Early Infant Oral Care

A. When will your baby start getting teeth?
Teething varies from child to child. Generally speaking, the lower front (anterior) teeth are the first to emerge. This usually happens between six and eight months of age. By age three, most children have all 20 primary teeth, although the pace and order of emergence may be different for each child.
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B. Tooth decay and early childhood caries (also known as baby bottle tooth decay) Tooth decay (also referred to as cavities or caries) is a progressive contagious disease that often begins in very young children. Decay is a result of the interaction between bacteria which are normally on our teeth and sugars in the everyday diet. The bacteria use those sugars to produce acid. A tooth exposed to this acid will lose mineral and that loss is the first step towards tooth decay.

Early childhood caries (ECC) is a severe form of decay in which many, usually the upper and/or lower front (anterior), teeth are affected.  This is usually due to nursing, drinking from a bottle of milk, formula or juice during naps or at night.

ECC is caused by frequent and long exposure to liquids that contain sugar.  The sugar pools in the child’s mouth over a prolonged period.  This allows bacteria to use the sugar as food and subsequently produce acid, which attacks the tooth enamel.

If your child has difficulty discontinuing the bottle at bedtime, the only liquid that is not harmful to the teeth is water.  If your child still has difficulty with water, you can dilute whatever you have been giving to your child with water and gradually replace it with water.
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Prevention

A. Caring for your child’s teeth
Brushing should actually begin before children are capable of doing it themselves. A wet cloth or gauze effectively cleans gums, removes plaque after nursing and establishes a good habit early on. Gentle brushing with a soft bristle brush begins with the first baby tooth and flossing when most of the primary teeth are in.

Non-fluoridated toothpaste should be used until the child is able to spit on his/her own.  This usually occurs at about three years of age. When your child is able to avoid swallowing the toothpaste, a pea-size amount of fluoridated toothpaste can be used.  Your child should always be supervised during brushing until your dentist has determined their skill level.  Generally, at around seven years of age is when a child is able to physically brush on their own.  Always keep in mind that each child is different and may need more or less help when it comes to brushing and flossing.

Your child’s teeth as well as gingiva (gums) need to be cleaned.  Using a toothbrush and floss together aid your child in establishing good oral health.  Brushing all of the teeth surfaces as well as the supporting gums is important in maintaining healthy teeth and gums.  Also, remember to brush the tongue as bacteria collects there as well.
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B. How to prevent cavities for your child
The following steps will help your child be free of cavities:

Avoid frequent snacking
Brush effectively twice a day with fluoride toothpaste
Floss once a day
Have sealants applied when appropriate
Seek regular dental check-ups
Assure proper fluoride through drinking water, fluoride products or fluoride supplements

Be sure your child has a balanced diet. Then, check how frequently he/she eats foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote dental decay. Fruits, some vegetables, and most milk products have at least one type of sugar.

Sugar can be found in many processed foods, even in some that do not taste sweet. For example, a peanut butter and jelly sandwich not only has sugar in the jelly, but also may have sugar added to the peanut butter. Sugar is also added to such condiments as ketchup and salad dressing.

The frequency and amount of time your child eats the foods high in complex carbohydrates is directly related to the risk of tooth decay. Snacks are usually a main source in causing tooth decay.  Always choose snacks that are low in complex carbohydrates and sugars, such as cheese, yogurt or vegetables.
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C. Sealants
Sealants are made of clear or shaded plastic and protect the grooved and pitted surfaces of the teeth.  The teeth most susceptible are the back teeth where most cavities in children are found.  These are usually the permanent molars and premolars.  The sealants aid in protecting teeth that are very difficult to clean with many tiny grooves and pits.  The sealant acts as a barrier to food and bacteria and reduces the risk of decay.

Sealants can last for years if properly cared for.  If your child has good oral hygiene and avoids hard and sticky foods, the sealants will last longer.  Sealants require periodic evaluation from your dentist and will need repair or replacement periodically.
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Frequently Asked Questions

A. What is a pediatric dentist?
The pediatric dentist is the specialist who is dedicated to the oral health of children from infancy through the teenage years. Young children, preteens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.

Pediatric dentists have had special training, which allows them to provide the most up-to-date and thorough treatment for a wide variety of children’s dental problems. They are trained and qualified to treat special patients who may have emotional, physical, or mental handicaps.

Because of this specialized training and commitment to comprehensive oral health, many parents wisely choose a pediatric dentist to treat their children.
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B. When do you like children to have a first dental visit?
The American Academy of Pediatric Dentistry recommends that your child visit a pediatric dentist within six months of eruption of the first primary tooth or by their first birthday. Early examination and preventive care will protect your child’s smile now and in the future.
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C. Why are primary teeth so important?
Primary teeth are important because they help with proper chewing and eating, help in speech development, and add to an attractive appearance. A child who can chew easily, speak clearly, and smile confidently is a happier child. Healthy primary teeth allow normal development of the jaw bones and muscles, save space for the permanent teeth, and guide them into place. If a baby tooth is lost too soon, permanent teeth may erupt (grow in) inappropriately. Decayed baby teeth can cause pain, abscesses, infections, and can spread to the permanent teeth. Also, your child’s general health can be affected if decayed primary (baby) teeth aren’t treated. Remember, some primary molars are not replaced until age 11-12, so they must last for several years.
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D. What is the best toothpaste for my child?
Choose a toothpaste specifically for children’s teeth and one recommended by the American Dental Association as shown on the box and tube.  These toothpastes have undergone extensive research and testing for safety in their use.

When using fluoride toothpaste, make sure your child is able to spit and doesn’t swallow any.  A condition known as fluorosis may occur if your child ingests too much fluoride.  Consider using non-fluoride toothpaste or a smaller amount of the fluoride toothpaste.
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E. Why visit the pediatric dentist twice a year when the child has never had a cavity?
Regular dental visits help your child stay cavity free. Teeth cleaning removes debris that builds up on the teeth, irritates the gums and causes decay. Fluoride treatments renew the fluoride content in the enamel, strengthen teeth and prevent cavities. Hygiene instructions improve your child’s brushing and flossing, leading to cleaner teeth and healthier gums.

Tooth decay isn’t the only reason for a dental visit. We provide an ongoing assessment of changes in your child’s oral health. For example, your child may need additional fluoride, dietary changes or sealants for ideal dental health. We may identify orthodontic problems and suggest treatment to guide teeth as they emerge in the mouth.
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F. What happens in a dental check-up?
We will review your child’s medical and dental history. We will gently examine your child’s teeth, oral tissues and jaws. The teeth will be cleaned and polished, followed by the application of a fluoride gel. We won’t just talk to you about oral hygiene instruction and dental health; we will talk to your child with easily understandable words, pictures and ideas. Your child will take responsibility for a healthy smile.
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