Oral Care for Children

The Primary Teeth
When infants are born, almost all of their primary or baby teeth already have formed although they still are hidden in the gums. They typically begin to erupt or cut through the gums when the baby is about 6 months old. Of course, your baby may begin teething a little bit earlier or a little later than this. That's okay. All children develop at their own pace and your 1-year-old may have a different number of teeth than your neighbor's 1-year-old child.

Usually the first baby teeth to erupt are the two bottom front teeth. Next come the top four front teeth. From here, teeth slowly begin to fill the mouth, usually two at a time on either side of the jaw. Your child should have all 20 primary teeth by the time he or she is 36 months old.

Your child's primary teeth typically will have spaces between them. Since there is a difference between the size of the permanent and primary teeth, these spaces help ensure there will be enough room for adult teeth. Spaces also make it easier to clean between your child's teeth.

Caring for Primary Teeth
Although baby teeth eventually fall out, they are just as important as permanent teeth. Baby or primary teeth:

• Help the child bite and chew food
• Make the child look more attractive
• Help the child speak correctly
• Save space for the child's permanent teeth
• Guide the permanent teeth into place

That is why it's vital that you take good care of your child's baby teeth.

You should start using a toothbrush twice a day once your baby has four teeth in a row, either on the top or bottom. Choose a soft toothbrush with polished, nylon bristles. You can make it even softer by soaking it in warm water for a few minutes. Use a pea-size amount of children's fluoride toothpaste on the toothbrush or use just water. Remember, your child will tend to swallow, not spit out, toothpaste. Swallowing too much fluoride toothpaste could lead to cosmetic problems in the permanent teeth. Keep wiping the toothless gum areas with gauze or a washcloth. Be sure to floss your child's teeth once a day as soon as two teeth touch each other. You should also talk to your pediatrician or dentist about your child's fluoride needs. If your child drinks water that isn't fluoridated, he or she may need to receive fluoride treatments or take fluoride supplements.

At some point, your child probably will want to try brushing, too. It's okay to give him or her a turn as long as you remember that you're the person in charge of keeping your child's teeth clean. He or she won't have the coordination or dexterity to do it well until he or she is 6 to 8 years old. Even then, it's important that you inspect your child's teeth each time he or she brushes. Go over them yourself for good measure.

Baby-bottle Tooth Decay
Baby-bottle tooth decay is a serious, but preventable, condition. It can occur when teeth are exposed to the sugars from carbohydrates for long amounts of time. Carbohydrates in liquids such as fruit juice and milk start to break down in the mouth into simple sugars. When these liquids are allowed to sit in the mouth, bacteria start feeding on the sugars. In the process, the bacteria produce acid, which can cause teeth to demineralize then decay if it remains in the mouth long enough.

This can happen if your baby is often:

• Put to bed with a bottle filled with formula, milk, fruit juice, sugar water, or any liquid other than plain water
• Given a bottle filled with sugary liquids or milk to calm or comfort him during the day
• Given a pacifier dipped in sugar, honey or any other sweet liquid

Human breast milk does not promote decay unless it is given with other sources of carbohydrates. Infants who get a mixed diet are at risk for dental decay. It's not just what your baby is drinking, but how often. The more time he or she has liquids other than water in his or her mouth, the higher the risk of serious decay. This is why it is dangerous to let your baby go to sleep with a bottle or use the bottle as a pacifier during the day. The teeth most often affected by baby-bottle tooth decay are the upper front teeth, although others can decay, too.

Your dentist or pediatrician might refer to baby-bottle tooth decay as early childhood caries (cavities), nursing caries or nursing-bottle syndrome. They all mean the same thing.

Baby-bottle tooth decay can occur only if your baby's mouth has a type of bacteria called Streptococcus mutans. While S. mutans constitutes less than 1 percent of the oral bacteria in a child with very little decay, it accounts for more than 50 percent in children with early childhood caries

S. mutans is common and is passed from parent to child, usually when the child is between 6 and 31 months old. This period is called the " window of infectivity." Keeping your own mouth healthy and decay-free will do much to help your child stay cavity-free.

In baby-bottle tooth decay, the top incisors typically are affected first. Often, decay occurs on the back, or tongue side of the tooth, which can't be seen easily. The top teeth in the back of the mouth are affected next, then the bottom back teeth. The lower incisors usually do not become involved because the tongue lies over them and keeps the liquid away from the bacteria on these teeth.

Decayed teeth that are left untreated can cause pain and infection. These may require extensive and complex treatment to be saved. Teeth that are very badly decayed may need to be removed to remove the infection, decrease the risk of infection spreading to the face and allow the permanent teeth to develop in an infection-free environment.

Any type of liquid that contain carbohydrates can cause baby-bottle tooth decay if it remains around the teeth. This includes formula, milk, fruit juice, fruit juice diluted with water, sugar water or any other sweet drink. Milk breaks down into simple sugars, which are food for bacteria. Water is the only liquid that is okay for your child to have in his or her mouth for longer periods of time.

