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| Childhood Cavities Are on the Rise But You Can Protect Your Child’s Smile By Kathy Sena
Early-childhood cavities are definitely on the rise, agrees Dr. Indru Punwani, D.D.S., M.S.D., professor and head of the department of pediatric dentistry at the University of Illinois, Chicago. In fact, dentists are now seeing cavities in children as young as 15 to 18 months, Punwani says. And heavy decay and dental infections can have devastating effects on the quality of a child’s life, adds Neal G. Herman, D.D.S., clinical professor of pediatric dentistry at the New York University College of Dentistry. “Pain, swelling and early tooth loss may result in eating and nutritional difficulties. These, in turn, can cause lethargy, impaired learning, poor behavior, moodiness and a general failure to thrive,” Herman says. To make matters worse, treating cavities in very young children comes with certain risks, Punwani explains, because at this age “we have to use drugs to sedate the child” before treatment. And at any age, cavities are just not fun. Much better to head off decay in the first place. Fortunately, “caries (cavities) are totally preventable,” Punwani explains. But fighting cavities requires parents to start teaching good dental habits early—and to stay vigilant as kids get older. Here’s what you can do to help ensure a cavity-free future for your child.
“It used to be that you didn’t really see caries until about 5 years of age,” Punwani notes. So, why the change? “The use of the bottle is the number-one culprit,” he says, explaining that it’s not giving a baby or toddler a bottle, per se, that causes cavities, but “using it as a pacifier rather than as a way to give nutrition.” When a child is allowed to have a bottle of formula or juice (or, worst-case scenario, a sugary drink) for an indefinite period of time, she will tend to use it as a pacifier, sucking on it throughout the day. The teeth are bathed in the sugars from the juice or formula for long periods of time, increasing the likelihood of tooth decay. That’s also the reason a baby or toddler should never be put to bed with a bottle, Punwani says. It’s important to remember that breast milk, too, contains lactose, a sugar. “So if the baby is allowed to fall asleep at the breast, the breast is being used as a pacifier of sorts,” Punwani says. While the problem is not of the same magnitude as that caused by unlimited access to a bottle, parents should be aware of the potential for decay when a baby is allowed to fall asleep at the breast, he adds. The American Academy of Pediatric Dentistry (AAPD) suggests avoiding nursing children to sleep or putting anything other than water in their bed-time bottle. Even if you use the bottle for regular feeding times only, try to switch to a sippy cup by your child’s first birthday, Punwani advises.
The AAPD recommends scheduling a first dental visit when the first tooth erupts or no later than the first birthday. “The dentist will check to make sure the teeth are well-formed and that the enamel is not defective,” Punwani says. This is also a good time to ask questions about caring for your child’s teeth. If something sounds confusing, ask for a demonstration from the dentist or hygienist. Be sure to ask your dentist about whether your local water is fluoridated. If it’s not, she may want to discuss topical-fluoride application during dental visits, the use of fluoride gel at home or the use of prescription fluoride supplements. (These come in drops for younger children and in chewable tablets for older kids.)
Punwani says researchers are now finding that mothers with active cavities in their own mouths can transmit the cavity-causing bacteria to their infants through kissing, eating from the same spoon, the baby putting fingers in mom’s mouth and then his own, etc. Herman notes that one way to help combat this transmission of bacteria is for the mother to practice good oral hygiene during pregnancy and the post-partum period. “For most people, brushing teeth twice daily with a fluoride toothpaste, flossing and using an over-the-counter fluoride mouth rinse” will do the trick.
