A Child's Chronological Oral Development
Although dental development of individual children happens at different rates, there are several common patterns that occur. The following describes those patterns and offers some guidelines for care. Regular dental visits, including comprehensive exams and cleanings should be scheduled every 6 months so that typical eruption patterns, hygiene instruction and anticipatory guidance can be provided.
Three to four months of age:
The first screening exam can be scheduled at this time as an infant's teeth should begin to break through the gums. Symptoms such as fussiness and drooling can be an indication that the gums may be sore. Parents can gently brush the baby's gums with an infant toothbrush at this stage to keep the mouth clean.
Eight to twelve months of age:
The lower incisors and other front teeth begin to appear at this time. A baby toothbrush (soft-bristled) should be used without toothpaste to clean the teeth and gums after all feedings including those at night. The first (or second) well-child dental exam should be scheduled. The pediatric dentist will examine and discuss 
hygiene and eruption patterns, as well as how to handle common dental emergencies. Additionally, the child's teeth will be cleaned and fluoride varnish is applied.
Twelve to eighteen months of age:
Incisors and canines may still be erupting. Caregivers should be aware of “baby bottle decay” during this time and be sure the teeth are brushed after all feedings, including those at night. Tooth brushing is important and parents and caregivers should brush the baby's teeth after each meal or snack. Positive reinforcement should be provided and the process should become a vital part of the child's daily routine. Encouraging the use of a regular cup instead of a sippy cup is very important at this stage. Sippy cups are discouraged as they tend to promote an immature swallow pattern causing pressure and malocclusion on the front teeth. Additionally, using sippy cups with milk, fruit juice, or sugared drinks throughout the day is harmful to baby teeth as tooth brushing does not always occur after exposure. Aggressive sucking on a pacifier, thumb, or fingers can cause malformations of the roof of the mouth and an open bite. The pediatric dentist can offer useful tips for weaning children from the use of pacifiers and thumb sucking.
Eighteen months to three year of age:
The child should have his canines and first and second molars. Although they will need help, children can begin to learn how to brush their own teeth and should be encouraged to do so after eating. Children over 2 years of age can use a smear of toothpaste on the toothbrush and caregivers should encourage spitting out used toothpaste. Caregivers should make sure all teeth are brushed well by “finishing” the process.
Three to five years of age:
The child should have all 20 of their primary teeth. Children should continue to receive assistance brushing and flossing. Flossing is particularly important if there is no space between teeth. Decay frequently starts between the teeth where they touch. For this reason, pediatric dentists obtain X-rays of the back teeth to check for cavities. Without these radiographs, it is extremely difficult (if not impossible) to diagnose interproximal decay. If a child chews gum, sugarless is the gum of choice. Preferably, gum sweetened with Xylitol should be offered. This sweetener cannot be digested by harmful oral bacteria, and it also helps to balance the pH in the mouth. It, therefore, does not promote decay as other sweeteners do.
Five years and older:
Children begin to lose their baby teeth during this time. Naturally, the permanent teeth begin to erupt as well. As teeth near exfoliation and as six-year molars erupt, some discomfort can be expected. These areas tend to harbor harmful bacteria that can cause decay as well as make the gums tender. Children should be encouraged to brush those teeth even though it may seem uncomfortable. Loose teeth should be wiggled frequently to aid in root resorption and speed tooth loss. Dental sealants are recommended on all fully erupted six-year molars as they tend to have deep grooves and fissures that are not easily reached by toothbrush bristles. Sealants have been found to be highly effective in preventing decay on the biting surface of teeth. Until a child has mastered cursive writing, they cannot be expected to have fully mastered the fine motor skills necessary for good tooth brushing. Until that time, parents/caregivers should brush the teeth, at a minimum, once per day, with nighttime considered the best time for this assistance. A pea-sized amount of toothpaste is adequate for brushing at this, and all future stages. It is also encouraged that children receive an orthodontic evaluation by Dr. Fales near the age of 7. Dr. Fales will usually obtain a full mouth or panoramic X-ray of the child's mouth at this stage. The purposes of this radiograph are to assess orthodontic status and to evaluate the position (or existence) of teeth that have not yet erupted.
Late teens/early twenties:
Unerupted and impacted wisdom teeth should be evaluated as they are often extracted during these years. Brushing after all meals and snacks and flossing remain very important even though it may seem difficult for teenagers to remember with their busy schedules. Continued 6 month check-ups will assist in continuing a lifetime of good oral healthcare.
Specifics About Prevention and Treatment
The enamel of baby teeth is not as strong as on adult teeth, therefore young children need extra care to avoid decay. Oral care should begin even before teeth erupt to ensure a pattern of good dental habits, with flossing introduced as soon as possible. As teeth erupt, avoiding extended exposure to sugary liquids and high carbohydrate foods is highly recommended. Bi-annual regular well-child visits will help to keep decay in check.
Many parents wonder why baby teeth need to be treated if they are ultimately going to fall out. Decay-causing bacteria sticks to teeth. Many of these teeth are expected to be retained until the child is 10-11 years of age. Untreated decay will grow and the teeth will eventually require more complex treatment or extraction. Prematurely lost baby teeth can lead to problems with the eruption of permanent teeth and ultimately the normal development of the jaws. Children with missing or decayed teeth may not be able to eat properly and pain or discomfort while chewing may affect a child's nutritional and caloric intake. Facial appearance, naturally, will be affected by tooth loss and children may be embarrassed by unsightly teeth during their sensitive years.