoms prior to the dental treatment. Such a situation requires cleaning out the top nerve supply of the tooth to re-create a sterile environment. A stainless steel crown is then placed on the tooth to maintain an adequate seal. Research has shown us that restoring a pulpotomized tooth with a composite resin restoration tends to have a much weaker prognosis than a crowned tooth in most cases.

Pediatric Root Canal (Pulpectomy) In situations where bacteria have extended well into the root of the tooth, sometimes a pulpotomy will not remove all of the bacteria or infected tissue. In this scenario, it may be indicated to completely remove the nerve and blood supply of tooth to the apex of the roots. This is designed to remove all of the infected tissue. The space created when the infected tissue is removed is then filled with a resorbable paste which helps keep the tooth from being re-infected.
Some parents will wonder why we should go to such efforts to save baby teeth which will eventually fall out of the mouth. Unfortunately, removing a baby tooth prematurely can have complicated life-lasting effects on the position of the future adult teeth. If a tooth were to come out prematurely for one reason or another, the space created by the missing tooth would likely need to be maintained using a space maintainer.

Space Maintainers maintain space to encourage future adult teeth to erupt into the mouth unobstructed. It is usually needed when a baby molar is lost prematurely. The type of space maintainer needed is dependent on the amount and location of space needed. Single tooth space maintenance is usually maintained with what is called a band and loop space maintainer. Multiple teeth space maintenance is usually accomplished with a lower lingual arch on the lower jaw or a palatal holding arch on the upper jaw. They are usually designed to remain in the mouth until the adult tooth or teeth erupt into the space being held for them.

Interceptive Orthodontics Dr. Atherton can provide early orthodontic intervention. This means we will monitor or head off any growth and development discrepancies that may impede the alignment or emergence of the primary or permanent teeth. Problems such as treatment include thumb sucking, cross bites, overbites, protruding upper teeth, open bites and / or crowded teeth can be corrected through the use of orthodontic appliances and techniques. As your child matures, we can help guide your child’s teeth with minor orthodontic corrections before they become a major concern. Beyond early or minor interventions, Dr. Atherton can provide an orthodontic referral for cases that require comprehensive orthodontic evaluation and treatment done by a board certified orthodontist.