Keeping Your Child's Teeth Healthy

When should I schedule my child's first trip to the dentist? Should my 3-year-old be flossing? How do I know if my child needs braces?

Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don't always know the best way to do so. Here are some tips and guidelines.

When Should Kids Start Brushing Their Teeth?

Good dental care begins before a baby's first tooth appears. Just because you can't see the teeth doesn't mean they aren't there. Teeth actually begin to form in the second trimester of pregnancy. At birth, your baby has 20 primary teeth, some of which are fully developed in the jaw.

Here's when and how to care for those little choppers:

• Even before your baby starts teething, run a clean, damp washcloth over the gums to clear away harmful bacteria.
• When your baby gets teeth, brush them with an infant toothbrush. Use water and a tiny bit of fluoride toothpaste (about the size of a grain of rice). Use fluoride toothpaste that carries the American Dental Association's (ADA) seal of acceptance. (If you are using baby toothpaste without the fluoride, keep it to the same amount because you still want to minimize any toothpaste that is swallowed.)
• When two of your baby's teeth touch, you can begin flossing between them.
• Around age 2, your child should learn to spit while brushing. Avoid giving your child water to swish and spit because this can make swallowing toothpaste more likely.
• Kids ages 3 and up should use only a pea-sized amount of fluoride toothpaste.
• Always supervise kids younger than 8 while brushing, as they're likely to swallow toothpaste.

Even babies can get tooth decay. Putting a baby to sleep with a bottle can harm a baby's teeth. Sugars from juice, formula, or milk that stay on a baby's teeth for hours can eat away at the enamel (the layer of the tooth that protects against tooth decay). This can lead to "bottle mouth" or "baby bottle tooth decay." When this happens, the front teeth can get discolored, pocked, and pitted. Cavities might form and, in severe cases, the decayed teeth might need to be pulled.

When kids are 6 months old, they can switch from a bottle to a sippy cup (with a straw or hard spout). This helps prevent liquid from pooling around a child's teeth. By their first birthday, they'll have the motor skills and coordination to use the cup on their own.

When Should Kids See a Dentist?

The ADA recommends that children see a dentist by their first birthday. At this first visit, the dentist will explain proper brushing and flossing techniques and do a modified exam while your baby sits on your lap.

These visits can help find problems early and help kids get used to visiting the dentist so they'll have less fear about going as they get older. Consider taking your child to a dentist who specializes in treating kids. Pediatric dentists are trained to handle the wide range of issues associated with kids' dental health. They also know when to refer you to a different type of specialist, such as an orthodontist to correct an overbite or an oral surgeon for jaw realignment.

If a child seems to be at risk for cavities or other problems, the dentist may start applying topical fluoride even before all teeth come in (this also can be done in the pediatrician's office). Fluoride hardens the tooth enamel, helping to ward off the most common childhood oral disease — dental cavities (also called dental caries).

How Can We Prevent Cavities?

Cavities happen when bacteria and food left on the teeth after eating are not brushed away. Acid collects on a tooth, softening its enamel until a hole — or cavity — forms.

Here's how to keep cavities away:

• Start good oral habits early. Teach kids to brush at least twice a day with fluoride toothpaste and to floss regularly.
• Get enough fluoride. Regular use of fluoride toughens the enamel, making it harder for acid to penetrate. Although many towns require tap water to be fluoridated, others don't. If your water supply is not fluoridated or if your family uses purified water, ask your dentist for fluoride supplements. Most toothpastes contain fluoride but toothpaste alone will not fully protect a child's teeth. Be careful, however, since too much fluoride can cause tooth discoloration. Check with your dentist before supplementing.
• Limit or avoid some foods. Sugary foods, juices, candy (especially sticky gummy candy, gummy vitamins, or fruit leather or "roll-ups") can erode enamel and cause cavities. If your kids eat these foods, have them rinse their mouth or brush their teeth after eating to wash away the sugar. The same goes for taking sweetened liquid medicines: always have kids rinse or brush afterward.

As your child's permanent teeth grow in, the dentist can help prevent decay by applying a thin wash of resin (called a sealant) to the back teeth, where most chewing is done. This protective coating keeps bacteria from settling in the hard-to-reach crevices of the molars. But make sure that kids know that sealants aren't a replacement for good brushing and regular flossing.

What Dental Problems Can Happen?

If you are prone to tooth decay or gum disease, your kids might be at higher risk as well. So sometimes even the best brushing and flossing habits can't prevent a cavity. Be sure to call your dentist if your child complains of tooth pain, which could be a sign of a cavity that needs treatment.

New materials mean pediatric dentists have more filling and repair options than ever. A silver-colored material called amalgam (a special mix of metals) was once the substance of choice for most fillings in permanent teeth. But now, other materials like composite resins are becoming popular. Resins bond to the teeth so the filling won't pop out, and also can be used to rebuild teeth damaged through injury or conditions like a cleft palate. Because resins are often tooth-colored, they're considered more attractive.

But in cases of fracture, extensive decay, or malformation of baby teeth, dentists often opt for stainless steel or ceramic crowns. Crowns maintain the tooth while preventing the decay from spreading.

In some rare instances, usually when a more complicated dental procedure is to be done, a dentist will recommend using general anesthesia. Parents should make sure that the professional who gives the medicine is a trained anesthesiologist or oral surgeon before agreeing to the procedure. Don't be afraid ask your dentist questions.

Regular checkups and good dental hygiene can help prevent the need for this kind of extensive dental work. Also, encourage your kids to use a mouthguard during sports, which can prevent serious dental injuries.

What Is Orthodontia?

As kids get older, their bite and the straightness of their teeth can become an issue. Orthodontic treatment begins earlier now than it used to, and braces have changed too. The embarrassing old gear — a mouth filled with metal wires and braces — is in the past. Kids as young as age 7 now wear corrective appliances, and plastic-based (sometimes clear) materials have replaced metal.

Orthodontists know that manipulation of teeth at a younger age can be easier and more effective in the long run. Younger children's teeth can be positioned with fairly minor orthodontic devices, preventing major treatment later on.

Looking Ahead

As kids grow, plan on routine dental checkups anywhere from once every 3 months to once a year, depending on your dentist's recommendations. Keeping sugary foods in check, encouraging regular brushing and flossing, and working with your dentist will lead good dental health.