Great Smiles: Homemade or Made in the Office?

Happy New Year! As we make our resolutions to get in shape this year, it reminds me that we always want our smiles to be in their best shape too. And we all want the best for our babies too. But are great smiles grown at home, or are they made in the dental office? We’re all aware that braces can be necessary to straighten teeth, but is there a way to prevent the need for cosmetic dental work altogether?

As my readers and patients know all too well, prevention is the name of the game in my office. So, let’s discuss what’s in your control and what isn’t when it comes to your baby’s smile. Much of how we look is genetic and is programmed well before we’re born. These include the number of teeth, tooth size, tooth shape, and general shading of the teeth. Soft tissues may have what’s called tongue tie or lip tie. The shape of our face and jaw is also predetermined. Sometimes deformities happen as well. Let’s break down each of the items out of our control.


Many people are born missing teeth. A child may have all their baby teeth but never develop certain adult teeth. Some are born with extra teeth. This means there may not be enough space in the mouth for all the teeth, and some teeth may not have room to grow in at all.



Let’s face it. Some people have big teeth, and some have small ones. Some are rounder, and some may look pointier. There isn’t anything you can do about that.


Baby teeth are typically several shades whiter than adult teeth. This is due to differences in mineral content in the enamel of the two sets. Often people will think their child’s first few grown-up teeth are coming in “yellow.” But don’t worry, they just appear that way next to baby teeth.


A frequent issue is lip-tie and/or tongue-tie. Tongue-tie is when a little piece of skin attaches the tip of the tongue to the floor of the mouth (see photo below), keeping it from moving freely. In older kids, this may influence speech development and cause some sounds to be mispronounced. A lip-tie is when the upper lip is tightly pinned to the upper gums and can prevent a baby from nursing because they cannot latch to the nipple well enough. Also, lip-tie nearly always results in a gap between the two front teeth of younger and older children.


This one is more straightforward. A small face or small jaw will have less room for teeth (especially larger ones) so they are more likely to be bunched up or crooked. Larger jaws (with smaller teeth) are more likely to have gaps and spacing. This is the cause of an underbite or overbite and can require professional intervention.


A cleft lip is when the structures forming the upper lip and face don’t come all the way together before birth. Cleft palate is when this happens in the back of the mouth. It can be very mild, barely noticeable, or severe, requiring one or more surgeries to repair. There may be a genetic predisposition, but unfortunately, this is not predictable or preventable.

Now that we have what you can’t control out of the way, let’s touch on what you can control. Keep in mind that your friendly local pediatric dentist may need to help you with some of it, so start your checkups by your kiddo’s first birthday.

Common preventable issues include misplaced teeth from a sucking or chewing habit, crooked teeth from a baby tooth that won’t come out, stained teeth from lack of brushing, and cavities from a diet problem. Let’s tackle these:


Let’s get this one out of the way first because it’s most important. Brush your baby’s teeth! And do not let them sleep with bottles or carry sip cups throughout the day. I cannot stress this enough.

I also recommend using children’s fluoridated toothpaste.


Even without cavities, lack of brushing can cause staining on teeth that turns yellow, orange, or even green. This is the most preventable problem, and it just takes effort and consistency to keep teeth their brightest. Using iron supplements can cause stubborn black stains, which can be brushed away eventually. Anemic children often take iron and show these stains. Some stains cannot be removed. Taking tetracycline antibiotics by pregnant women or newborns can cause teeth to grow in with dark brown enamel that cannot be lightened. These drugs should be avoided when possible if you’re expecting.


I say misplaced and not “crooked” here because we are talking about habits that actually move teeth around. Overuse of a pacifier or frequent thumb/finger sucking can cause the teeth to tilt in, flare out, or make openings in front teeth while back teeth are closed. Pacifiers connected to a stuffed animal can be even worse because the toy’s weight increases the force moving the teeth. Ween your baby from the pacifier as soon as possible and gently discourage finger sucking. Get your pediatric dentist involved if it’s a tough habit to break. We can recommend helpful products on a case-by-case basis.



One of the all-time top reasons for concerned parents bringing their kids to me is what’s often called “shark teeth” (see photo). This is when the grown-up front teeth are growing in before the baby teeth have fallen out. It can look very concerning, but it’s not a big deal if the baby teeth are loose. If the baby teeth are not loose when this happens, it may be necessary to have the baby tooth pulled, or else braces are much more likely in the future.

This is a lot of information and can sometimes be hard to process. The moral of the story is, bring your baby to a pediatric dentist for a checkup as early as possible. Whether you think something is wrong or not. You get all the information you need customized to serve your family best. Feel free to reach out to me at any time at @dr.raytucker on Instagram. Thank you so much for reading, and have a great start to your year.


“I am a pediatric dentist with 8 years experience treating the most severe cases of dental decay, bottle rot, and oral neglect. I recently moved to Las Vegas from Portland, OR, and pivoted my practice to focus more on prevention rather than treatment. Now my goal is to give education and information to moms, dads, and kids, so that they have happier, healthier experiences and avoid drilling and filling. “
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