What your mouth needs at every stage

1. 01

   First tooth to age 3

   Toddlers: habits before treatment

   The first visit is about making the room ordinary. We count teeth, look at how the jaws are growing and show a parent how to brush a mouth that does not want to be brushed.

   In the chair

   • A knee-to-knee exam with the child lying back on the parent, not on us
   • A wipe or a polish only if the child is happy with it
   • Fluoride varnish applied in about twenty seconds when it is indicated

   At home

   • Brush twice a day with a smear of fluoride toothpaste the size of a grain of rice
   • Wean off the bottle at bedtime; milk pooling overnight is the single biggest risk at this age
   • Lift the lip once a week and look for white or brown lines at the gum margin

   Bring it in early if

   • White chalky patches near the gum line
   • A tooth that has gone grey after a fall
   • Teeth that do not appear by about 12 months

   Check every 6 months, from the first tooth or the first birthday

2. 02

   Ages 4 to 12

   Children: the adult teeth arrive

   The first permanent molars land around age six, at the back, where nobody is looking. They arrive with deep grooves and a child who still cannot brush thoroughly without help.

   In the chair

   • Sealants on the biting surfaces of permanent molars as soon as they are fully through
   • Bitewing x-rays only when the contacts have closed and we cannot see between the teeth
   • Brushing checked with disclosing dye so the child sees what is being missed

   At home

   • A parent finishes the brushing until roughly age eight, when handwriting is neat enough to do it alone
   • A pea-sized amount of fluoride toothpaste, spat out, not rinsed away
   • Start cleaning between the back teeth on the day they touch each other

   Bring it in early if

   • Adult teeth coming through behind the baby ones
   • A permanent front tooth knocked in a fall
   • Complaints about a back tooth catching food

   Check every 6 months, x-rays roughly every 12 to 24 months

3. 03

   Teens 13 to 19

   Teenagers: the decade of risk and independence

   Supervision stops, energy drinks start and the mouth is still finishing. This is the stage where a good result at twelve quietly turns into a problem at twenty.

   In the chair

   • Erosion mapped on the inner surfaces, where acidic drinks show up first
   • Wisdom teeth tracked on a panoramic image in the later teens
   • A frank conversation about vaping, smoking and gum health, without the lecture

   At home

   • Acidic and energy drinks kept to mealtimes, through a straw, and never sipped over an hour
   • A night appliance if grinding is wearing the front teeth flat
   • Aligners are the practical fix for crowding when brushing between teeth has become impossible

   Bring it in early if

   • Bleeding gums that are shrugged off as normal
   • Front teeth that look shorter or more see-through
   • Whitening bought online before an exam

   Check every 6 months, more often during aligner treatment

4. 04

   Adults 20 to 64

   Adults: keep what you have, repair what you must

   Most adult dentistry is maintenance of past dentistry. Old fillings age, gums recede, and a bite that has been grinding for twenty years starts to show it.

   In the chair

   • Six-point gum charting at least once a year, because bone loss is silent
   • Existing crowns and fillings checked at the margins, where new decay starts
   • Oral cancer screening at every exam, including the tongue and the floor of the mouth

   At home

   • Clean between the teeth every day; the brush reaches three of the five surfaces
   • Treat a cracked cusp early, before it becomes a root canal
   • Tell us about pregnancy, diabetes, new medication or a dry mouth: each one changes the plan

   Bring it in early if

   • Gums that bleed on the same tooth every time
   • A tooth that twinges on releasing a bite
   • A sore spot that has not healed in two weeks

   Check every 6 months, or every 3 to 4 months if you have treated gum disease

5. 05

   65 and older

   Older adults: dry mouth, roots and dexterity

   Teeth are lasting longer than they used to, which is a good problem. The risks shift to exposed root surfaces, dry mouth from medication, and hands that find flossing harder than they did.

   In the chair

   • Root caries checked carefully, since exposed root surfaces decay faster than enamel
   • Denture and partial fit reviewed yearly, along with the tissue underneath
   • Medication list reviewed at every visit for anything that dries the mouth

   At home

   • High-fluoride toothpaste where we have prescribed it, for root surfaces
   • Interdental brushes or a powered brush with a wide handle when dexterity is the limit
   • Sip water, not sweetened drinks, for a dry mouth; sugar-free lozenges help at night

   Bring it in early if

   • A partial denture that has started to rock
   • Notching or sensitivity at the gum line
   • Difficulty chewing that has quietly changed the diet

   Check every 6 months, or every 3 to 4 months with dry mouth or gum disease

General information, not dental advice. Recall intervals and x-ray frequency are set for the individual after an examination and a risk assessment, so yours may differ from the rhythms above.