home articles directories family fun parents only reviews a closer look

February 2009

Giving Tooth Decay the Brush-Off

By Michelle Moncrieffe

February is National Children's Dental Health month, and although cavities are the most common chronic infection in children, they are preventable.

This morning like every morning, Michelle McQuistan and her infant daughter, Alexa, sit on the bathroom floor, face each other and brush their teeth. McQuistan, who's a dentist, speaks warmly of this morning ritual but also acknowledges the difficulty of "getting in there." The morning ritual for many of us may consist of chasing our infants with a toothbrush, then attempting to pry open a tiny mouth, and if it's a good day, we might spend a few moments brushing before releasing an undoubtedly resistant child.

With holidays, birthday parties and the rest of the social gamut that make up the life of a child, how do we ensure that by the time our children become adults, they don't have a mouth full of cavities to mark the occasion? According to the American Academy of Pediatric Dentists, it should start when your infant is a toothless cherub.

Start When Your Infant is a Toothless Cherub

It's at around 6 months old that infants' teeth make their first appearance. As soon as this happens, a child is at risk for tooth decay. Cavities are caused by the bacteria that we all have in our mouths, and it's staying on top of this with good oral hygiene practice that keeps our teeth healthy. We develop cavities when the good bacteria are losing out to the bad bacteria, says McQuistan, a member of Washington, D.C.'s, American Dental Education Association.

Pediatric dentists recommend that you schedule your first dental visit for your child as early as six months. "Early on, infants are breastfeeding or bottle feeding, and parents don't see this as real food," says pediatric dentist, Roya Pilcher, D.D.S., who practices in Washington, D.C. "Parents ask me all the time about cavities and are really surprised when I say that young children get them," she says.

In reality, it's at around 3 years old when parents take their children for their first dental visit, but by that time, according to experts, they are likely to have already been infected with dental caries, more commonly known as cavities. According to the American Academy of Pediatric Dentistry, cavities are the number one chronic infection in children. These cavities are contagious but can be prevented.

"The window of infectivity [for cavities] is between 6 to18 months," says Pilcher. Bacteria causing cavities are often transferred from caregiver to child during early infancy. This often happens from something as innocent as sharing utensils with your child--the same spoon or cup--or orally cleaning pacifiers.

With a never-ending to-do list for our children, it's easy to see how we might just leave questions around oral hygiene for our scheduled visits to the pediatrician. The American Dental Association says that early childhood cavities or baby bottle tooth decay are the diagnosis for children age 6 or under with tooth decay resulting in missing teeth or filled tooth surfaces in any primary tooth. In the best case, these teeth will gradually be replaced by permanent teeth once a child reaches 7 years old, but without adequate care she already may be infected with cavity-causing bacteria.

Care for Baby Teeth

Should we breathe a huge sigh of relief knowing that one day our children's baby teeth will be replaced by a set of adult teeth? According to McQuistan, that's part of the problem: parents rely on Mother Nature to take care of a relatively short-term condition. "Baby teeth are most important," she says. "Left untreated, decay can generate an abscess and spread to the other parts of the body. It's rare, but it happens."

We all remember losing a tooth. In fact, we lose 20 baby teeth and gain 32 adult teeth. "I've seen children start losing their baby teeth as early as 4 and as late as 8," says Pilcher. Losing a baby tooth is a natural process that might take days or sometimes weeks. Dentists say they rarely intervene by pulling a tooth, as this delicate timing of loss and gain allows for correct spacing for adult teeth, especially at the back of mouth. Kids should have fun with the process, says Pilcher, adding that we should encourage our children to "play with the loose tooth," using clean hands of course. Chewing on a carrot or bagel is another healthy way to move things along.

The First Dental Visit

When a child visits Pilcher for the first time, she gathers vital information about the oral health history of the parents, as well as assess the child's oral health. A healthy set of teeth and gums is due not only to early care and hygiene practices, but genetics and the family diet are also predictors for oral health. "One thing that parents don't understand is that it's diet, genetics and bacteria," Pilcher says. These three factors provide a looking glass for dentists as to what's likely for a child's future oral health.

While there is more temptation around the holidays (think Valentine's Day) with seemingly no escape from cavity-inducing candy, Pilcher says the key to managing those periods of excess is moderation. It's not just the availability of candy but how parents manage food and beverages. "When I hear of children having juice with every meal, that is when I worry."

Now, if you are just getting serious on the dental hygiene front for your preschooler, all is not lost. Dealing with a wiggling and wailing infant every morning becomes tiresome for the most loving of parents, but this can be avoided by starting dental care when they're young, creating healthy rituals and not necessarily shying away from candy, but according to Pilcher, "being smart and using moderation." Providing dental care for an infant takes skills and a lot of creativity. "I use a lot of distraction techniques; I keep the visits short and set goals for the visit. For the under 2s, it's a little more challenging, but every child is different," says Pilcher.

For safety's sake, consider brushing your infant's teeth in a high chair to avoid potential hazards. Make sure to lift up that upper lip. Even a seasoned professional like McQuistan admits, "It's hard to get in their mouth, but brush every day; help at least until they're 6. But let your child hold her toothbrush, because we all know that kids like to be independent." It's clear we can raise the standards of oral health for our children by making a few small changes. The American Academy of Pediatric Dentistry recommends visits to the dentist every six months and:

Michelle V. Moncrieffe is a writer and communications consultant specializing in public health, in University Park, Md. She is a mother of one son.