Children's Dentistry

The first visit and check-ups

• The first visit. The first teeth usually come through at around 6 months, but it is also normal for them to come earlier or later. The American Academy of Pediatric Dentistry also advises the first visit before 12 months of age⁴; it gives this recommendation no evidence grade.
• The check-up interval. National guidance in England (NICE) sets the shortest interval between check-ups at 3 months and, for under-18s, the longest interval at 12 months⁵. The interval is set with the dentist, according to your child's level of disease and risk. There is no "every 6 months" rule for everyone.

Who this page is for

• Parents whose baby's first tooth has come through or is about to
• Parents who have noticed a mark, decay, pain or a knock on their child's teeth
• Parents whose child has been offered fissure sealants, fluoride or a filling
• Parents with questions about thumb sucking, dummies or front teeth that stick out

When to look at another page

• Bite problems and braces. The treatment plan is made after an orthodontic assessment; see the braces page.
• Children with disabilities or additional needs. Tell the dentist about your child's needs before the first appointment, so that the visit can be planned around them.
• Adults. For root canal treatment, fillings or gum disease in adults, see the relevant treatment pages.

Children have 20 baby teeth. Baby teeth usually start to come through at around 6 months⁶. In some babies they start before 4 months, in others after 12 months. In most children, all the baby teeth are through by the age of 2 to 3⁷.

Adults have 32 permanent teeth, including four wisdom teeth. These teeth have usually come through by the age of 21⁶.

In some children, one or more permanent teeth never form. Leaving wisdom teeth aside, in pooled studies 6.4% of people were missing at least one permanent tooth from birth⁸. The teeth most often missing are the second premolars in the lower jaw and the lateral incisors in the upper jaw. Most cases are mild. It is often an X-ray that shows it.

Under 3

Teeth are brushed twice a day as soon as the first tooth comes through, once just before bed. A parent or carer does the brushing. The NHS advises a toothpaste with at least 1,000 ppm fluoride, only a smear on the brush¹. The point of using a small amount is to limit the risk⁹ of marks on the teeth called fluorosis. Fluoride-free toothpaste is not recommended.

Ages 3 to 6

Use a pea-sized amount¹ of toothpaste with 1,000 to 1,500 ppm fluoride. Teeth are brushed twice a day. A parent does the brushing or helps the child. When your child starts brushing their own teeth, stay with them and watch.

Age 7 and over

The European Academy of Paediatric Dentistry advises parents to help with or supervise brushing until at least 7 years of age¹⁰. After this age, children can usually brush their own teeth. At this age the NHS still advises keeping an eye on your child and using a toothpaste with 1,350 to 1,500 ppm fluoride¹.

At every age

• Spit, don't rinse. After brushing, the toothpaste is spat out, and the mouth is not rinsed with water¹. This way the fluoride left on the teeth is not diluted¹¹.
• Cut down on sugar. When sugar makes up less than 10% of daily energy, tooth decay is less common¹². This is moderate-quality evidence from cohort studies.
• Any extra benefit from xylitol is uncertain. In children, a fluoride toothpaste with 10% xylitol was compared with a fluoride toothpaste alone over 2.5 to 3 years. It may have reduced decay by 13% (4,216 children)¹³. But this estimate rests on two studies by the same authors in the same population, and the quality of the evidence is low. Studies of other xylitol products are small and stand alone.

The options below are ordered by the state of the tooth: first monitoring and prevention, then repair such as a filling. The figures come from published studies, not from our own records.

