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Early Childhood Dental Health

Caring for the teeth of infants, toddlers, and young children

Volume 7, Number 6 - August, 2003

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Download PDF version of this newsletter [933k]

Inside HealthHints....

• Early Childhood Dental Health
• A Healthy Start
• Brushing for Beginners
• Dental Care
• Cavities
• Baby Bottle Tooth Decay
• Breastmilk Issues
• Thumb-sucking
• Teething
• Nutrition for a Healthy Smile
• Caution: Fruit Juices
• Dental Sealants
• When Accidents Happen
• Bad Breath
• Oral Piercing: A note for older children
• Family Fun
• Programming Tips
• HealthHints Announces Web-Based Format
• References

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Early Childhood Dental Health: Caring for the teeth of infants, toddlers, and young children

Healthy teeth and gums are essential to a healthy body (American Dental Association, 2003h). "A child needs strong, healthy teeth to chew properly and speak clearly. In addition, strong, healthy teeth help give your child's face its shape (American Dental Association, 2003j)." Left untreated, pain and infection caused by tooth decay (also called dental caries) can lead to problems in eating, speaking, and the ability to learn (U.S. Department of Health and Human Services, 2001b).

It is important for parents to make it a top priority to help their children develop good oral health practices (American Dental Association, 2003k). Parents can start their children off right by setting a good example with their own dental care routine (American Dental Association, 2003j). To develop good oral health practices, parents must help their children clean their teeth, as well as help them to develop healthy dietary and behavioral practices that will give them the best chance for developing healthy teeth and gums.

In this issue of HealthHints, we will look at healthy cleaning and brushing practices, when to seek dental cleanings and care, healthy dietary practices, breastfeeding and bottle feeding issues, teething, thumb-sucking, primary and permanent teeth, dental sealants, and more.

A Healthy Start: Dental care begins before birth and before teeth erupt

Giving a child a healthy start on strong teeth can begin in utero. "Good health habits are important for development of the unborn child (American Dental Association, 2003k)." Between the third and sixth months of pregnancy, a child's teeth begin to form. That's why it is especially important for women to consume dairy products during pregnancy (unless otherwise instructed by a doctor). Dairy products, such as milk, cheese, and yogurt, are the best sources of calcium, which is the main building block for teeth and bones (American Dental Association, 2003k).

At birth a baby already has 20 primary teeth (also called "baby" teeth), some of which are almost completely formed in the jaw (American Dental Association, 2003k). Baby teeth help your child chew food, speak clearly, and leave space so the permanent teeth can grow in straight (American Academy of Family Physicians, 2000). Although you can't yet see the teeth at birth, it is important to keep the gums free of plaque, residual food, and bacteria that can harm erupting teeth later (American Dental Association, 2003j). Thus, "you should start caring for your child's gums and teeth at birth (American Academy of Family Physicians, 2000)." To clean baby's gums, simply wipe them with a soft, wet cloth or clean gauze pad after each feeding to keep them free of plaque and bacteria (American Academy of Family Physicians, 2000; American Dental Association, 2003k).

Brushing for Beginners: Brushing should begin as soon as the first tooth erupts

Babies' first four teeth usually begin to erupt between ages six months to one year. Typically, some of the first teeth to appear are the upper and lower central incisors (top and bottom center, respectively) and the upper and lower lateral incisors (either side of the central incisors). See the American Dental Association's Primary Teeth eruption chart at http://www.ada.org/public/games/animation/index.asp for more information on primary tooth eruption (American Dental Association, 2003i).

As soon as the first teeth start to erupt, parents should begin to brush them twice a day with a soft, child-sized toothbrush and water. Toothpaste is not needed before the child reaches age two -- if you are considering using toothpaste at this age, consult your dentist for recommendations. (Note: Some toothpastes are not recommended for children under age six. When choosing a toothpaste, read the manufacturer's label or consult your dentist.)

