Molars (permanent) teeth in children

How does teeth change?

The rudiments of future permanent units are located under the root of the baby tooth and are separated from it by a thin bone septum. At 6–7 years of age, osteoclasts of the connective tissue surrounding the baby tooth dissolve the mineral component of the septum and destroy it. At the same time, the pulp of the temporary unit is gradually transformed into granulation connective tissue rich in osteoclasts, which gradually destroy the dentin of the primary tooth. At the same time, the roots of the temporary units dissolve and, in fact, only the crown of the baby tooth remains. It can be easily removed on its own, with the help of the dentist’s manipulations, or it can be pushed out by an actively growing molar (permanent) tooth.

Anatomy of permanent teeth The permanent units of a child (and an adult) have a complex anatomy.

Visually, the tooth consists of three parts - crown, neck, roots.

The crown is the visible part of the tooth that rises above the gum.
The neck is the part of the tooth at the gum level, in the place where the crown meets the root, and the enamel of the unit turns into cement.
The root is the part of the unit invisible to the eye, located in the alveolar socket. The base of each unit is made of dentin, a hard tissue. In the coronal part, dentin is covered with enamel, and in the root part there is cement. Inside the dentin is the dental pulp - loose fibrous soft connective tissue, penetrated by a large number of blood and lymphatic vessels and nerve endings. Passing along the root canal, through the apical foramen located on the upper part of the root, they communicate with the main neurovascular bundle, providing nutrition to the tooth, drainage of excess fluid and its innervation.

Normally, by the age of 13, when a permanent bite is formed, a child has 28 permanent teeth. At the age of 17 - 25 years, third molars (wisdom teeth) erupt and the number of units may increase - 32 teeth.

When should you start brushing your child's teeth?

Now pediatric dentists are inclined to believe that systematic cleansing of a child’s oral cavity should begin... from the first days of his life. After feeding, you need to take clean gauze or a bandage, wrap it around your finger, moisten it with boiled water and rub it over the newborn’s gums. This is how you can avoid such major troubles as, for example, oral candidiasis (thrush).

Cleaning the first teeth can be done with a cotton swab or fingertip. You should start using toothpaste and brushing at 12-14 months. Almost all children's brushes are now made from soft artificial bristles, but still be careful and check the brush you like: what age it is designed for, and whether it is soft enough. Give preference to products from well-known manufacturers. Toothpaste also differs in composition and taste depending on the age of the children for whom it is intended. The child should be explained that toothpaste should be spat out, even though it is sweet. However, keep in mind: nothing bad will happen if a child swallows a certain amount of paste at first: manufacturers are aware of this tendency of children and make children's pastes safe for the body.

Of course, it is necessary to involve the child in the dental care process as much as possible: show how to use a brush correctly, brush your teeth in the presence of the child, thereby demonstrating how important this procedure is. You can involve your baby in the process of choosing toothpaste and brush, especially since the brush needs to be changed every 3 months. A slightly older child can be asked to choose brushes for the whole family. It is necessary to develop in your child the skill of regular brushing of teeth 2 times a day. More attention should be paid to brushing your teeth at night. And yet, you can let go of the situation and leave the child to his own devices in matters of oral hygiene only when the child turns 10 years old.

Timing and order of eruption of permanent teeth

Normally, the eruption of permanent units occurs 3 to 4 months after the loss of baby teeth. In girls, this process occurs a little earlier and faster than in boys. In both sexes, the first lower molars appear first. Then the sequence of eruption of permanent teeth is approximately the same as for milk teeth and looks as follows.

6 - 7 years - central incisors.
7 - 8 years - lateral incisors.
9 - 12 years - fangs.
10 - 12 years - premolars.
10 - 12 years - molars.

The eruption of the second molars completes the formation of the permanent dentition.

How many baby teeth do children have?

Milk teeth and even some molars begin to form at the stage of intrauterine development. Of course, a child has no visible teeth at birth - they begin to erupt only after 6 months. During this six-month period, they are hidden under the gums, but slowly develop and form, beginning to move outward.

In total, a child grows 20 baby teeth:

Central and lateral incisors – 8.
Fangs – 4.
First and second molars – 8.

Their main function is to form a space where molars will then grow.

The main differences between baby teeth and permanent teeth

Unlike 28 permanent teeth, the primary dentition requires the presence of 20 units. At the same time, they have a number of characteristic features.

