Care for Your Child’s Teeth

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home.  Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth.  Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well-baby” checkups.  In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can a pediatric dentist care for my child’s teeth?

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents.  In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist: the child’s mouth will be fully examined; the teeth will be professionally cleaned; topical fluoride might be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed.  The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the ages of two and three), the pediatric dentist may coat them with dental sealant.  This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles, and acid.  Dental sealant may last for many months or many years, depending on the oral habits of the child.  A dental sealant is an important tool in the fight against tooth decay.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

Diet – Parents should provide children with a nourishing, well-balanced diet.  Very sugary diets should be modified and continuous snacking should be discouraged.  Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food, emitting harmful acids that erode tooth enamel, gum tissue, and bone.  Space out snacks when possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign.  If the child must use a pacifier, choose an “orthodontically” correct model.  This will minimize the risk of developmental problems like narrow roof arches and crowding.  The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

General oral hygiene – Sometimes, parents clean pacifiers and teething toys by sucking on them.  Parents may also share eating utensils with the child.  By performing these acts, parents transfer harmful oral bacteria to their children, increasing the risk of early cavities and tooth decay.  Instead, rinse toys and pacifiers with warm water, and avoid spoon-sharing whenever possible.

Sippy cup use – Sippy cups are an excellent transitional aid when transferring from a baby bottle to an adult drinking glass.  However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning acid continually attacks tooth enamel.  Sippy cup use should be terminated between the ages of twelve and fourteen months or as soon as the child has the motor skills to hold a drinking glass.

Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft-bristled brush and a pea-sized amount of toothpaste.  Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth.  Parents should always opt for ADA-approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter).  For babies, parents should rub the gum area with a clean cloth after each feeding.

Flossing – Cavities and tooth decay form more easily between teeth.  Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other.  The pediatric dentist can help demonstrate correct head positioning during the flossing process and suggest tips for making flossing more fun!

Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel.  Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay.  It is important to get the fluoride balance correct.  The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

How does my child’s diet affect his or her teeth?

Almost every snack contains at least one type of sugar.  Most often, parents are tempted to throw away candy and chocolate snacks – without realizing that many fruit snacks contain one (if not several) types of sugar or carbohydrate.  When sugar-rich snacks are eaten, the sugar content attracts oral bacteria. The bacteria feast on food remnants left on or around the teeth.  Eventually, feasting bacteria produce enamel-attacking acids.

When tooth enamel is constantly exposed to acid, it begins to erode – the result is childhood tooth decay.  If tooth decay is left untreated for prolonged periods, acids begin to attack the soft tissue (gums) and even the underlying jawbone.  Eventually, the teeth become prematurely loose or fall out, causing problems for emerging adult teeth – a condition known as childhood periodontal disease.

Regular checkups and cleanings at the pediatric dentist’s office are an important line of defense against tooth decay.  However, implementing good dietary habits and minimizing sugary food and drink intake as part of the “home care routine” are equally important.

How can I alter my child’s diet?

The pediatric dentist is able to offer advice and dietary counseling for children and parents.  Most often, parents are advised to opt for healthier snacks, for example, carrot sticks, reduced-fat yogurt, and cottage cheese.  In addition, pediatric dentists may recommend a fluoride supplement to protect tooth enamel – especially if the child lives in an area where fluoride is not routinely added to community water.

Parents should also ensure that children are not continuously snacking – even in a healthy manner.  Lots of snacking means that sugars are constantly attaching themselves to teeth, and tooth enamel is constantly under attack.  It is also impractical to try to clean the teeth after every snack, if “every snack” means every ten minutes!

Finally, parents are advised to opt for faster snacks.  Mints and hard candies remain in the mouth for a long period of time - meaning that sugar is coating the teeth for longer.  If candy is necessary, opt for a sugar-free variety or a variety that can be eaten expediently.

Should my child eat starch-rich foods?

It is important for the child to eat a balanced diet, so some carbohydrates and starches are necessary.  Starch-rich foods generally include pretzels, chips, and peanut butter and jelly sandwiches.  Since starches and carbohydrates break down to form sugar, it is best that they are eaten as part of a meal (when saliva production is higher), than as a standalone snack.  Provide plenty of water at mealtimes (rather than soda) to help the child rinse sugary food particles off the teeth.

As a final dietary note, avoid feeding your child sticky foods if possible.  It is incredibly difficult to remove stickiness from the teeth - especially in younger children who tend not to be as patient during brushing.

For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life.  Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.

According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old.  Thumb sucking can be a harder habit to break and tends to persist for longer without intervention.  Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.

How can thumb sucking and pacifier use damage children’s teeth?

Pacifier and thumb sucking damage can be quite insidious.  Both can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time.  Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:

Jaw misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold.  Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.

Tooth decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance.  Oral bacteria feed on sugar and emit harmful acids.  The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.

Roof narrowing – The structures in the mouth are extremely pliable during childhood.  Prolonged, repeated exposure to thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device).  This can cause later problems with developing teeth.

Slanting teeth – Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results.  In addition, thumb sucking and pacifier use in later childhood increases the need for extensive orthodontic treatments.

Mouth sores – Passive sucking is much less harmful than aggressive sucking.  Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.

If you do intend to purchase a pacifier:

• Buy a one-piece pacifier to reduce the risk of choking.
• Buy an “orthodontically correct” model.
• Do not dip it in honey or any other sugary liquid.
• Rinse with water (as opposed to cleansing with your mouth) to prevent bacterial transmissions.

How can I encourage my child to stop thumb or pacifier sucking?

In most cases, children naturally relinquish the pacifier or thumb over time.  As children grow, they develop new ways to self-soothe, relax, and entertain themselves.  When thumb sucking or pacifier use persists past the age of five, a gentle intervention may be required.

Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use:

• Ask the pediatric dentist to speak with the child about stopping.  Often, the message is heard more clearly when delivered by a health professional.
• Buy an ADA recommended specialized dental appliance to make it difficult for the child to engage in sucking behaviors.
• Implement a reward system (not a punishment), whereby the child can earn tokens or points towards a desirable reward for not thumb sucking or using a pacifier.
• Wrap thumbs in soft cloths or mittens at nighttime.

Why brush primary teeth?

The importance of maintaining the health of primary (baby) teeth is often understated.  Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth.  Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.

What differences are there among toothpaste brands?

Though all kinds of toothpaste are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.

The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring.  Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis.  Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.

Be aware that adult and non-ADA-approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth.  In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which causes painful mouth ulcers in some children.

So which toothpaste brand should I choose?

The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child.  Home oral care should begin before the emergence of the first tooth.  A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.

Prior to the age of two, the child will have many teeth and brushing should begin.  Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day.  Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.

Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride.  The ADA logo is clear and present on toothpaste packaging, so be sure to check for it.  Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing.  Eliminating toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty.  If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.

Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.

If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.