Children aged 4 years and older

Childrens oral health needs vary greatly as they grow and develop. This guide has been written to walk you through each stage of their journey from three years old and above.

Baby teeth

By the age of three, most children will have a full set of 20 baby teeth. More information about baby teeth can found in babies and toddler oral health.

Baby teeth eventually fall out to make way for the permanent adult teeth but that does not mean cleaning them is not important. If baby teeth are lost or removed much earlier than intended, this may lead to future problems such as crowding of the teeth as the permanent teeth push through.

Losing baby teeth

As children get older, the baby teeth become loose and fall out ready for the new adult teeth to push through into the mouth. Baby teeth will start to become loose and wiggly from around the age of six. This often starts with the lower front teeth. It is important to remember that all children develop in different time frames and some may lose their first tooth earlier than 6 years and others may be a little late. This is absolutely normal.

Once a tooth becomes loose, it is important that this tooth is not left loose for a long period of time as it may cause the child to stay away from this tooth when brushing.

Permanent teeth eruption

Permanent teeth, often called adult teeth, start to develop in the jaw from birth and continue to grow after the child is born. From six years of age, the four first permanent molar teeth will appear in the mouth behind the baby teeth already present in the mouth. As your child continues to get older, more adult teeth will push out the baby teeth creating space for the adult teeth to move into the mouth.

The timing of when permanent teeth erupt differs from child to child, however, the rough timeline of when the adult teeth appear in the mouth is below.

Around the age of 21, most people have a full set of 32 permanent teeth, including 16 in the upper jaw and 16 in the lower jaw. It is common for wisdom teeth to not develop or be able to push through to fit in the mouth. Therefore, many people will only have 28 teeth in their mouth.

Brushing and flossing

Teeth should be brushed twice daily, ideally in the morning and then at night as the last thing that is done before bed with no foods or drinks after. Brushing should go for 2 minutes each time. This can be made more fun by playing a song or using a phone app that has a 2-minute timer to ensure the correct length of brushing and provides positive reinforcement.

Look to use a toothbrush with a small head and soft bristles. Powered toothbrushes can be introduced from 3 years of age. Some powered toothbrushes come with an in-built 2-minute timer to make brushing for the recommended amount of time easy.

Until 6 years of age, children should be using a low-fluoride toothpaste which is marketed in stores as children toothpaste. There is less fluoride in these kinds of toothpaste compared to the toothpastes created and recommended for children older than 6 years of age and adults.

Flossing is recommended for children once they have at least two teeth touching side-by-side. This cleans the surfaces in between the teeth that the toothbrush bristles cannot reach. Your dentist can show you and your children techniques and items that can make this an easier process. Some children will have naturally occurring spaces between their primary teeth which means flossing may not be necessary between all teeth. Flossettes can be useful for parents cleaning between their child's teeth or for children to use themselves.

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Children should be assisted by their parents when brushing and flossing until around the age of 8 or 9. At this age, their physical dexterity develops further allowing for better control of their toothbrush or floss. A good reference for this time is when your child starts using a pen at school, instead of a pencil.

Visiting the dentist

The Australian Dental Association recommends children have their first dental visit when their first teeth appear in the mouth, or by the age of one, whichever comes first. Therefore, by 3 years of age, your child should have had their first dental visit and hopefully are starting to understand what it takes to keep their teeth healthy.

Children should see their dentist regularly and understand that visiting the dentist is an important part of growing up. Visiting the dentist as a child is not only important to ensure the teeth are being cleaned well and that no tooth decay is present but to also monitor development such as whether the teeth are appearing in the mouth at the correct time.

Young children may be recommended to attend every 6 months as they continue to grow, and their teeth appear in the mouth. Once children are older and have routinely good oral hygiene, their dentist may suggest moving to 12 monthly appointments.

If you receive a Government benefit, such as Family Tax Benefit A payments, your child may be eligible for the Child Dental Benefits Schedule. Eligible children up to 18 years are eligible for $1,013 of general dental treatment over a two-year period.

Eating and drinking habits

As well as maintaining good oral hygiene through daily brushing and flossing, it is important to limit your child's sugary food and drink intake. Added sugar is the largest contributor in the development of tooth decay. Beware though, it is not just well-known sugary foods such as lollies, cakes and biscuits but foods such as breakfast cereal, muesli bars and flavoured yoghurts can include a lot of added sugar.

When it comes to drinks, water and milk are the best options for healthy teeth. Soft drink, cordial, sports drinks, energy drinks and fruit juice can be high in sugar which can increase your child's risk of developing tooth decay. Sugar-free options of these drinks are also not recommended as a replacement as they can still affect the teeth by wearing away the tooth structure (known as tooth erosion). Fresh fruit accompanied by water makes a great tooth-friendly snack to replace fruit juice.

Tooth-friendly snacks include carrot and celery sticks, hard cheese and fresh fruit. Making your child's meals and snacks from scratch can help to limit the amount of added sugar and allows for the use of fresh ingredients.

If you are providing a sweet treat, try to do so as part of main mealtimes and limit ongoing snacking between meals. These eating behaviours can increase the risk of tooth decay developing.

If you are struggling for time, have fussy eaters or looking for healthier options, this podcast featuring Paediatric Dietician Dr Kyla Smith gives a great insight into how to get your kids to try anything.

Snoring and tooth grinding

If you notice that your child grinds their teeth or snores whilst sleeping, it is recommended that they have an examination with a dentist. These habits may be a sign of issues that need to be investigated further.

Dental trauma

A knock to the mouth can cause a tooth to come out of the mouth completely. If this is a baby tooth, it should not be replaced in the mouth. Only adult teeth should be placed back in the mouth if knocked out.

If you are sure the tooth is a permanent adult tooth, replant the tooth in the mouth in the space that it came from. If you are not confident in replanting the tooth or are unsure whether it is a baby or adult tooth, place the tooth in saliva or milk and transport it to the dentist as soon as possible. Your dentist will review the knocked-out tooth as well as check that there has been no other damage to the surrounding bone, the lips and cheeks or any other teeth.

For more information on dealing with a knocked-out tooth, see dental trauma.

Sports mouthguards

Mouthguards can help to protect teeth and keep dental trauma to a minimum. Mouthguards are particularly important for contact sports, even for primary school-aged children. Avoid the do-it-yourself 'boil and fit' type mouthguards as they are unlikely to provide effective protection and are often uncomfortable, and can make it hard to breathe. See your child's dentist for a professionally fitted custom mouthguard. Professionally fitted mouthguards are comfortable, allow speech and do not restrict breathing.

It is important that your child wears their mouthguard at training as well as games, as this can help to improve comfort, and safety as accidents also happen at training. You should aim to update the mouthguard every 12 months to ensure it still fits and is working to the best of its ability. Store the mouthguard in a hard case away from the heat so that it maintains its shape.