National Children’s Dental Health Month is sponsored every February by the American Dental Association (ADA) to raise awareness about the importance of developing good habits at an early age and scheduling regular dental visits to help ensure a lifetime of good oral health.
Whether you have kids or just love kids, there is no doubt that it can be a challenge to keep up with them. Parents understandably have many questions about caring for their children’s teeth, and with the many conflicting messages in the media it’s hard to know what’s best. Your dental health professional can help sort out all the information, but there are some important guidelines to bear in mind:
Taking care of your child’s oral health actually begins even before pregnancy!
Expectant parents should meet with their dentist and pediatrician to discuss nutritional guidelines for pregnant mothers and children, as well as important developmental milestones. Every child is different, but in general you can expect that:
- 6 weeks after conception the early tooth “bud” forms.
- 3 to 4 months gestation the hard tissue that surrounds the teeth is formed,
- Beginning 4-6 months after birth, the first baby teeth begin to erupt – often sooner for girls than for boys, and permanent teeth are already forming under the gums.
- Beginning at about age 6, the first permanent molar erupts behind the last baby tooth and soon after, the front baby teeth begin to fall out to make room for the permanent ones.
The American Academy of Pediatric Dentistry recommends that a child have their first dental office visit before age 1.
While this might seem surprising, one in four children develops a cavity before they are four years old. Your child’s oral health is influenced by many factors including the oral health and habits of the parents and siblings, genetics and diet. It’s a good idea meet with dental professionals early on to discuss potential problems before they start, and to establish a care plan for your child that includes:
- Caring for an infant’s or toddler’s mouth at home and at school
- Decisions about using fluoride
- How to manage oral habits like pacifier, finger or thumb sucking
- How to prevent and manage trauma and emergencies
- Teething and developmental milestones
- Diet and oral health
Plan ahead for bottle battles and sippy-cup strategies
Milk, formula, juice, and other drinks such as soda all have sugar in them. The more time the teeth are bathed in these liquids, the greater the risk of getting cavities. Most parents will agree that weaning children from bottles and sippy cups is easier said than done; but from an oral health perspective, it’s smart to eliminate them completely around one year- or as soon as possible after tooth eruption. The National Institute of Health suggests other strategies for minimizing risk, including:
- Don’t put children to bed with a bottle containing anything but water.
- Don’t let baby have a bottle or sippy cup to carry around between feedings.
- Don’t dip baby’s pacifier in anything sweet.
Brushing and flossing is important, but it’s not as easy as it looks!
Seasoned parents know that once children start asserting their independence, it can be difficult to convince them to cooperate with someone trying to brush their teeth. Teach children to accept help – and someone else’s hands in their mouth- from infancy. Even before the first tooth appears, it’s a good practice to remove sugars and bacteria by gently wiping the gums with a soft damp cloth after feeding. Introduce an age-appropriate toothbrush (the right size and shape) once several baby teeth have come in. Use a fluoride free toothpaste until the child can be trusted not to swallow it- and use only a pea sized drop on the brush.
It’s encouraging when a child enjoys brushing and does it often, but most children don’t have the motor skills and manual dexterity to brush by themselves until they are at least eight or nine. Until that time, they will need help and supervision. Every child is different, so talk to your dental provider to find out how your child is doing and what you can do to help.
Let’s face it- flossing is hard to do, even for grown-ups. Children have an extra hard time, because they lack the coordination to do it until they are teens. Disposable hand held floss “picks” can help, but it’s easy to misuse them and cause an injury to the gums. Let children begin practicing once their permanent front teeth erupt around age 7. Before that, and for all of the back teeth, give them a hand!
X-rays are essential. If the dentist can’t see a cavity, chances are you can’t either.
It is very common for parents to say, “My child doesn’t need x-rays. He doesn’t have any problems”, but cavities often begin between the teeth where they can’t be seen, and where the toothbrush doesn’t reach. By the time pain is felt the cavity is often big enough to require a large filling, a root canal or an extraction.
Sometimes, a dentist will recommend taking X-rays on a very young child if they are at high risk for cavities; but more often than not, children can’t hold the x-ray film or sensor in their mouth without help until they are somewhat older. This is generally not a problem, because baby teeth usually have plenty of space between them to allow the dentist to visually check for cavities.
Once the first permanent molar erupts at about age 6, spaces begin to get tighter and it’s important to take x-rays to check for cavities between the teeth. Sometimes, fluoride can heal early cavities so they don’t have to be drilled.
Furthermore, some children never develop one or more of their permanent teeth. This is rarely a major problem but it is important to know about it in advance to plan ahead for braces (orthodontics) if necessary. When no permanent tooth exists, the baby tooth doesn’t always loosen and fall out by itself. In fact, it’s very possible to keep the baby tooth in place for many years as long as it is well cared for, thereby avoiding a variety of potential complications.
Modern Dental X-rays are extremely safe, and without them your dentist has an incomplete picture of your child’s oral health. Knowing in advance what is developing under the gums and between the teeth can help avoid long term problems.
Fluoride is safe, effective and has been recommended by the American Dental Association for 50 years for the prevention of cavities. The dental provider may apply it during checkups in a gel, foam, rinse or varnish; and a variety of prescription and over the counter products containing fluoride are available for home use. The dentist or hygienist will provide you with individualized recommendations for your child.
The American Dental Association advises against using fluoridated water for mixing infant formula because it can damage developing tooth enamel; the local health department can provide information about water fluoridation. Parents should keep fluoride products, including toothpaste out of children’s reach and be alert for signs of fluoride overdose (abdominal pain, vomiting, and diarrhea) if they suspect a child has ingested a large amount of these products.
Permanent molars (and sometimes premolars) develop with deep narrow grooves in them. Bacteria that cause cavities become trapped in the grooves, but toothbrush bristles are too large to clean them. A sealant is a plastic coating that is painted on to the chewing surface of to fill in the grooves and create an easily cleanable surface. The sealant can’t be applied once an obvious cavity has developed, so the dentist may recommend sealants as soon as the first permanent molars begin to erupt around age 6.
Children’s oral health is a team effort… and it’s all about prevention.
Armed with the right information and a good oral health team, teachers, parents and caregivers can help establish the foundation necessary for life-long oral health. It’s a team effort that requires a variety of different strategies from good nutrition to regular professional care.
It’s probably no surprise to hear that despite our best efforts to intervene, kids don’t always brush very well; and to make matters worse they probably (at least occasionally) eat and drink things that they shouldn’t. They fall down, they have accidents, and they are sometimes faced with oral health issues that no one can prevent or predict.
The key to a lifetime of healthy smiles in spite of it all is to have a plan in place to compensate for kids being… well, kids.