Smaller in size compared to permanent teeth.
White with a slightly blue tint (permanent units have a slightly yellowish tint).
Less developed and slightly short roots compared to permanent teeth.
The enamel of primary teeth is poorly formed - thinner.
Milk units can be erased (permanent ones can too, but this is considered a pathology).

As the child grows, baby teeth fall out on their own - this is the norm. The permanent dentition units should not fall out on their own.

What deviations from the norm can there be when baby teeth fall out?

Each child develops individually. Sometimes the timing of the replacement of certain teeth may differ from the generally accepted norm. Minor deviations are allowed up to 12 months. But sometimes the change in the primary bite begins too early or, on the contrary, the temporary teeth do not want to fall out.

Causes:

long-term breastfeeding;
severe infectious diseases in infancy;
pathologies of intrauterine development.

Reference!

Dentists believe that a safer deviation is a late change in the primary occlusion than vice versa.

Let us consider in detail the common violations and their causes.

Early tooth loss

We can talk about such a pathology if a child’s baby teeth begin to fall out before the age of 5. Possible reasons:

advanced multiple caries;
injury;
gum disease;
manual loosening of the tooth.

In all these cases, consultation with a pediatric dentist is required.

Important!

Parents should record the time of tooth loss. If after 4 months the permanent tooth does not begin to emerge, then the help of a doctor is required.

In case of early unnatural tooth loss, it is advisable to conduct an X-ray diagnosis. This will help to identify possible damage to the permanent root rudiment in time and begin treatment. Otherwise, the child will need prosthetics in the future.

Late change from primary to permanent occlusion

The deadline for starting the process of changing baby teeth is 8 years. But this is considered a late shift. The disorder may be caused by:

heredity;
metabolic disorders;
infectious diseases suffered in early childhood;
mental disorders.

If after 8 years a child has not lost a single baby tooth, this is a reason to consult a doctor.

How to determine that a child will soon have molars?

An increase in jaw size is the main sign of a future change of teeth. Visually this may not be noticeable. But the appearance of three and diastema (gaps) between the baby teeth indicates that the child’s jaw is growing and preparing for the formation of a permanent bite.

The following signs are purely individual - they may or may not be present in the child.

Increased salivation.
Redness, swelling of the gums and oral mucosa.
Sore gums.
Unpleasant itching of the gums.
Increased body temperature.
Unreasonable cough, runny nose.
Stool disorder.
General malaise, lethargy.
Loss of appetite.
Sleep disturbance or, on the contrary, drowsiness.
Anxiety, irritation, whims.

Important! During the period of permanent teeth erupting, parents should monitor the condition of the child, the oral cavity and gums. If symptoms that cause concern appear, you should immediately consult a doctor - a pediatrician or pediatric dentist.

Possible problems when changing baby teeth

Common dental pathologies when changing a primary dentition to a permanent one include:

Shark teeth. A phenomenon in which baby and permanent teeth are located parallel to each other, in 2 rows. This arrangement can interfere with the normal development of the dental system. But in most cases, the temporary root becomes loose, and the “extra” tooth falls out on its own. If this does not happen, removal at the doctor's office is recommended.
Increased pain. Sometimes a change in the milk bite is accompanied by increased body temperature, redness of the gums and severe pain. These symptoms usually accompany early or late change of teeth. Inflammatory diseases of the oral cavity may also be the cause.
The appearance of a hematoma.

In rare cases, when molars erupt, a hematoma occurs on the gum in the form of a small bubble with an accumulation of blood. This occurs due to severe eruption, which leads to rupture of blood vessels. The gums may be pale in color. Pain and discomfort occurs. If suppuration occurs, medical attention is required.

If pathological phenomena do not go away for a long time, and the child is irritable and complains of pain, be sure to visit the dentist.

Possible problems

Despite the fact that changing teeth is a natural physiological process, some children and their parents may encounter a number of problems that require contacting a pediatric dentist.

No molars

The absence of permanent units can be caused by congenital edentia - the complete or partial absence of tooth buds.

Another reason for the absence of molars is previous inflammatory diseases - periostitis or periodontitis, resulting from progressive caries. Inflammatory diseases of the periosteum and periodontal tissues have an extremely negative effect on the condition of the tooth buds and can lead to their death.