Here are some tips on preventing baby-bottle tooth decay:

• Don't put your baby to bed with a bottle filled with liquids that contain carbohydrates. This includes any liquid except plain water. Even watered-down fruit juice or milk can increase the risk of decay.
• Wean your infant, in consultation with your physician, when he or she is 12 to 14 months old.
• Don't use a bottle during the day to comfort your baby unless it's filled with plain water.
• Don't dip your baby's pacifier in sugar or sugary liquids.
• Don't add sugar to your child's food.
• Clean your baby's teeth and gums after each feeding.
• Take your baby for his or her first visit to the dentist as soon as his or her first tooth erupts.
• Teach your baby to drink from a cup by his or her first birthday.
• Make sure your baby is getting the right amount of fluoride. If your town does not have fluoride in the drinking water, ask your pediatric dentist or pediatrician about fluoride supplements.

The Permanent Teeth
Sometime around your child's sixth or seventh birthday, he or she will begin losing baby teeth and adult or permanent teeth will begin to move in. It may be fine if this process starts in your child earlier or later. Each child has his or her own timetable set by heredity. Symmetry, or the order that your child's teeth come in, is more important than when they
come in.

Most often, the first permanent teeth to emerge into the mouth are the lower central incisors. However, in some children, the first permanent molars (sometimes called the 6-year molars) are the first to emerge.

Since 32 permanent teeth replace 20 primary (baby) teeth, the permanent molars farthest back in the mouth emerge in back of the primary teeth and do not replace primary teeth. The primary molars are replaced by permanent premolars, also called bicuspids. The primary incisors and canines are replaced by permanent incisors and canines.

By the time your child is 13 years old, most of his or her permanent teeth will be in place. Wisdom teeth, or third molars, come in between ages 17 and 21. However, not everyone develops every wisdom tooth. Some people don't get any. More often, wisdom teeth develop, but they may not be in the proper position to emerge through the gums, or there is no room in the mouth for them to erupt.

Until your child is between 6 and 8 years old, you should continue to help him or her brush at least twice a day — once in the morning and once before bed. It's very important to keep your child's teeth free of food particles, especially the molars. These teeth have lots of little grooves and crevices where food particles can hide.

The easiest way to help your child brush is to cradle his or her head in your one arm, while keeping your other hand free for brushing. Once children have the coordination and dexterity, they can brush on their own. However, be sure to inspect after each brushing and go over spots he or she may have missed.

A few other tips:

• Use a soft nylon toothbrush with just a small, pea-size dab of fluoride toothpaste.
• Teach your child how to spit out the foamy saliva so he or she doesn't swallow it.
• As soon as any two of your child's teeth touch each other, floss the teeth. After age 9, children have enough dexterity to begin to floss their own teeth. Flossing removes food from between the teeth where a toothbrush can't reach and helps prevent cavities.
• Talk to your child's dentist or pediatrician to be sure he or she is getting the right amount of fluoride.

Diet and Your Child's Teeth
What your child eats is important for healthy teeth, but it's just as important to be careful about when and how often they eat. A balanced diet is important for long-term dental health — teeth that grow properly and healthy gums. When and how often your child eats can have more immediate effects.

Cavities can develop when carbohydrate foods are allowed to stay in the mouth or on the teeth for a long time. Bacteria that live in the mouth feast on these food particles and create an acid that eats away at tooth enamel. Time between meals allows saliva to wash away the acid. Frequent snacking keeps the mouth acidic and decay-prone.

When most people think of sugar, they think of sucrose, which is found in candy and baked goods. But all foods containing carbohydrates ultimately break down into simple sugars. Research shows that bacteria do not discriminate. They like pretzels and potato chips just as much as lollipops.

Here are a few tips for snacking and mealtime:

• Give your child healthy snack foods, like fresh fruits, vegetables and cheeses.
• Buy foods that are sugar-free or unsweetened.
• Serve sugary or starchy foods as part of a meal rather than as a snack. Most children drink fluids during a meal that will wash many food particles off the teeth. Saliva also does a good job of clearing the teeth.
• Avoid sticky foods unless your child plans to brush right after he or she eats them. These foods get between teeth and are hard to remove from the grooves in the tooth surface. Some of these foods, which are more likely to lead to cavities, may surprise you: creme-filled sandwich cookies, dried figs, granola bars, jelly beans, oatmeal cookies, peanut butter cookies, plain doughnuts, potato chips and pretzels, puffed oat cereal and raisins.
• Offer fewer snacks. If your child is eating frequently, the level of acid in the mouth remains high for longer periods of time.
• After your child snacks, make sure his or her teeth are brushed. If this isn't possible, then have him or her rinse with water several times.
• Encourage your child to choose xylitol-sweetened or sugar-free gum.
• Never put your child to bed with a bottle filled with milk, formula, juice or soda.

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