At age two, a child should begin using a pea-sized amount of fluoride toothpaste. "Fluoride helps make teeth strong and prevents tooth decay (American Academy of Family Physicians, 2000)." Between about the ages of 2 to 6 years, parents should assist in brushing their children's teeth or supervise their brushing to be sure the toothpaste is spit out and not swallowed. Children should be taught to brush thoroughly, spit out the toothpaste and to rinse with water. Swallowing too much fluoride can result in white spots on the teeth. Additionally, if the local water supply is not fluoridated, you may need to give your child a fluoride supplement (your dentist can make recommendations regarding fluoride).

As soon as two teeth touch, parents should begin to help their child floss. Cleaning between the teeth is important for removing the plaque that a toothbrush cannot reach. Parents will need to assist their children in flossing until about age seven, until they have the dexterity to do it themselves (American Dental Association, 2003j; American Dental Association, 2003k; American Academy of Family Physicians, 2000).

Dental Care: Scheduling your child's first visit to the dentist

The American Dental Association recommends seeing a dentist within 6 months of the first tooth eruption, and no later than the child's first birthday (American Dental Association, 2003e). The goal of the first dental visit is to help you prevent any problems related to the mouth, teeth, and gums. At the first visit, you can expect your dentist to:

• check for decay and other problems
• assess risk for dental disease
• teach you how to clean your child's teeth
• identify your child's fluoride needs
• recommend how often your child should have dental visits (American Dental Association, 2003e; U.S. Department of Health and Human Services, 2001b).

Cavities: The most common chronic disease of childhood

"Dental caries [cavities] is the single most common chronic disease of childhood, occurring five to eight times as frequently as asthma, the second most common chronic disease in children (Department of Health and Human Services, 2000)."

Children are susceptible to decay as soon as their first teeth appear. "More than half of all children have caries [cavities] by the second grade... (U.S. Department of Health and Human Services, 2000)."

It is important for young children to retain their primary (baby) teeth until they come out naturally and are replaced by permanent teeth. Healthy primary teeth can enhance self-image, while missing primary teeth (due to decay) may cause a child to become self-conscious and reluctant to smile. Pain and infection from dental decay can also affect the ability to eat and speak well. Tooth decay can ultimately result in impaired speech, failure to thrive, absence from school, inability to concentrate on school work, and reduced self-esteem (U.S. Department of Health and Human Services, 2000).

Baby Bottle Tooth Decay: Early childhood tooth decay

Tooth decay that occurs in infants is often called baby bottle tooth decay (BBTD) or early childhood caries (ECC). Prolonged contact with almost any liquid other than water (e.g., formula, milk, juice, soft drinks, sugar water, sugared drinks, etc.) can result in tooth decay. Allowing a child to suck from a bottle or breastfeed for longer than the mealtime, whether during awake hours or at naptime or nighttime, can cause BBTD. This can also occur if a child is repeatedly given sweetened liquids during the day. When these liquids pool or build up in the mouth, around the teeth, "the natural or added sugars found in the liquid are changed to acid by germs in the mouth (American Academy of Pediatrics, 2000.)" This acid can then actually dissolve the teeth causing them to decay (American Academy of Pediatrics, 2000; American Dental Association, 2003d).

Not only does it matter what you put in your baby's bottle, but how often and for how long (American Dental Association, 2003d; American Dental Association, 2003e). When you give food with a meal, more saliva is produced in the mouth, which helps to wash food and germs away from the teeth. However, food given between meals without brushing or cleaning the teeth and gums can further create decay. This decay can destroy the baby teeth, cause problems affecting the permanent teeth, and lead to painful and expensive dental procedures, such as extractions and restorations (American Dental Association, early childhood tooth decay, 2003). "The pain, psychological trauma, health risks, and costs associated with restoration of these carious teeth for children affected with ECC can be substantial (U.S. Department of Health and Human Services, 2000)."