• Monitoring and care at home. Tooth decay can be stopped at an early stage, and even reversed¹⁴. The basis for this is the right fluoride toothpaste for your child's age and less sugar. The dentist watches for change at check-ups.
• Fluoride varnish. A dentist can apply a fluoride varnish¹⁵ to stop early decay. Varnish is also used to prevent new decay. The national prevention guidance for England is called Delivering Better Oral Health. It gives fluoride varnish twice a year for all children¹¹ from the age of 3 as a strong recommendation. Your dentist plans what your child needs according to their risk of decay.
• Fissure sealants. The pits and grooves on the biting surface of the permanent back teeth (molars) are covered with a thin resin. A review pooled 7 studies covering 1,548 children aged 5 to 10¹⁶. After 24 months, decay was clearly less common in first permanent molars that had a sealant¹⁶. The quality of the evidence is moderate. The same guidance recommends sealants for children whose risk of decay is a concern¹¹.
• Silver diamine fluoride (SDF). A liquid painted onto the decay to stop it; the tooth does not need drilling. After one application, the share of decay that stopped has been reported at between 47% and 90%¹⁷. The rate varies with the size and position of the decay. The treated decay usually turns black and hard, and the colour is permanent.
• Fillings. Once a hole (cavity) has formed in the tooth, a filling will probably be needed¹⁵. Ask which filling material is proposed for your child. Dental amalgam is the silver-coloured filling material. In Great Britain (England, Scotland and Wales), the UK version of the EU regulation on mercury applies¹⁸. Under it, amalgam is not to be used for baby teeth or for children under 15¹⁹. The exception is when the dentist judges it strictly necessary because of the child's specific medical needs. Northern Ireland follows the EU regulation instead, with separate arrangements for amalgam¹⁸ that this page does not set out. We hold no source for the rules on amalgam in Turkey. Ask whether the clinic uses amalgam fillings for children. Filling materials are described on the fillings page.
• Pulp (nerve) treatment or extraction of a baby tooth. If decay has reached the nerve, pulp treatment or extraction is discussed for baby teeth too. The choice depends on the state of the nerve. A crown may also be needed to protect the treated tooth. After an extraction, a space maintainer may be needed to keep the gap open. We do not give figures for the results of these treatments on this page; ask your dentist.

Children who cannot cope with treatment

Some children cannot cope with treatment because of fear or their age. In this case, splitting treatment into several short appointments, sedation or general anaesthetic may be discussed. This page does not cover who sedation and general anaesthetic suit in children, their risks, or the setting they should be done in. The UK standard for sedation in dentistry requires an escort for every form of sedation in children²⁰. If an escort cannot be assured, it says treatment under sedation must not be provided. The sedation page is written mainly for adults. Ask your dentist whether these options suit your child, what the risks are and where it would be done.

The steps below are for a check-up or a first examination. Your dentist decides how long the examination takes and which steps are needed according to your child's age and situation.

Young children can often sit on a parent's lap during the examination. Before the visit, talk to your child about it in a calm way that does not frighten them.

Risks and limits

• SDF leaves a permanent black colour on the tooth. Decay treated with SDF usually turns black and hard¹⁷. This is a side effect, not the aim of treatment. The American Academy of Pediatric Dentistry's guide on SDF recommends getting consent about this before it is applied.
• Too much toothpaste can raise the risk of fluorosis. The point of putting only a smear of toothpaste on the brush for under-3s is to limit the risk of marks on the teeth. Do not use more than the recommended amount.
• Fissure sealants do not prevent all decay. The result above comes only from a review of the biting surfaces of permanent back teeth. Baby teeth were outside its scope. Sealants do not last for life¹⁶; they are checked at check-ups.
• An examination by eye cannot catch every early decay. A review covering 67 studies applied its results to an example in which 28% of tooth surfaces had decay. On that basis, for every 1,000 tooth surfaces, 40 early enamel lesions would be missed and 163 sound surfaces wrongly called decayed²¹. Most of these studies were done in a laboratory, and the certainty of the evidence is low. This result does not directly measure how well a child's examination works; but it is a reason not to judge a mark from a photograph. The dentist decides whether an X-ray is needed from what the examination shows.
• Sedation and general anaesthetic. This page does not cover their risks in children. Before deciding, ask your dentist for the risks and safety measures in writing.

Benefits

• Decay picked up at an early stage can often be stopped without drilling.
• Fissure sealants reduce decay on the biting surface of the permanent back teeth.
• Regular check-ups can help identify conditions such as missing teeth or bite problems early.

A long-lasting thumb, finger or dummy sucking habit is linked with bite problems, and the risk rises the longer it goes on²². But this is not the only cause of bite problems; genes, injuries and losing teeth early or late can also play a part.