Even before a baby cuts her first tooth, parents should be wiping the gums clean with a bit of moistened gauze wrapped around the finger or just a moistened, clean baby washcloth. When the teeth begin to erupt, continue this wiping process after meals and before bed. According to the AAPD, fluoridated toothpaste should be introduced when a child is 2 to 3 years old. Before that, parents should clean the child's teeth with water and a soft-bristled toothbrush. When toothpaste is introduced, parents should supervise brushing and make sure that the child uses no more than a pea-sized amount on the brush. Children should spit out and not swallow excess toothpaste after brushing. Punwani stresses that fluoride is potentially harmful in large amounts and should be treated like a drug. Toothpaste—especially in kid-friendly flavors—should not be left unattended where young children can reach it. Parents and caregivers should monitor all tooth-brushing at this age. Swallowing too much toothpaste can make a child sick and can also lead to fluorosis, a condition in which the teeth can become damaged and discolored. Up to ages 6 or 7, children need supervision when brushing, especially to help with blind spots, Punwani says. He recommends using disclosing tablets as part of a random check now and then to show the child where his brushing is missing.
While the novelty of using a “kiddie” toothbrush, either battery-operated or plug-in, might make brushing more fun, studies have shown these brushes are no more effective than an old-fashioned manual toothbrush, Punwani says. Still, if a little fun gets kids to grab their toothbrush more often, that’s not all bad. Some of these brushes even include built-in timers. There are, of course, more sophisticated (and more expensive) electric toothbrushes available, such as Sonicare, which can help clean more thoroughly between teeth and under the gum line. However, the experts I spoke with said a good old-fashioned toothbrush—with soft bristles to prevent gum damage—will work just fine for kids. Punwani recommends flossing between your child’s teeth daily as soon as the baby teeth come together—at about age 2 ½. No need to be aggressive, he says. “You just want to disrupt the bacterial flora between the teeth.” By about kindergarten or first grade, you can start to teach kids how to floss on their own. Any earlier than that and a child may do more harm than good. “The training is not a one-shot deal,” Punwani emphasizes. “It can take five to six training sessions for a child to learn how to do it right.” Asking your dentist or hygienist for a lesson (for both you and your child) on how to floss your child’s teeth can be helpful.
Dental sealants are yet another way to help kids prevent cavities. A pediatric dentist might describe this procedure as “tooth painting” to a young child. The sealant is brushed onto the crevasses on the chewing surfaces of the teeth, filling them in, and thus creating a smoother surface that is less likely to trap food particles and cause cavities. The application is fast and comfortable and can effectively protect teeth for many years, according to the AAPD. Punwani recommends sealants for the biting surfaces of high-risk permanent molars and wisdom teeth. “There’s a 65-percent retention rate over a 5-year period,” he says, noting that even if the sealants eventually come out or simply wear away, the teeth will have likely benefited from the sealants “because the tooth is at it’s most vulnerable time (for decay) right after it comes into the mouth.”
One can of soda contains about 10 teaspoons of sugar. And many older kids and teens who frequent fast-food restaurants are super-sizing their sugar consumption with extra-large drinks that can contain up to a whopping 25 teaspoons of sugar, says Punwani. That can translate into super-sized cavities too. To make matters worse, they tend to sip these drinks over long periods of time—not unlike those sippy cups they loved to hang onto when they were little—while hanging out with friends, watching T.V. or playing video games. This, of course, keeps sugar in contact with the teeth even longer than usual. Not good. Kids’ frequent snacking, too, can promote cavities. “It’s better to have sugar as part of a meal than to do a lot of in-between snacking,” says Punwani, who adds that it takes about 45 minutes of “oral clearance time” for the acid balance in the mouth to return to normal after eating. Frequent snacking doesn’t allow that natural process to happen, contributing to a cavity-promoting environment. When you add braces to the mix, fighting cavities becomes even more challenging. Kids with braces can often benefit from using fluoride gels or rinses, which can reach areas where brushing sometimes can’t, Punwani says. “The fluoride can help remineralize the areas of the teeth around the brackets,” he explains. For more solutions to your family’s dental dilemmas, pick up the March and April issues of Sacramento Parent, with parts 2 and 3 in our 3-part series on keeping kids’ smiles healthy and bright. Copyright 2008 Kathy Sena.
Check out our March and April issues for more advice on how to
keep kids’ smiles healthy and bright! American Academy of Pediatric Dentistry American Dental Association
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