The good news is...baby bottle tooth decay is preventable by following a few pointers in caring for your child:

• Never allow your child to fall asleep with a bottle containing liquids other than water. (Note: In addition to problems with tooth decay, children who drink bottles while lying down may be more prone to getting ear infections [American Academy of pediatrics, BBTD, 2000]. Placing baby on his or her back, rather than stomach, to sleep without a bottle can actually reduce his/her risk for ear infection, as well as fever and runny nose [Cable News Network, 2003]).
• Do not use the bottle as a pacifier. If your child needs comfort between regular feedings, at night, or during naps, give the child a clean pacifier (never dip a pacifier in any sweet liquid).
• Avoid filling your child's bottle with liquids such as sugar water, sugared drinks, or soft drinks. Better yet, when not breastfeeding or taking formula, choose water rather than other liquids. When juices are offered they should be from a cup. (See more information on fruit juices later in this issue of HealthHints).
• Encourage your child to drink from a regular cup when he/she nears one year of age. A cup cannot be taken to bed like a bottle. Infants should be weaned from the bottle at 12 to 14 months of age.
• Keep your child's mouth clean. Wipe the gums with a clean gauze pad or washcloth and brush any baby teeth that have erupted with water and a soft child-sized toothbrush. Consult your dentist if your water supply does not contain fluoride (American Academy of Pediatric Dentistry, 2001; American Academy of Pediatrics, 2000; American Dental Association, 2003d).

Thumb-sucking: Thumb- and finger-sucking in early and late childhood

Thumb- and finger-sucking is a normal behavior for young children. In fact, most children suck their thumb or finger(s) at some time early in life. The need to suck is present in all infants -- some infants even suck their thumbs in utero.

Children need to be encouraged to cease thumb-sucking, however, by the time their permanent front teeth are ready to erupt (usually around age six), since thumb-sucking can eventually lead to crooked teeth, bite problems, and changes in the roof of the mouth.

Many children who suck their thumbs or fingers give up the behavior by age 6 to 7 months. The only time it may cause problems is if thumb- or finger-sucking goes on beyond 6 to 8 years of age, when permanent teeth are erupting and it can affect the shape of the child's mouth or teeth. Most children give up this behavior by age 4 and do no harm to their teeth.

As children grow and develop, the need to suck usually goes away by the time they are 6 to 8 years old. Additionally, increases in peer pressure usually cause children to control this behavior.

If your child has a thumb- or finger-sucking habit, the first step in dealing with it is to ignore it. Most often the habit will subside in time. Harsh words, teasing, or punishment can upset a child and actually make the habit worse. Children age 3 and older may suck their thumb or fingers to relieve boredom. Involving your child in fun, hands-on activities can help alleviate the sucking. Praise your child when he/she does not suck his or her thumb or fingers. Try a sticker chart, or other small daily rewards along with gentle reminders to help encourage cessation of thumb- or finger-sucking.

If your child continues the behavior, consult your dentist or pediatrician who can recommend a thumb guard (plastic cap taped to the thumb), or a device placed in the mouth that prevents the thumb or fingers from putting pressure on the teeth and palate -- usually making the behavior unpleasant wherein the child removes the thumb or fingers from the mouth. Note: Treatment options should be described to your child. Allowing your child to be a part of the decision-making process will likely yield the best results for healthy teeth and palate (American Academy of Pediatrics, 1997; American Dental Association, 2003j; American Academy of Family Physicians, 2000).

Teething: Soothing your child through the transition

Teething can be a painful process. Teething usually occurs between ages 4 months and 2 1/2 years. When babies are teething, their gums may become sore, tender, and swollen where the tooth is trying to erupt. You can make going from a toothless grin to a toothy smile less painful by rubbing the gums with a clean finger, a small cool spoon, or wet gauze pad, or by allowing your child to use a teething ring or pacifier. If your child continues to be upset or uncomfortable, consult your pediatrician or pediatric dentist.

Many parents and care providers have been told that teething may cause a child to run a fever -- teething does NOT cause a fever. If your child has a fever during the time he/she is teething, it should be treated as a separate medical concern (American Dental Association, 2003e).

Nutrition for a Healthy Smile: Diet and dental health

A healthy, well-balanced diet is important for healthy teeth and gums. To get a well-balanced diet, parents should offer their children foods from the following major food groups:

1. breads, cereals, and other grain products
2. fruits
3. vegetables
4. meat, poultry and fish
5. milk, cheese, and yogurt.

