Singapore’s Ministry of Health recommends the first dental check-up to be done by the first birthday. Such early check-ups allow the dentist to educate parents on diet and brushing techniques so that diseases like tooth decay and gum disease can be prevented. Regular check-ups throughout childhood and adolescence will allow our dentist to also check on the development of the teeth and jaws and identify any bad habits.

For example, thumb-sucking is a habit that can disturb the development of teeth into proper alignment. Persistently and forcefully sucking on a thumb, finger or a soother can lead to a gap between the upper and lower front teeth.

This 4-year-old child already shows an “open bite” caused by sucking a thumb. There is a gap between the upper and lower front teeth even when the child is biting down fully. This not only affects the alignment of the teeth but, in severe cases, may also affect speech.

Our doctor can advise you, and your child, on how to break bad habits.

When is the best time to start braces?

There is no one best time to start treatment with braces. The decision to start treatment is based on many factors like the nature of the problem, the stage of physical development and the level of maturity of the child.

The American Association of Orthodontists recommends that all children get an assessment no later than age 7 years. Such assessments need to be repeated as the child grows.

Some Common Development Problems

1. Cross-bite
When the upper teeth are positioned behind the lower teeth, it is described as a “cross bite”.

In this child, the upper tooth on the right is overlapping the lower tooth. This is the normal relationship.

However, the upper incisor on the left side is growing on the inside of the lower tooth. This is a cross-bite.

If detected early, this sort of cross-bite can be corrected with a relatively simple, removable, plastic appliance.

2. Severe crowding
Some problems like severe crowding (or lack of space for all the teeth), if detected early, can be treated by serial extraction from as early as seven years of age.

3. Protruding Teeth

Teeth that protrude out are more likely to be injured during falls or sports.

Early treatment of protruding teeth may help to prevent damage to the teeth.

4. Disproportionate Jaws
When the upper and lower jaws do not grow in harmony, they are disproportionate to the rest of the face. This can be treated effectively if it is detected before puberty. Puberty is a time of rapid growth. The onset of puberty can be quite variable. It may be as early as 9 years for girls or 11 years for boys. Timing treatment with the growth spurt will help to modify the growth of the jaws.

Conclusions

Depending on the nature of the mal-alignment, treatment may be done in phases. The first phase may be to guide growth of the jaws. The second phase may be with conventional braces to straighten crooked teeth. Phase two may be delayed till all the baby teeth have been replaced by permanent teeth.

It is difficult for the layperson to know which cases are to be treated at which time, so it is best to come for regular checkups to assess growth and development and seek advice on the timing of treatment.

Make an appointment to learn more about starting treatment with braces and general dental care.

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When is the Best Time to Start Braces?

There is no best time to start treatment with braces. The decision to start treatment is based on many factors like the nature of the problem, the stage of growth and the level of co-operation or motivation to get treatment.

It is good practice to take your child for regular checkups and ask if a problem of crooked teeth is anticipated. A child can be examined at the ages of 7 years, 9 years and 12 years to check for problems related to the alignment of teeth and jaws.

Some problems like severe crowding (or lack of space for all the teeth), if detected early, can be treated by serial extraction from as early as seven years of age. In other cases, treatment may need to be done when all the baby teeth have been replaced by permanent teeth.

Other problems, like disproportionate jaws, can be treated effectively if it is detected before puberty.

The timing of treatment depends on the nature of the problem
	Irregular teeth can sometimes be due to missing or buried teeth. This needs to be identified early for optimum management.
	When a child has difficulty putting the lips together, early treatment – possibly even as young as 8 years — may help to promote growth to overcome this problem.
	It is never too late to treat “crowded teeth” like this. It can be treated even if you are middle-aged!

It is difficult for the layperson to know which cases are to be treated at which time, so it is best to come for regular checkups and so that treatment can be well-timed.

Make an appointment to learn more about starting treatment with braces and general dental care.

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Babies even less than one year, can develop tooth decay. This may not be noticed as the initial stages of tooth decay can be as subtle as a chalky white streak along the neck of the tooth. Even if it is noticed, many parents tend to ignore it as they think that baby teeth are “going to fall off anyway”. Or they may think that their child is simply too young to get treatment. This kind of thinking stops them from taking their child at an early age to the dentist so that initial problems can be identified and preventive measures taken.

The Ministry of Health recommends taking children for their first dental visit by the first birthday. At this first visit, the parents can get educated on the proper methods of cleaning their child’s teeth.

During the first visit, parents can be advised on diet, habits like thumb-sucking and importantly, the correct way to clean their child’s teeth. Oral hygiene is one of the most important ways of preventing tooth decay.

Tooth decay occurs when the bacteria on teeth produce acid from food sugars left in the mouth. The acid attacks the tooth surface causing cavities or holes in the teeth.

There are many factors contributing to tooth decay e.g. the strength of the structure of the tooth, the amount and nature of bacteria in the mouth, the frequency and kinds of foods eaten, the ability of saliva to neutralise acids and so on.

One common cause of tooth decay in very young children is allowing the child to fall asleep with a milk bottle. This habit can result in rapid spread of tooth decay because the milk residue left in the mouth while the baby sleeps is a ready source of sugars for the bacteria in the mouth. As explained above, the bacteria acting on the sugars produce acids which attack the tooth. Hence is it is necessary to change the habit of putting baby to sleep with milk.

Remember, the best time to take the child to the dentist is before there is a problem.

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Care for baby teeth should begin as soon as they appear. This includes cleaning the teeth after meals. Babies should not be left to fall asleep with a bottle of milk or juice as this can lead to rampant decay called ” baby-bottle decay “.

