April 23, 2013

Caring For Your Child's Teeth: Ages 0-3

I've had a few requests to discuss the proper dental care for infants and toddlers, ages 0-3 (i.e. before their first dental appointment). As usual, I've tried to keep it basic and as short as possible.

Take note that dental professionals may suggest a few different things when it comes to a child's first dental appointment. Some dentists will recommend scheduling the first one at age five. Others will say age three. And still others (the best of the best) will say as soon as all of her baby teeth erupt. Sadly, many times these suggestions are based on what your insurance allows (i.e. some insurance will only reimburse a general dentist for children older than five), or the dentist's personal preference (i.e. he does not like working with children).

I'll begin by addressing a few of the more common questions that I am commonly asked:

At what age should her first dental appointment be?
As long as you don't see anything wrong in her mouth, many dentists recommend it anywhere from ages three to five. However, and this is a BIG however, when she gets old enough to sit quietly and entertain herself for 45 minutes, I encourage her to simply accompany you to your cleaning appointment. This serves many purposes. It allows the child to get used to the sights and sounds and smells of the dental office. It allows a foundation for you to to educate her on oral hygiene. And if there is extra time, the hygienist may allow her a bit of 'hands-on' time (sit in the chair, hold the mirror, get a prize, etc). Familiarizing the child with the dental office goes a long way in allowing for a smooth first appointment.

It is important to note that this is the official recommendation from the American Dental Association:

The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth, and no later than the child's first birthday. Preventive care such as cleanings and if necessary, fluoride treatments, provide children with 'smile' insurance. Routine dental exams uncover problems that can be easily treated in the early stages, when damage is minimal.

How do I brush my baby's teeth if she doesn't have any?
Simple. You don't. Wipe her gums daily with a damp washcloth. This gets her used to things in her mouth, helps you form a correct habit, and also allows you to check for anything out of the ordinary.

When do I begin brushing my baby's teeth?
As soon as the teeth come in. Use a baby-sized toothbrush. Brush twice each day.

When should my child begin using toothpaste? 
Now. Use toothpaste that is specific to her age. This toothpaste will not have fluoride in it and is completely safe to swallow.

Does my child need fluoridated toothpaste?
YES. Almost every person in the US needs to be using a fluoridated toothpaste. As soon as the child learns to spit (and not swallow the toothpaste), she should switch to fluoridated toothpaste. I know there are many concerns floating around regarding fluoride. Please, if you have questions, email me at MTurnerRDH@hotmail.com

At what age can my child brush her own teeth?
Honestly, some adults shouldn't even be brushing their own teeth. Parents, please, brush your child's teeth until they absolutely won't let you. And then when they won't let you, STAND beside them and watch. You may not like me saying this, but parents should be monitoring their kids through age ten. MANY cavities would be prevented if parents monitor their kids more. What's wrong with the idea of a family toothbrushing party around the bathtub at night?

For a toddler who expresses interest in brushing her teeth by herself, let her. She may only brush her two front teeth, but let her take ownership of the action. And then, of course, you brush her teeth afterwards.

Can my child use an electric/battery-powered toothbrush?
Yes. As soon as she learns to play with toys, you can buy her a battery-powered toothbrush. Even if she just walks around the house sucking on the toothbrush and draining the battery, consider it successful: You have introduced the toothbrush to her and she considers it fun. It is acceptable to brush with an electric toothbrush once per day and then use a regular toothbrush the other times.

Do I have to floss my own teeth my kiddo's teeth?
Yeah. Yeah. Yeah. Same as an adult: floss every day. For children, I recommend using the floss-on-a-stick. There isn't as much to floss in a child's mouth and it may only take five seconds, but you will be beginning a great habit. Just imagine if your parents introduced flossing to you at a young age (like they did with brushing), then you wouldn't moan and groan about having to do it now.

Why does my toddler have spaces between her teeth?
If your child has spaces between her teeth, that is great. It is considered normal and the spaces should be present. As your child grows, her mouth will grow, and more spaces may develop. If there are no spaces between her teeth by age five, then it is a good indication that she may need braces in the future.

Is it bad that my child sucks her thumb?
Unfortunately, yes. Children that suck their thumbs (and similarly, use pacifiers) are more likely to have a narrow palate, have the typical "buck teeth," and are more likely to need braces. However, it is acceptable for an infant to suck her thumb. Just try to stop the habit as soon as possible.