Sweets (candy and cookies), starchy foods (crackers), and sticky foods (raisins) stay in the mouth longer, and can easily cause tooth decay.

Decay occurs when foods meet up with germs or bacteria that live in your mouth. These bacteria love sugars and starches found in many foods. When you hear your dentist talk about plaque, he is talking about a sticky film of bacteria. If you don't brush immediately following a meal or snack, plaque bacteria use the sugars and starches to form acids that can destroy the hard surfaces of the teeth, known as tooth enamel...and ultimately the tooth decays.

Not only is what you eat important, but also when you eat. During a meal, a lot of saliva is produced, which helps wash foods away from the teeth. Frequent snacking and drinking of sugared beverages can increase the risk of tooth decay because it increases the number of harmful acid attacks on the tooth enamel.

When helping your child choose snacks, choose fruits and vegetables most often. For older children, another good choice is a piece of sugarless gum, which can increase the flow of saliva and help wash away the acids that attack the teeth.

Of course, when possible, you should always brush your teeth and help your child brush his or hers after meals as well as after snacks. At the least, you should be sure to brush your child's teeth at least twice a day (American Dental Association, 2003a; American Dental Association, 2003j; American Family Physicians, 2000).

Dental Sealants: Sealing out cavities

According to Healthy People 2010 (goals for the year 2010), increased use of dental sealants, along with toothbrushing with fluoridated toothpaste, community water fluoridation, and sound dietary practices are needed to reduce tooth decay (U.S. Department of Health and Human Services, 2000).

Dental sealants are thin, plastic coatings that are painted onto the chewing surfaces of the back teeth. Getting sealants is painless and protective. "By covering the chewing surfaces of the molars, sealants keep out germs and food that can cause decay (U.S. Department of Health and Human Services, 2001a)."

Parents should consider having dental sealants applied to their children's teeth as soon as the permanent teeth come in. Your dentist may also recommend sealants for baby teeth if your child has deep pits or grooves in the teeth, since baby teeth are necessary to hold the correct spacing for permanent teeth.

Sealants are typically less costly than fillings per tooth and a lot less painful, since decay must be cleaned out by drilling and then filling the tooth. Although sealants have been around for over 25 years, many parents still do not know about them and their effectiveness in sealing out decay. Talk with your doctor about having your children's teeth sealed to protect their dental health (American Dental Association, 2003k; U.S. Department of Health and Human Services, 2001a).

Bad Breath: Helpful hints for handling halitosis

"What you eat affects the air you exhale.... Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled (American Dental Association, faq: bad breath, 2003)."

The first step in fighting bad breath (halitosis) is brushing and flossing regularly. Secondly, don't use tobacco products, which can cause bad breath. If you experience dry mouth, you will want to ask your doctor about artificial saliva, which will help to cleanse the mouth by removing food particles that may cause bad breath. (Foods that collect on and between the teeth can rot, causing an unpleasant odor).

Bad breath, however, may also be an indicator of Periodontal (gum) disease, or some other medical disorder, such as chronic sinusitis, local infection in the respiratory tract, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney problems. If you or your child is experiencing chronic bad breath, consult your dentist.

Family Fun: Making dental care fun for your children

One of the best ways to help your children develop good dental health habits is to make it fun for them. To accomplish this, try the following ideas with your kids:

• Brush together.
• Take turns brushing each other's teeth.
• Read books about good dental care.
• Purchase your child a cute toothbrush, or one with their favorite character on it -- let your child choose.
• Count out loud as you brush teeth (e.g., "Tooth number 1 is clean, tooth number 2 is clean...."). This is also great for encouraging counting.
• Pretend to brush your child's stuffed animals' teeth or ask if your child wants to show his/her stuffed animal how to brush.
• Make up a silly song to brush your child's teeth by or create your own toothbrushing ideas. Have fun! (Adapted from Del Pharmaceuticals, 2003.)

For more fun ideas, see the American Dental Association Kid's Corner at http://www.ada.org/public/games/index.asp.