Singapore’s Ministry of Health recommends that the first dental check-up for your child should be done by the first birthday. Your toddler can be brought to our dentist for a simple check-up to make sure the teeth are growing well.

Dental care is best introduced when there is no pain. The first dental visit should be like a visit to a new friend — the dentist.

Importantly, this first visit is for parents to learn the right techniques of taking care of your child’s first teeth. Take the opportunity to clear any doubts you have with the dentist.

Pre-school children can develop tooth decay. It is important to keep baby teeth healthy until the permanent teeth have grown which can be as late as 12 or 13 years.

Early stages of tooth decay do not cause pain. So it is necessary to have regular check-ups to detect cavities caused by decay and get the cavities (holes) repaired — before they cause pain.

If your child is particularly prone to decay, Smile Makers can:

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Oral hygiene

• Brush 2 times a day (morning and night).
• Floss once a day.
• Use an age-appropriate toothpaste with fluoride.
• Use a pea-sized amount of toothpaste until your child is able to spit out the toothpaste independently.
• Young children often do not have the co-ordination and discipline to brush/ floss by themselves. You, as the parent or guardian, need to help them with this task until they can clean their teeth independently.

Diet

• Keep to a well-balanced diet
• Constant snacking increases the chance of tooth decay.
• Foods high in sugar e.g. Sweets, chocolate, ice cream, soda drinks and sweet biscuits should be limited to special treats.
• A child should be weaned off sucking on a milk bottle to go to sleep by the first birthday or sooner as this could lead to tooth decay.

Habits that may lead to crooked teeth

• Sucking a pacifier: Avoid using a pacifier. If your child uses a pacifier, break the habit as early as 3 months old.
• Thumb sucking: Discourage the child from thumb sucking by reminding the child vocally and by positive re-enforcement.

Prevention of Problems

• Regular visits to the dentist: The Ministry of Health recommends that children see a dentist by their first birthday for early detection. Apart from allowing a child to get accustomed to the dental setting, it is an opportunity for care-givers to get advice on home dental care.
• Fluoride treatment by the dentist may be recommended to children who are prone to tooth decay
• Fissure sealants: They may be recommended for children with irregular shaped teeth or teeth with deep pits and grooves. After placement of sealants, the grooves are shallower – making it easier to clean your child’s teeth.

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It is best to complete any outstanding dental work before pregnancy. Indeed, if you are contemplating having a baby, it is good practice to schedule a visit with us so that any little problems like cavities, broken fillings or undetected infections can be taken care of – and your mouth can stay trouble-free during your pregnancy.

During pregnancy, a routine dental check-up and cleaning are recommended to make sure that a high level of cleanliness is maintained. This is especially so during the 4th to 8th months when bleeding from the gums is most commonly seen.

Recent studies have shown that uncontrolled gum disease, or periodontitis, is associated with pre-term births. Considering all the complications of pre-term (premature) births, it makes sense to ensure that your mouth is clean and healthy during your pregnancy. So, don’t stay away from your dental check-ups! Use your check-up to assure yourself that your mouth is healthy and you are practising the right hygiene techniques.

If morning sickness keeps you from brushing with toothpaste, just brush with a wet toothbrush or use bland, non-foaming toothpaste. Frequent vomiting may cause wear or erosion of the dental enamel, which could lead to sensitivity at a later stage. Talk to us to see how this sensitivity can be managed.

If emergency dental work needs to be done due to pain, infection or injury, don’t delay getting it done. After all, if it improves your health, it’s probably good for your baby as well.

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This is a disease that attacks the gums and bone that hold your teeth. It is a slowly progressing disease and is often overlooked because in the early stages, there is no pain or discomfort.

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make sure that your own mouth is healthy.

New DNA coding techniques have allowed medical researchers to trace the path of infection from one person to another. One of the most common oral infections, gum disease (also known as periodontal disease), was found to be transmitted by saliva contact between family members.

Studies from Brazil to Japan have shown that the bacterial flora (number and kind of bacteria) in a child’s mouth is very similar to the bacterial flora of their mothers.

Transmission of bacteria, and thereby disease, can occur through saliva contact in many ways e.g. 

• Kissing
• Coughing
• Sneezing
• Sharing food
• Sharing a cup, glass, straw, spoon and other utensils
• Blowing on food to cool it

All this can give periodontal disease to children.

In a 1997 study, it was found that one type of periodontal infection was found 26 times more often in children younger than three years – if the mother tested positive for the same infection.

Is periodontal disease serious? It is well-recognised that periodontal disease is the most common cause of tooth loss in adults. Treatment of advanced periodontal disease and its consequences e.g. replacement of lost teeth, can be both complex and expensive.

The good news is that periodontal disease and tooth decay is easily preventable. Here is what you can do:

• Make sure that you practise good oral hygiene – learn the correct techniques of brushing and flossing and do it everyday. Over my 30 years of dental practice, I have observed that the parents who have good attitudes to dental care and are conscientious about hygiene almost invariably have kids with good dental health.
• Every care-giver – this includes grandparents and maids – should have regular dental check-ups to make sure their teeth are thoroughly cleaned through scaling and polishing. Any diseased teeth must be treated. This greatly reduces the amount of harmful bacteria in the mouth.
• Be alert to personal hygiene habits like sharing of towels and tooth brushing.
• Learn the appropriate techniques for cleaning your child’s teeth as soon as the first baby teeth grow.
• And of course, take your child and yourself for regular check-ups at the dentist – don’t wait for pain. Ask the dentist whether you are cleaning your own teeth well and find out the best way to clean your children’s teeth too.

As parents, your attitudes to good health are bound to rub off on your child.

Find out more about gum disease on our website.

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