Why won't the dentist let me (the parent) come back to the room with the child?
Children behave much better without a parent looking over their shoulder. Most times, she feels independent and a 'big girl' without a parent around. If you still prefer to observe the appointment, sneak back after she is in the chair and observe from the hallway. Do not smother her (or for that matter, the hygienist). At the very end of the appointment, you may take some time to ask questions.

Do I need to take my child to a pediatric dentist?
This depends on the child and your insurance. If your child is younger than five, and you prefer to have regular cleanings, then a pediatric dentist is for you. If your child is anxious, then a pediatric dentist is for you. If your child needs extensive work, then a pediatric dentist is for you. Keep in mind that many times insurance will only cover a pediatric dentist if you have a referral from your general dentist. This is more of a hindrance than anything. Basically, the general dentist will look in your child's mouth for a second, write the referral, and then send you on your way. Call your insurance company so that you know for sure.

Does my child need X-rays during that first appointment? Is it safe?
Your child will need xrays during that first appointment if:

a) there are visible cavities,
b) a baby tooth never erupted,
c) adult molars have already erupted,
d) there are no spaces between her baby teeth.

The frequency and type of dental xrays are based on the individual and the situation.  Expect to have xrays taken about once each year. If your child has a history of cavities, we will take xrays more frequently. If your child has recently broken a bone and received other types of medical xrays, we may wait until the next appointment.

A few random points:
  • Please do not buy unusual, food-like, toothpaste flavors such as bubblegum, chocolate, strawberry, etc. This makes the child confused. 'I am allowed to eat chocolate. But I am not allowed to eat the chocolate on my toothbrush?'
  • On the same token, some formulations of mint toothpaste (peppermint, spearmint, etc) may be too spicy to a child. If she cries or complains of it hurting/burning her tongue, this may be the issue. Children's taste buds are growing and changing (hence why babies love to suck on lemons and it doesn't bother them). Change toothpastes and try again. She may be fine in a few months.
  • It may not seem like the dentist or dental hygienist does much during those first few dental appointments. And the appointment may only last fifteen minutes (which probably equals no cavities and a compliant child). But as the child gets older, I promise there will be more to discuss.

Here are a few mistakes parents unintentionally make and the consequences that follow:

Mistake: The parent rarely attempts oral hygiene care until the child's first dental appointment. OR the child's first dental appointment is at age seven.
Consequence: The child refuses to open her mouth. The child gags, cries, and spits up. The child has many painful cavities. She is far too young, however, to define oral pain and subsequently express it to the parent. So she goes about her day, in pain, without knowing what is happening. This effects daily functions such as eating, talking, and concentrating.
Solution: Begin good habits young. It is always better to error on having the first dental appointment earlier rather then later. Children should have a cleaning every six months.

Mistake: Mother says to the child "Don't be afraid when you go to the dentist today. They won't hurt you." Father jokingly says to the child "The dentist will pull your teeth out if you aren't good."
Consequence: The child is unnecessarily frightened of the dentist. This creates chaos for parents, child, and dentist. 
Solution: Do not suggest fear to the child. Many times, these suggestions can happen through well-intentioned children's books. At this stage, fear of the dentist is a learned behavior. Granted, dental fear is justifiable after hearing what some people have experienced. However, modern dentistry is very different than what our parents experienced; thus, many patients no longer associate fear/pain with dentistry.

Mistake: The parent routinely puts the child to bed with a bottle of milk.
Consequence: The child has numerous visible cavities on her front teeth. This is nicknamed as baby bottle decay. Subsequently she is in pain and does not smile, does not like to eat, and may have trouble concentrating.
Solution: If you allow your child to walk around the house or go to sleep sucking on a bottle, then only allow it to have water in. A good rule of thumb (for everyone) is to drink only water between meals, and to drink sugary drinks (milk, orange juice, fruit juice, etc) with a meal.

Just remember, the key to infant/toddler oral hygiene care is this: 
creating good habits and preventing bad habits.

I hope this has helped clarify things a bit!

Your friendly hygienist, 
<< m >>

1 comment:

  1. When your child is getting their new adult teeth it is extremely important to care for the properly to prevent them developing dental problems. The new adult teeth are very vulnerable and need special care and attention.

    child teeth