Programming Tips

Inserted in this issue of HealthHints county Extension Agents will find a brochure entitled "Tips for Terrific Teeth: A Guide for Parents" by Courtney Schoessow. This handout would make an excellent resource for programs with Head Start or any other early childhood or day care audiences.

County Extension agents can also link to this and other related resources at our website at: http://fcs.tamu.edu/health/index.htm.

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References

• American Academy of Pediatrics (2003). AAP warns parents and pediatricians that fruit juice is not always the healthiest choice [on-line]. Available: http://www.aap.org/advocacy/archives/mayjuice.htm.
• American Academy of Pediatrics (2000). Baby bottle tooth decay [on-line]. Available: http:// medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/ M_ContentItem/ZZZKBW52R7C.html&soc=AAP&srch_typ=NAV_SERCH.
• American Academy of Pediatrics (1997). Thumbs, fingers, and pacifiers: Guidelines for parents [brochure]. American Academy of Pediatrics, Division of Publications. Elk Grove Village, IL.
• American Academy of Pediatric Dentistry (2000). Policy on breastfeeding [on-line]. Available: http://www.aapd.org/member/referencemanual/pdfs/02-03/Breast%20feeding.pdf.
• American Academy of Pediatric Dentistry (2001). Policy on baby bottle tooth decay (bbtd)/early childhood caries (ecc) [on-line]. Available: http://www.ada.org/public/topics/bottle.html#aapd2f.
• American Dental Association (2003a). ADA dental minute: Your diet and dental health [on-line]. Available: http://www.ada.org/public/media/minute/DmVo110/dm-diet.html.
• American Dental Association (2003b). Frequently asked questions: Bad breath (halitosis) [on-line]. Available: http://www.ada.org/public/faq/breath.html.
• American Dental Association (2003c). Frequently asked questions: Diet and dental health [on-line]. Available: http://www.ada.org/public/daq/diet.html.
• American Dental Association (2003d). Frequently asked questions: Early childhood tooth decay [on-line]. Available: http://www.ada.org/public/faq/bottle.html.
• American Dental Association (2003e). Frequently asked questions: Infants and children [on-line]. Available: http://www.ada.org/public/faq/infants.html.
• American Dental Association (2003f). Frequently asked questions: Oral piercing [on-line]. Available: http://www.ada.org/public/faq/piercing.html.
• American Dental Association (2003g). Oral health topic: Early childhood tooth decay [on-line]. Available: http://www.ada.org/public/topics/bottle.html.
• American Dental Association (2003h). Oral health topic: Infants and children [on-line]. Available: http://www.ada.org/public/topics/infants.html.
• American Dental Association (2003i). Oral health topic: Primary teeth eruption chart [on-line]. Available: http://www.ada.org/public/topics/primaryteeth.html.
• American Dental Association (2003j). Quick tips for parents and caregivers of young children [on- line]. Available: http://www.ada.org/public/topics/parents/parentips.html.
• American Dental Association (2003k). Tips for parents [on-line]. Available: http://www.ada.org/ public/topics/parents/tips.html.
• American Academy of Family Physicians (2000). Taking care of your child's teeth [on-line]. Available: http://www.aafp.org/afp/20000101/20000101b.html.
• Cable News Network (2003). Fewer ear infections for babies who sleep on backs [on-line]. Available: http://www.cnn.com/2003/HEALTH/parenting/05/12/babies.earinfections,reut/index.html.
• Del Pharmaceuticals (2003). Ten ways to make brushing fun [on-line]. Available: http:// www.orajel.com/baby/baby_make_brushing_fun.htm.
• U.S. Department of Health and Human Services (2000). Healthy people 2010: Oral health [on- line]. Available: http://medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ ZZZHKKKIMCC.html&soc=GOV&srch_typ=NAV_SERCH.
• U.S. Department of Health and Human Services (2001a). Seal out dental decay [on-line]. Available: http://www.nidcr.nih.gov/health/pubs/sealants/main.htm.
• U.S. Department of Health and Human Services (2001b). Trends in children's oral health [on-line]. Available: http://www.mchoralhealth.org/PDFs/OHTrendsfactsheet.pdf.

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