Important! It is absolutely necessary to treat baby teeth for caries. You should not assume that the problem will go away on its own with the change of teeth. The progression of the disease can negatively affect the health of the tooth buds.

Molar tooth hurts

The enamel of newly emerging permanent teeth is still poorly formed. The low level of its mineralization makes teeth vulnerable to cariogenic microflora. This can lead to the development of caries and cause pain.

Due to poorly formed enamel, tooth sensitivity to external irritants (cold, hot, sour, sweet) may increase, which is also accompanied by painful sensations.

Important! Normally, permanent teeth do not hurt. If pain occurs, you should contact your pediatric dentist. The specialist will determine the cause of the pain, carry out the necessary treatment, fluoridation or remineralization of tooth enamel.

Molars grow crooked

The incorrect position of permanent teeth can be caused by two reasons - the growth of the permanent unit outpaces the process of loss of baby teeth or they were removed ahead of schedule, which led to incorrect formation of the rudiments of permanent teeth.

In this case, there is only one way out - orthodontic treatment of malocclusion.

Important! A malocclusion must be corrected. The sooner you contact a dentist, the more successful the treatment will be. The child will be prescribed to wear removable or fixed orthodontic appliances that will help straighten the permanent teeth and bite.

Injuries

Due to their activity and lack of experience, children can accidentally injure a newly emerging permanent tooth. Due to mechanical damage, cracks and chips may appear on it. The damage looks unattractive. Caring for such teeth is complicated, since food debris can get stuck in the cracks, which will certainly lead to the development of caries.

Important! If a child accidentally injures a permanent tooth, it is necessary to seek help from a dentist. The specialist will assess the complexity and depth of the damage and will build up the missing volume of tooth tissue with composite materials.

Tooth loss

Loss of healthy permanent teeth can only occur as a result of severe trauma to the jaw, for example, during a child’s fall or fight. A diseased molar may fall out on its own. In this case, you will also need to consult a specialist. Most likely, the child will undergo temporary prosthetics for the lost unit, which will not disrupt the formation of a correct permanent bite.

The tooth is loose

Looseness of a permanent tooth is an alarming symptom indicating a pathology of the dentofacial apparatus or the presence of inflammation. Consultation with a specialist is required!

What should parents do?

The process of changing teeth in children worries parents, but this is quite natural, and most children do not experience significant pain. However, this does not relieve parents of the need to constantly monitor the condition of their child’s oral cavity. There is no need to remove baby teeth yourself. When the time comes to say goodbye to a tooth, a certain mechanism is activated in the child’s body that dissolves the milk tooth roots. You should seek help from a specialist only if the baby tooth does not want to fall out, but the permanent one is already beginning to appear.

After a tooth falls out, you may experience some bleeding. If desired, have your child rinse his mouth with a solution of soda with a drop of iodine as a preventative measure.

If you have a problem similar to that described in this article, be sure to contact our specialists. Don't diagnose yourself!
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What to do if a child does not allow or is afraid to have his teeth treated?

Many children experience panic, so it is very important to intelligently approach the question of how to properly persuade a small child to have their teeth treated. To make the process painless and, perhaps, even positive, adhere to the following rules:

Meet the doctor.
This should be done not at the moment when the tooth is already sick, but in advance - during a preventive examination.
Motivation.
The child does not know why this is needed and what awaits him in general, so you should tell him about the importance of the procedure or, for example, show him in a playful way on his favorite toy.
Elimination of physical force.
If a child resists, is capricious and protests, he should not be forced into the dental chair. This will not only traumatize the psyche, but will also completely discourage you from visiting dentists. Here it is better to act carefully - persuade, talk about the great benefits of treatment, or offer a new toy as a present.
Timing.
If treatment is required, you should see a doctor without delay, but you should also consider the child’s needs. If he is used to, for example, sleeping at a certain time, you should not go to the doctor at that very moment. This is fraught with bad mood and whims. First, let your child sleep, and only after that get ready for the dentist. The same goes for eating, playing and other hobbies.
Do not lie.
Many parents say that the doctor will only look and do nothing. This is a very big mistake, because the child expects one thing, but in the end it turns out something completely different. It will be better if you tell him the truth in a positive way.
Read also: Can a baby vomit during teething?

Another good way to motivate your child is by example. If you regularly visit a doctor for preventive purposes and talk about the benefits of procedures, then your child will follow your example.