In children whose upper front teeth stick out noticeably (an increased overjet), these teeth are more likely to be injured. Where the overjet was greater than 5 mm, the odds ratio for injury was about 2.43²³. This figure is for children with a mix of baby and permanent teeth, or with permanent teeth only. In 12-year-olds it was about 1.81²³. An odds ratio is not a measure of risk; it does not mean "injured twice as often". These are associations from observational studies.

Treatment started early, between the ages of 7 and 11, with a functional appliance reduced new injuries to the front teeth. Of every 100 children in the group that waited until adolescence, 30 reported a new injury²⁴, compared with 19 in the early-treatment group. This result rests on 332 children, and the quality of the evidence is moderate. The same review showed no other advantage²⁴ of early treatment: when treatment ended, the results of the two groups were similar. Early treatment happens in two phases; it does not mean braces will not be needed later. Details are on the braces page. In England, if a dentist thinks a child needs braces, they refer the child to an orthodontist²⁵. The orthodontist decides whether the child is eligible for braces on the NHS.

Some children have black marks along the gum line, in the form of a row of dots or a line. These marks are a deposit formed by bacteria²⁶. Decay has been found less often²⁷ in children with these marks. But this is an association, and it does not show that the stain protects the teeth.

Not every dark mark on a tooth is of this kind. Decay, and decay that has been stopped with SDF, can also look dark. A mark needs to be assessed at an examination, not from a photograph.

• If your child had a local anaesthetic, they may bite their lip, cheek or tongue until it wears off. Keep an eye on them during this time and hold off eating until the numbness has gone.
• It is expected that decay treated with SDF turns black; the colour does not fade. Ask your dentist whether the tooth can later be covered with a filling.
• Fissure sealants, fillings and teeth treated with SDF are checked at check-ups, usually by your child's own dentist in the UK. If you notice that a sealant or filling has broken or come out, book an appointment without waiting for the next check-up.
• Daily care stays the same after treatment. Keep brushing twice a day, once just before bed, with the right amount of fluoride toothpaste for your child's age.

Contact a dentist if any of the following happens:

• Toothache, or discomfort when eating
• A change of colour, a mark or a hole in a tooth
• A pimple-like swelling or discharge on the gum
• A thumb or dummy sucking habit that continues, or front teeth that stick out
• A permanent tooth that has not come through long after the baby tooth fell out

If you think your child has an abscess, see a dentist without delay, even if there is no fever or swelling. A dental abscess does not go away on its own and needs urgent dental treatment²⁸. If your child has swelling in the face or jaw, or a fever together with toothache, get them seen the same day wherever you are. If you think your child has a dental abscess, the NHS website for England advises an urgent dentist appointment or help from NHS 111²⁸. If you do not have a dentist or cannot get an emergency appointment, it says to call 111²⁸.

A tooth that has had a knock. For a tooth that is broken, loose or knocked out, contact a dentist straight away. This page does not cover how to store a knocked-out tooth or whether it can be put back; call for advice without waiting.

While you wait. Treating an abscess means the dentist draining the pus and removing the cause of the abscess²⁸. Antibiotics do not replace this treatment. Use painkillers as directed on the pack; children under 16 must not be given aspirin²⁸. Rinsing with salt water is not recommended for children²⁹. Clove oil is not recommended³⁰ for under-18s; life-threatening reactions have been reported in children under 2 after swallowing it.

Emergencies. The following need urgent medical help²⁸. Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling around the eye or in the neck²⁹
• Swelling or pain in the eye, or sudden problems with sight
• Major swelling inside the mouth
• Difficulty opening the mouth

Before you fly home

If your child was treated in Antalya, know what was done on which tooth and what is still to come. Make sure you have written care instructions, the treatment record with copies of any X-rays, and a way to reach the clinic. If there is pain, swelling or bleeding where a tooth was treated, ask the dentist before you fly.

Once you are back in the UK

If a problem comes up that is not urgent, write to the clinic and send photographs. For anything that needs someone to look at the tooth, see your child's own dentist in the UK. Take the treatment record and X-rays with you. If you think your child has an abscess, follow the NHS advice above. In the emergencies above, do not wait for a reply.

