Children begin losing teeth at around six years old and continue through their teens. Initially, the primary dental concerns for children and their dental health are to control plaque accumulations and minimize sugar exposure to reduce the incidence of decay. In my experience, cavities are the greatest risk to newly erupted permanent teeth, followed by traumatic dental emergencies in young patients. However, as children near their teen years, a change occurs in the bacteria in their mouths that increases not only their cavity risk but also impacts their gum health.
Between the years of 10 and 13 years old, approximately 16 teeth will have been shed and erupted from both the top and bottom arch of the oral cavity. Primary molars and cuspids will be pushed out and replaced, while permanent second molars (12-year-old molars) will erupt in the deepest area of the mouth, just in front of the future wisdom teeth. When all is told, 28 adult teeth will be in place. Tooth buds for the permanent teeth can be observed as early as 20 weeks in utero, but calcification of the adult teeth starts at birth and continues until approximately 8 -10 years of age (aapd.org).
While the first adult teeth erupt around six years of age, the heaviest transition, or tooth loss and tooth eruption occurs, on average, between 10 and 12 years old. This is followed by a quieter period until the wisdom teeth mature. Permanent incisors can erupt with three “bumps” on their edges. These give the appearance of chipped or rough teeth but are completely normal. These bumps are called mamelons and become flat with wear. Permanent teeth are also yellower than baby teeth. This is due to the darker layer below the enamel (dentin) being larger in size than in baby teeth, showing through the enamel layer.
In many cases, the wisdom teeth or 3rd molars are removed. Evaluations can begin as early as 16 years old. Many parents with young teens have commented that it seems wisdom teeth are removed more often today than when they were younger. Due to advances in dentistry, there is more often truth in that observation. The desire to have straight teeth, along with its proven oral health benefits, and the increased availability to orthodontics has caused heightened attention to the position and location of wisdom teeth.
After completing orthodontic treatment, there is an increased concern for the dentist and patient alike to not only achieve a beautiful smile but maintain it by removing the wisdom teeth that may cause movement and crowding in the already straightened teeth. Also, it is not unusual for third molars to be lying horizontally in the jaw, posing not only a crowding threat but also a concern for the development of a cyst around the buried tooth. Sideways molars can also be found lodged into the tooth in front causing erosion of the crown or root surface. Many patients do not have room for the full eruption of their wisdom teeth which leads to a partial covering of the biting surface which traps food or poses a chewing problem. These are just a few of the considerations given to making the decision to remove third molars. Individual evaluations are made for each patient.
“Girls Chase Boys Chase Girls” (Ingrid Michaelson)
The lack of focus on homecare habits begins to take its toll on the gum health during the tween and teen years. My observations have been that young children with high plaque levels may have a high cavity rate with limited impact on their gum health; still relatively healthy in appearance and pink in color. However, as children enter their tweens and teens, not only do they pay less attention to detail but may become somewhat lazy and complacent. As hormonal changes begin to occur, so do changes in their gum health, often resulting in red, puffy gums with light bleeding, or in other words gingivitis. Studies show that with the onset of puberty and hormonal changes, changes occur in the oral bacteria of our mouths, with an increase in number and strength of the types of bacteria influencing periodontal health. In other words, along with greasy hair, pimples, body odor and unsightly tufts of hair growth so come gum disease and bad breath! I’m feeling more sympathetic towards these kids! Also keep in mind that hormonal changes begin before notable visual changes which means bacterial changes could be occurring as young as ten to eleven years old.
Because of these changes, home care habits, including two minutes of brushing every morning and night, daily flossing and fluoride rinses help to stave off gingivitis. Establishing good oral habits at a young age will allow the greater success of a healthier mouth in the teen years.
I’ve never found a better motivator for improved home care by a teen than reminding them about the cute boys or girls at school. These tactics may seem a bit underhanded, and won’t have the same impact coming from a parent, and in fact, may backfire so don’t try this at home! But I will stop at nothing to help a hormonally raging teen by reminding them that they want to have clean, bright smiles with fresh breath to make the best impression with a teacher, a lab partner, or that cute special someone they’ve noticed in the hall. Your welcome!
Insult to Injury
Further complicating the goal of a plaque free adolescent existence is orthodontic treatment. Orthodontics has been a God send in improving self-esteem and correcting compromised oral conditions for decades. Studies show that crowding and malposition teeth greatly impacts one’s confidence and increases self-consciousness.
Advancements in orthodontics allow for less invasive treatment options, including shorter time in brackets and Invisalign, which takes away bracketing altogether. However, plaque removal and good home care habits must take top priority while wearing braces. Gingivitis, white spots, and cavities become a greater risk if the bacteria are not removed on a daily basis. Small brushes and rubber tips are available to help remove food and plaque from around the tight spots created by the presence of brackets and wires. The use of fluoride rinses is also encouraged to help strengthen the teeth during the treatment.
Developing good home care habits early on is critical for the longevity of our teeth. Preventative treatments like fluoride use and the placement of sealants give the teeth a fighting chance to stay cavity free and strong for a lifetime. Helping tweens and teens develop good hygiene habits and eating habits now will help minimize visits to the dentist in the future and reduce costs for parents. Establishing a regular home care routine now will help to propel these kids through high school and on to college with success!
by Julia Guerra, RDH, BA