Dental caries (cavities) is one of the most common chronic diseases seen in children, even in the developed world, affecting 45% of children between ages 2-19 in the USA, with 13% of these being untreated.
It’s tempting for many pediatricians to skip over the health of teeth. After all, we’re not dentists. But teeth are really important. And when teeth aren’t healthy, it’s hard for a child to be happy. It can make it hard for children to learn and develop. Dental cavities cause pain, missed school, procedures and complications like infections which need antibiotics, or even hospital admissions at times.
Likewise, I found some parents overlook the importance of baby teeth, thinking they fall out anyway. They may not realize that starting dental care early, even as soon as teeth emerge from gums, prevents colonization with cavity-causing bacteria as well as the formation of bad habits.
Even dentists have historically blown off the importance of early dental care. Every week in my office I have parents tell me their dentist told them not to worry about dental visits for their child until age 3, because “there is nothing we really do for them”. Sorry, but this is just plain bad dental advice. Since pediatric dentists have come on the scene within the field of dentistry, we know better. The American Academy of Pediatric Dentistry, the American Dental Association and the American Public Health Association all recommend a first dental visit at or near 1 year of age for all children, but especially if a child is at high risk for cavities.
There are some things they should do- they clean the teeth and look for any spots that look like they’re getting missed with brushing, and apply a topical fluoride varnish every 3-6 months. In my office, I apply this fluoride varnish to my patient’s teeth during well child visits as soon as their teeth come in, and continue until my patients start seeing a dentist.
Below are some of the factors that determine whether your child is at risk for dental caries.
- The primary caregiver(s) has/have dental cavities. Since cavities are caused by bacteria, the bacteria in parents’ mouths usually ends up getting easily transmitted to baby’s mouth because of the close contact between mom and baby. This is why I don’t recommend parents clean off a baby’s binky with their mouth, or chew baby’s food for them before giving it to baby, or even sharing cups, utensils or straws.
- Low socioeconomic status or poor access to medical or dental care.
- Breastfeeding beyond 12 months (though breastfeeding <12 months seems to decrease the risk).
- Frequent use of a sippy cup or bottle throughout the day or in bed, or past 12 months of age. Better to phase these out and use a regular open cup or “360 degree” cup, and don’t put a baby or child to bed with any beverage (besides water if necessary).
- Consumption of juice or soda.
- Exposure to secondhand smoke.
- Lack of or low levels of fluoride in drinking water, which is the case for most of southern Utah.
Whether they have risk factors or not, there are some things that you can do with your child to not only take care of their teeth, but teach them good habits so they can continue to take care of their own teeth throughout their lives.
If your child is old enough to poop, you wipe their bottom, right? Likewise as soon as they have teeth, you start cleaning them! You can use a finger brush or small soft infant tooth brush to gently brush a baby’s tiny cute little teeth twice a day.
Here’s something that usually surprises parents: use toothpaste WITH fluoride. Many baby or “training” toothpastes do not contain fluoride. Skip those and go right to the fluoridated stuff, but only use a rice grain-sized amount of toothpaste each time. The “pea sized” amount most people have in their minds is way too much, and could give a baby too much fluoride. But getting a small amount of fluoride regularly is very important for strengthening enamel and very safe for babies. The key is to let that small rice-grain sized dab of toothpaste sit on their teeth after brushing so it will soak into the enamel. Don’t try to make them spit it out or rinse their mouth or give them anything to drink right after brushing because that will rinse the fluoride off the teeth.
If toddlers are wary of having parents brush their teeth, you can take advantage of their natural curiosity and tendency to model their parents by just putting a toothbrush in their hands. Chances are, it’s likely to end up in their mouths, especially if you start brushing with your own brush,.
For babies that have a bottle at or near bedtime, you can keep a brush/paste near the crib and brush after they finish the bottle. Otherwise the sugar from the milk will sit on their teeth all night long and provide the perfect environment for bacteria to grow and cause cavities. The same is true of sugar from juice. Be sure to brush in the morning after baby eats, and avoid giving juice throughout the day. Babies under a year old shouldn’t have juice at all, and really toddlers don’t need it either- it’s much better to eat whole fruit- but if they must have it, keep it to 4 oz/day of 100% fruit juice. Too much juice or milk throughout the day can make kids picky eaters and lead to low iron in addition to causing cavities. (Keep the milk to maximum 20 oz/day).
To prevent malocclusion -a poor fit between top and bottom teeth when the mouth is closed- start weaning baby off a bottle after 6 months of age and for sure by 12 months of age. Use an open or 360-degree cup.
Take your baby to their regular check-ups with their pediatrician and ask about flouride varnish, and plan on taking them to see a pediatric dentist by around 12-18 months of age, and every 6 months thereafter.