Most of a child's dental care is not a single appointment. Check-ups are repeated at an interval set by your child's risk of decay. Fluoride varnish may be repeated, and sealants and fillings are checked over the years. Brushing and diet at home do most of the work. So the dentist who sees your child regularly is usually one near where you live. In England, NHS dental appointments and treatment are free for anyone under 18, or under 19 and in full-time education³. The General Dental Council suggests talking to your own dentist³¹ before treatment abroad. For a child, this is the dentist who will carry on the care.

When a visit in Antalya can make sense, and when it does not

For a family living in the UK, travelling to Antalya only for a child's check-up or routine prevention is unlikely to make sense. These are repeated over the years, so they belong with a dentist who can follow your child over time.

Seeing a dentist in Antalya can make sense in a few situations:

• A problem that starts while you are in Antalya. Toothache, a broken or knocked tooth, or a swelling should be looked at where you are. An abscess cannot wait for your return (see above).
• A stay you are already making. For example, a parent is having their own treatment in Antalya. A check-up for your child during the same stay is possible. It does not replace the regular check-ups at home.

It is less likely to make sense in these cases:

• The treatment needs several visits, or a follow-up that your stay cannot cover. Examples are treatment split into short appointments for an anxious child, or a treated baby tooth that then needs a crown.
• Sedation or a general anaesthetic is being considered for your child (see "Children who cannot cope with treatment" above). Talk to your child's dentist in the UK first.
• Your child may need braces. Braces need adjustments over many months, so ask your child's dentist in the UK about an orthodontic assessment first.

If your child is seen or treated in Antalya

If you would like your child examined while your family is in Antalya, write to us before you come. A photograph cannot show whether a mark is decay, so the plan follows the examination. If treatment is needed, ask for the plan in writing before it starts, with the appointments it needs. Ask too which treatment could wait for your child's dentist in the UK. An abscess cannot wait: it needs treating wherever you are (see above). You can take time to decide, and you can say no, or ask to stop, at any stage. Treatment that is not urgent can also be left to your child's dentist in the UK.

Before you leave, ask for a written record of what was done on which tooth, and copies of any X-rays. "Back in the UK" below lists what the record should say.

Flying. A 2023 review of flying after dental treatment suggests waiting 24 hours after a filling and 24 to 48 hours after a simple extraction³². For most other dental procedures it suggests about a week³². These times apply only when there is no pain, swelling or bleeding where the tooth was treated. It gives no separate advice for children. The authors note that the research is limited and comes mainly from military aviation. Treat it as a starting point for your dentist's advice, not as a rule.

If your child is examined or treated in Antalya, this is done by our clinic there and carried out by the clinic's dentists.

In Turkey, children's dental treatment can be carried out by dentists. A dentist is authorised to carry out the professional work² of diagnosing and treating diseases of the teeth and gums. The title "specialist in paediatric dentistry" (çocuk diş hekimliği uzmanı) is different. Only a dentist who holds a specialist certificate issued and registered by the Ministry of Health³³ may use it. The usual route to this certificate is the national specialty entrance exam (DUS), specialty training, a thesis and a final exam. In a Turkish dental practice, an approved copy of the dentist's practising certificate is displayed where patients can see it³⁴.

In the UK, dentists do not have to join a specialist list³⁵ to practise a specialty. They may use the title "specialist" only if they are on the GDC's list.

Ask who will examine your child and carry out any treatment. Ask what their title is, where they qualified, and whether they hold a Ministry-registered specialist certificate in paediatric dentistry. Ask for the answers in writing. On this page, "your child's dentist in the UK" means the dentist your child sees at home.

Your child's dentist

Once you are home, check-ups, fluoride varnish and the follow-up of any treatment carry on with your child's dentist in the UK. Tell them what was done in Antalya, and give them the records. If your child does not have a dentist in the UK, it helps to find one before you travel. National guidance in England (NICE) says the interval between check-ups should be set for each person according to their risk⁵ and discussed with them.

