Hugh Silk, MD, FAAFP
An important part of your child's overall health is the health of his or her teeth. Teeth help your child chew food and form sounds for speaking. Parents often focus on their safety, child's sleeping habits, and immunizations. While these are important issues, so is caring for your child's teeth.
Cavities of the teeth are the most common disease in children. It is five times more common than asthma. Most children do not receive dental care until they are three years old, yet by that time more than 30 percent of children already have cavities.
Teething
Every baby is different, but teeth normally start to appear at about six months old. However, your baby may begin drooling more at four months. When teeth start to come through the gums, they can cause discomfort and fussiness. Teething does not cause a fever. If your baby has a fever, talk to your doctor.
To help with the discomfort you can give your child a cold teething ring or a cold washcloth to chew and suck on. Teething gels should be used carefully because too much is not good for your child. Acetaminophen and/or ibuprofen can be used as well.
Cavities
Cavities are holes in the teeth that can lead to pain, infections, lost teeth, missed school and other problems. Cavities happen when bacteria (germs) in the mouth use the sugar in food and drinks to make acid. This acid eats away at the teeth. Cavities are more common in some children. Your child may be at higher risk if he or she:
• Was born early (prematurely) or weighed very little at birth (low birth weight)
• Has ongoing special health care needs
• Has a parent/guardian with lots of cavities (a reflection of poor household eating habits)
• Eats a lot of sugary foods (such as cookies and candy)
• Drinks a lot of sweet liquids (such as fruit juice, punch, and soda)
• Has white spots or brown areas on any teeth
• Does not go to the dentist very often
Teeth Friendly Eating and Drinking
Cavities can be prevented. Let's look at some ways to help prevent cavities.
Breastfeeding is good for your baby's teeth. The sugar in breast milk is not the kind of sugar that leads to cavities. (Breast milk is good for many other reasons too!) If you do use a bottle fill it only with breast milk, formula, or water. Do not put juice in a bottle. Children don't need juice on a regular basis.
The way you feed your child is also important. It is best if your child eats planned regular snacks and meals rather than grazing. If you give your baby a bottle, always hold the baby when you feed him or her. Never leave a bottle in the crib or car seat with your baby.
Your baby should start using a sippy cup when he or she is six months old. Aim to stop giving your baby a bottle when he or she is one year old. Do not let your child walk around with a sippy cup unless it has only water in it. Do not give your child a sippy cup of juice or milk in the crib.
After your child is one year old, give only water or plain milk between meals. If you give your child juice or flavored milk, give it with meals only. Juice and flavored milk have a lot of sugar in them and can cause cavities if given more frequently.
Teeth-friendly snacks include fresh fruits and vegetables, cheese and crackers, and dry cereal and yogurt.
Brushing Teeth
Start brushing your baby's teeth twice a day once the first tooth appears. The most important time to brush is just before bedtime because there is less saliva (drool) at night to clean and protect the teeth. Use a small soft baby toothbrush. Children usually swallow most of the toothpaste, so put just a small dab of toothpaste on the brush. The dab should be the size of a rice grain.
You can ask your doctor or dentist what kind of toothpaste you should use. He or she may suggest that you use regular adult toothpaste which has fluoride in it. Fluoride helps stop cavities. It is safe to use this kind of toothpaste with babies if you use only a small dab.
If you choose to use baby toothpaste, it is important to know that it does not have fluoride. If you use baby toothpaste, be sure to switch to regular toothpaste with fluoride in it when your child reaches age two. Your child will need help with tooth brushing until about age eight.
Fluoride
Some children need extra fluoride. It depends on whether your town puts fluoride in the drinking water. If you do not have fluoride in your drinking water, your child may need to use liquid fluoride or chewable fluoride tablets starting at six months of age. You can call your water company and find out how much fluoride is in the water. If you have well water, have it checked for fluoride before you give your child extra fluoride. Ask your doctor or dentist how to have the well water tested. Never start fluoride treatment without testing the well water. Too much fluoride can cause spots on your child's teeth. Spots also happen when children use too much toothpaste. Your child may need the extra fluoride supplements until age 16. Your doctor or dentist can help you decide.
Visits to the Dentist
Your baby should see a dentist around his or her first birthday, or sooner if the child is at high risk for cavities or has any problems with his or her teeth. The American Academy of Pediatrics, Family Medicine, and Pediatric Dentistry all agree on this. It is better for your child to meet the dentist and see the office before he or she has a tooth problem. If you decide to wait until your child is older to see the dentist, then be sure to follow all of the advice in this article and talk to your child's doctor regularly to avoid cavities.
Everyone in your family has to take good care of their teeth. Family members with lots of cavities can pass the cavity-causing bacteria to babies and children. The bacteria, predominantly strep mutans, is passed from a parent (usually mom) when mom kisses baby on the mouth or puts the baby's spoon in her mouth to taste the baby's food. There is no reason that your child should have problems with his or her teeth if you and your child eat healthy foods, drink non-sugary drinks, brush twice daily, and visit the dentist twice a year. It only takes a little extra effort to have a great set of teeth and a nice smile!
Hugh Silk, M.D., is Assistant Professor of Family Medicine at the University of Connecticut School of Medicine, Farmington, Connecticut. He received his medical degree from McMaster University, Canada. He completed his residency in family practice at the University of Massachusetts. He also teaches and sees patients at Asylum Hill Family Practice Residency in Hartford, CT. His clinical interests include oral health, family centered maternal/child care, and school health.
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