Infants' teeth begin to erupt around the age of 6 months, but some children do not have their first tooth until 12 to 14 months. Most children have their first full set of teeth by age 3. These primary teeth are susceptible to decay as soon as they appear in the oral cavity, and dental caries matter more than most people think.
The American Academy of Pediatrics considers early childhood caries to be the number one chronic disease affecting young children. Dental caries in infants or early childhood caries is often referred to as baby bottle tooth decay. The decay may be so severe that the affected tooth may need extraction. When primary teeth are lost too early, the surrounding teeth may drift into the empty space. This movement makes it difficult for the permanent teeth to have proper room for eruption, causing these teeth to be crooked or crowded.
Role of Bacteria
Dental caries is preventable. The American Dental Association recommends that parents take their children to a dentist within six months after the first tooth appears, but no later than the child's first birthday. Cavity-causing bacteria can be transmitted from caregiver to infant, so parents should also visit their dentist to help ensure their own oral health. Caregivers should refrain from cleaning the infant's pacifier with their mouth or sharing eating utensils with the infant.
Oral Hygiene Home Care
Parents may begin cleaning their infant's mouth during the first few days of birth by wiping the gums with a clean, moist gauze pad or washcloth. When teeth begin to erupt into the oral cavity, the parent may gently brush the infant's teeth twice a day with a child-size toothbrush and water. A pea-sized amount of fluoride toothpaste may be added for children older than 2 years old, and the child must be able to spit out the toothpaste. Flossing should begin once two teeth come in contact.
Parents should care for their child's teeth until they feel comfortable that the child is able to care for his or her own teeth. Starting children early with good oral hygiene can lead to a lifetime of good dental health.
An inadequate amount of fluoride may increase an infant's risk for early childhood caries. Fluoride strengthens the enamel of teeth, making them more resistant to decay. It is found in toothpaste, mouthrinses and often added to community tap water. Bottled water may not contain fluoride. Parents should discuss with a dentist or pediatrician the fluoride needs of their child. Fluoride supplementation may be recommended.
Dietary factors contributing to dental caries in infants has been considered by both the American Academy of Pediatrics and the American Dental Association. Increased risk for dental caries has been affirmed to be associated with an excessive intake of sugar by an expert panel of the World Health Organization.
Nutritional recommendations for infants include:
- Providing the infant only formula, milk or breast milk in bottles. Liquids such as sugar water, juice or soft drinks should be avoided.
- Infants should also finish their bedtime and nap time bottles before going to bed.
- A pacifier should never be dipped in sugar or honey.
- The child should be encouraged to drink from a cup by his first birthday.
- During the transition to solid foods, parents should provide nutritious foods.
Following these recommendations will reduce the amount of sugar exposure to the infant's teeth.
When an infant's first tooth appears, parents should discuss with their dentist about scheduling the first dental visit. Parents should treat the first dental visit as they would a checkup with the infant's physician. Once there, the dental team will be able to provide proper guidance on how to care for the infant's teeth.