Your child's records

Ask the clinic for a written record of the treatment to take back to your child's dentist. For each tooth, it should say:

• which tooth was treated, and whether it is a baby tooth or a permanent tooth
• what was done: fluoride varnish, a fissure sealant, SDF, a filling and its material, pulp treatment, a crown or an extraction
• whether a space maintainer was fitted after an extraction
• what still needs to be done, and by when

Ask for copies of any X-rays, in a form your child's dentist can open. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging³⁶. The NHS lists exchanging medical records and arranging aftercare back home³⁷ among the things to consider before treatment abroad.

What the NHS does and does not do

If your child later needs NHS dental care in England or Wales, having been treated abroad does not by itself shut them out of it. An NHS dental practice may accept your child for a course of treatment, not only an urgent appointment. If it does, it provides clinically necessary treatment, subject to consent³⁸. This means the treatment that every NHS dental contract must offer. However, the NHS free-repair and replacement provisions do not apply³⁸ to work done by another provider. These are the free repair or replacement an NHS practice can give for its own work. Separately, NHS dental treatment in England is free for anyone under 18³ (see above). The NHS website for England also states that the NHS is not liable for negligence or failure of treatment³⁷ when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment³⁹.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, and we hold no source for them. We also hold no source on free dental treatment for children in Wales. If you live outside England, check the arrangements where you live.

Travel insurance

The NHS website for England says that most travel insurance policies will not cover you for planned treatment abroad, so you may need specialist cover³⁷. If your child may be seen or treated during your stay, tell your insurer. Check whether your policy covers your child for a dental problem that starts while you are away. Check too whether anything linked to planned treatment is covered.

The General Dental Council lists questions to ask before treatment abroad³¹. Below is our selection for a parent: what this page can tell you today, and what to ask for in writing.

1. Who will carry out the treatment, and what are their qualifications? Your child is seen by our clinic in Antalya, Turkey. Ask for the name of the dentist who will examine and treat your child. Ask where they qualified and what their title is (see who carries out the treatment, above).
2. Will someone speak our language, or will there be a translator? Ask who will explain the findings, the plan and the consent form to you in English, and who will talk to your child.
3. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate³⁶ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes⁴⁰, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
4. How many times have you carried out this treatment, and what are your rates of success and complications? We publish no figures of our own yet: the figures on this page come from published studies, not from our own records. Ask for the clinic's own figures in writing, and ask how they were measured.
5. Is the work guaranteed, are the terms in writing, and for how long do they apply? This page makes no guarantee. Sealants and fillings are checked over the years, usually by your child's dentist in the UK. Ask what the clinic's written terms cover if a sealant or filling breaks or comes out, and whether they cover a repair in the UK.
6. What aftercare do you provide, and who can we contact after the treatment? For a problem that is not urgent, you write to the clinic and send photographs. Check-ups and problems that need someone to look at the tooth are with your child's dentist in the UK. Ask whom to contact at the clinic, how, and in which language.
7. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before treatment starts. Ask too what you pay for the examination and any X-rays if no treatment is needed. The same applies if treatment is left to your child's dentist in the UK.
8. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre³⁶. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.
9. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds⁴¹; its investigations concern the dentists on its own register. Turkey's health tourism regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided³⁶.

Ask too from what age the clinic sees children. Ask whether a parent must be present at every appointment, and how a parent gives consent.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³⁹. Apply them to this clinic too.

This page carries no prices. The plan is prepared for your child after an examination. The main factors that shape it are:

• Whether only a check-up and prevention are needed, or treatment too
• How many teeth need treatment, and whether each is a baby tooth or a permanent tooth
• The size of the decay, and whether it has reached the nerve of the tooth
• Whether an X-ray is needed
• How many appointments the treatment is split into; whether sedation or general anaesthetic is needed
• Whether treatment is done during your stay or with your child's dentist in the UK

Ask for the plan in writing. It should say what is included and what would be charged separately. In England, NHS dental treatment is free for children (see above). So ask your child's dentist in the UK what they would offer before you plan treatment in Antalya.