Dr Nita Pai BDS (Adel), MDS (Adel)



A paediatric dentist has had two or more years of speciality training following dental school and limits his or her practice to treating children only. A paediatric dentist is dedicated to providing dental care for children from birth through to 18 years of age.

The Australasian Academy of Paediatric dentistry recommends that children have their first dental check up at around 12 months of age. So that an assessment can be made of your child’s dental health. This visit also gives the paediatric dentist an opportunity to discuss all aspects of preventive dentistry including importance of good oral hygiene, diet and correct brushing/ flossing techniques.

Baby teeth are important for a number of reasons including – chewing, appearance and speaking. They also hold space for the permanent teeth and guide them into the correct position.

Although the front teeth fall out at approximately 6-7 years of age the back teeth (canine to molars) do not fall out until 11-13 years of age. If the baby teeth are lost ahead of their natural time, space for the permanent teeth may be lost. This in turn can cause crowding of the adult teeth. Healthy baby teeth set the stage for healthy permanent teeth.

In some instances however, it may not be possible to fix the baby teeth and extraction may be the only option available. Retaining a severely broken down baby tooth may cause pain, infection and risk of damage to the developing adult tooth. Following extraction of the baby tooth it may be necessary to construct a space maintainer to hold the gap open.

The Australasian Academy of Paediatric Dentistry recommends a dental check up at least twice a year. Some children however, might require more frequent visits because of special risk factors for tooth decay, unusual growth patterns and problems with oral hygiene.

A child’s history of tooth decay is the main factor in deciding how often X-rays should be taken. X-rays detect cavities between the teeth, which cannot be seen by just looking in the mouth. If a child has had a lot of fillings, the dentist may recommend X-rays every six months.

There is very little risk in dental X-rays. Lead aprons, high-speed films and new X-ray machines ensure safety and minimise amount of radiation exposure.

Sydney water is fluoridated. Your child should be encouraged to drink tap water as the fluoride in the tap water prevents decay. Research shows that fluoridated tap water reduces children’s decay by up to 50%.

Children under the age of six often tend to swallow toothpaste. Junior toothpaste with less fluoride (400ppm) is therefore recommended in children under six. This has less fluoride than adult toothpaste (1000ppm). Place only a smear of toothpaste on the toothbrush and keep the toothpaste safely out of reach. Parents should supervise brushing of teeth.

Some children as do some adults seem to do a more effective job cleaning their teeth with the aid of an electric toothbrush. It is a matter of personal preference. The novelty of using an electric toothbrush may also motivate your child to brush their teeth better. Tooth brushing has to be done twice a day for two minutes.

0-2 Years

The first tooth usually erupts at about six months of age. Most often it is a lower front tooth. During the next 18-24 months the rest of the teeth appear, although not in an orderly sequence from front to back. All 20 primary teeth should be present by about 2-3 years of age.

Biting on teething rings has been found helpful for some babies. Teething medications such as “Bonjela” rubbed on the gum can also relieve discomfort.

As soon as they appear. The gums and tongue also need to be brushed regularly.

A clean soft gauze towel or a clean dry wash cloth can be used to remove plaque bacteria that can lead to decay. Once a child has back teeth, a small head soft toothbrush specially designed for babies can be used to clean the grooves on the chewing surfaces of the back teeth (molars). This should be done twice a day.

Around one year of age is a good time to wean the baby from the bottle.

Sucking is a natural instinct of infants. If it helps to comfort your child then use a pacifier. If however, a pacifier is used for long periods when your child is a toddler, they may develop an open bite (where the front teeth do not meet). Once the dummy sucking habit ceases this can correct it self. Do not coat the dummy with honey, jam, or anything sweet as this can lead to tooth decay.

2-5 Years

Yes, it should be treated as soon as possible to avoid pain and infection.

Approximately 1 in 10 children get tooth decay before two years of age (Early Childhood Caries).

The most common cause is placing the baby in bed with sugary liquids like milk (including breast milk), formula or other sweetened liquids. Some infants have a high level of decay forming bacteria and are at an increased risk of developing decay if they are given sugary liquids. The sugar content of the pooled milk changes to acid, which softens teeth thereby causing tooth decay. Also, during sleep the flow of saliva is reduced and the natural self-cleansing action of the mouth is diminished.

Feeding child with a milk bottle/ sweetened liquid/ breast-feeding at frequent intervals can also be the cause of decay. Typically, children with Early Childhood Caries have the upper front teeth affected.

Decay-producing bacteria are transferred to the infant usually from the infant’s primary care giver. There is a high correlation between the mother and child’s bacterial count. So, mums with healthy gums and no active decay have children with healthy gums and no cavities.

Very likely-unless the cause of the decay has been determined and proper preventive steps have been introduced.

Avoid nursing the child to sleep or putting anything other than water in the bottle at nap time/ night time. Take your child to the paediatric dentist at around the age of one for a dental check up and then schedule visits every six months for their ongoing preventive care. The paediatric dentist will give you advice on oral hygiene, diet, fluoride and the correct way of brushing and flossing your child’s teeth.

Thumb sucking generally only becomes a problem if the child continues the habit for a very long period of time. Most children give up the habit spontaneously by about age three. If the thumb sucking habit continues when the adult teeth arrive, a mouth appliance may be recommended.

6-12 Years

The arrival of the first adult teeth is at approximately six years of age. The first permanent molars (six year old molars) and the lower permanent central incisors begin to erupt at approximately six years of age. With the exception of the wisdom teeth, the last of the permanent molars come through at around 12-13 years of age.

Having a gap between the upper front teeth as they come through is quite common. The space usually closes when the upper canine teeth erupt at approximately 10-12 years of age.

Two rows of teeth are usually due to the permanent incisor erupting behind the baby tooth before the baby tooth has fallen out. Usually the baby tooth falls out within a few weeks of eruption of the permanent tooth. However, if the baby tooth is still retained and firm the paediatric dentist should assess it.

Yes, narrow microscopic pits and fissures are naturally present on the chewing surfaces of the molar tooth. A toothbrush bristle is too big to clean out all the food and plaque retained in the narrow grooves. Fissure sealant is a plastic material that flows within the pits and fissures to form a plug, thereby preventing food and plaque from embedding within the pits and fissures. This in turn prevents tooth decay. Fissure sealants should be routinely applied to the first permanent molars (six year old molars) and the second permanent molars.

Use of mouth guard whilst playing contact sports helps lessen injuries to the mouth and the teeth. They are recommended for sport such as football, soccer, netball, hockey, skateboarding and basketball. Commercial mouth guards can be purchased off the shelf or a custom made mouth guard can be made by dentists. A custom made mouth guard has a superior fit and is more comfortable to use and also makes it easier for the child to talk whist wearing.

Dr. Nita Pai Paediatric Dentist - FAQs