DBA and Oral Health

Dental Milestones

The diagrams below provide the approximate time scales for the eruption of baby teeth and adult teeth:

First teeth usually appear when your baby is about 6 months old. All 20 baby teeth should be present in the mouth when your child is 30 months.

Permanent teeth erupt from the age of six and are mostly in place by the age of 14, although, wisdom teeth may appear later, between the ages of 18-25.

As with walking and talking, children hit developmental milestones at different rates. This means a variation in the timings of tooth eruption is normal.

Dental Differences to look out for


Hypomineralisation is a tooth condition affecting the formation of enamel (outer layer of the tooth). This can make the teeth more prone to decay and breakdown. It can also make it more dicult to numb the teeth if dental treatment is required. It is thought to be caused by a disturbance in tooth development around the time of birth or in the first few years of life. The cause is not fully understood although severe childhood illnesses, high fevers, or a traumatic birth period have all been suggested as possible causes.

Signs and Symptoms

You or your child may have noticed that their front teeth and/or back teeth may have discoloured and appear speckled, cream, yellow, or brown. These teeth may also be sensitive and may even be crumbly.

Tooth Decay

What is tooth decay?

Tooth decay occurs when sugars from our food and drink are turned into acid by bacteria that live in plaque on our teeth. Persistent acid attacks on teeth will lead to dental decay and a cavity (hole) forming. Untreated tooth decay can
cause pain, swelling and infection. It may result in your child avoiding food and becoming very unwell.

Children with medical problems are considered to be at higher risk of developing tooth decay.

What can I do to help prevent tooth decay?

Diet Advice

Delivering Better Oral health Toolkit (Public Health England) have advised the following:

  • Reduce the amount and frequency of sugars. You can do this by:
    • Keeping sugary food and drink to meal times
    • Providing dentally safe snacks to eat between meals including cheese, crackers, raw fruit and vegetables
  • Ideally to stop bottle feeding by one year. We recognise that this may not always be possible. A free-flowing cup is great for coordination and for healthy teeth. We suggest moving on to this from 6 months!
  • If you have any concerns, speak to your dental team or Pediatrician
  • Dental friendly snacks form part of a well-balanced meal:

Oral hygiene and health

Delivering better oral health: an evidence-based toolkit for prevention (Public Health England, 2021) advises the following:

Brushing Teeth

  • Help brush your child’s teeth twice a day for at least 2 minutes using fluoride toothpaste appropriate for their age
  • Brush your child’s teeth last thing before bed and one other time of the day
  • Spit out the toothpaste but do not rinse with water or mouthwash after
  • This is to ensure the fluoride can benefit teeth for longer
    • Under 3 years old- use a smear of toothpaste.
    • Over 3 years old- use a pea-sized amount
  • Parents should help their children brush their teeth until they are 7-8years old


  • Research has shown great benefit for surface fluoride application in preventing tooth decay as it helps strengthen tooth enamel
  • Fluoride can be delivered in the following ways:
    • In age-appropriate toothpaste:
      • Under 6 years old: over 1000ppm
      • Over 6 years old: 1450ppm
    • In mouth rinse- If you chose to use mouth rinse, this should not replace
      toothbrushing. It should be carried out at a different time than brushing
      teeth e.g straight after school
    • Fluoride varnish – Fluoride varnish can be applied at regular intervals by
      your local dentist (usually 2-4 times a year after the age of 2). Please discuss this further with your local dentist for more information

Toothbrushing hints and tips

Brushing Teeth

  • Make toothbrushing as interactive as possible. Sticker charts provide great positive reinforcement to get your little one excited about brushing their teeth!
  • Where tooth brushing is diffcult, we suggest two techniques:
    • Distraction: Smartphone applications are a great way to keep your child busy
    • Focus on a common goal: Use of an egg timer provides your child with a focus on the end goal
  • Positioning – Positioning your child for optimal toothbrushing can be dicult. Each child is di erent, some options include:
    • Kneel in front of your child. Divide the mouth into four corners and focus on each corner for 30 seconds ensuring you brush all surfaces of the teeth
    • Lay your child on your lap and brush with good visibility of all the teeth
  • Disclosing tablets – for children who are slightly older, disclosing tablets are a great way to keep on top of toothbrushing. These can be bought from your local shop/pharmacy. They stain the plaque which hasn’t been brushed pink!

Regular dental visits

  • Dental Check by One – This is a great initiative from the British Society of Paediatric Dentistry. Having dental appointments early on promotes positive dental experiences and gets a child used to the dental environment. This can make future appointments more relaxing for both you and your child
  • Regular dental check-ups are an important part of maintaining oral care throughout life

What can you expect on your first dental visit?

The first dental visit is used to familiarise your child with the dental environment. A dental mirror will be shown and used to check the teeth and gums. They can also practice sitting in the dental chair!

Toothpaste options


There are a huge variety of different toothpaste flavours available. These range from very berry to tutti fruity and mild mint. Feel free to use any flavour your child prefers as long as it had the right concentration of fluoride. Fluoride
concentration information can be found in the ingredients section at the back of the packaging.


Children sometimes don’t like the bubbles/foam that forms when using toothpaste. This occurs when toothpaste contains the ingredient sodium lauryl sulfate.

  • A great toothpaste alternative is: ORANURSE


This may occur in patients undergoing bone marrow transplant (BMT) as part of their long term treatment. Mucositis is when your mouth is sore and inflamed making it dicult to eat and drink as normal. It’s a common side effect of chemotherapy and radiotherapy.

The best form of treatment is prevention. We know that good oral hygiene habits prior to a BMT reduce the severity of mucositis. Follow our toothbrushing hints and tips below!

Resources to encourage toothbrushing and help with dental visits

Smartphone applications


Where can I access more information from?

  • Your dentist. Local dentists have a wealth of knowledge about the management of baby teeth and adult teeth
  • https://www.bspd.co.uk/Patients/PatientInfo. The British Society of Paediatric Dentistry has a dedicated space on its website for patients and parents
  • British Society of Paediatric Dentistry: A practical guide to children’s teeth is available for download from their website linked above
  • https://www.bspd.co.uk/Kidsvids. The British Society of Paediatric Dentistry has bitesized YouTube videos about toothbrushing
  • The Oral Health Foundation has a free dental helpline: 01788 539780

All the information above is accurate as of 07/04/2022.

Created by Miss Rakhee Budhdeo (Registrar in Paediatric Dentistry) and Miss Marielle Kabban (Consultant in Paediatric Dentistry) – Guy’s and St Thomas’ NHS Trust