The Importance of Oral Health at a Young Age
Jennifer Dubail, MD., FAAP of MMP
We recognize that many parents in Maine view tooth decay as an inevitable childhood disease and yet it is nearly completely preventable.
The three things that parents can do to help prevent dental problems are:
1. Improve the oral health of their own mouths by getting regular dental care and brushing daily to reduce the amount of bacteria in their own mouths. Tooth decay is caused by bacteria passed through saliva.
2. Fluoride - Fluoride makes teeth stronger, prevents tooth decay (cavities) and also reverses early tooth decay. Specifically:
a. Parents should brush their children's teeth with fluoride tooth paste twice a day.
b. Parents should ask their child's medical provider for fluoride varnish applications. Fluoride varnish applications are safe, simple and effective. They can prevent up to half of all cavities.
3. Start taking their child to the dentist by the child's first birthday - or as soon thereafter as possible.
Other things that can help prevent tooth decay are selecting low-sugar foods and limiting drinks for toddlers to milk and water.
Dr. Jennifer Dubail is here to talk about early childhood dental care.
Dr. Jennifer Dubail (Guest): Oral health should really start from the very beginning. Parents should be comfortable looking inside their children’s mouths, wiping it off as they get a little bit older and watching for those first teeth to erupt which can start as early as four months old.
Melanie: Before the teeth erupt we should still be looking at their teeth for any signs of problems, yes?
Dr. Dubail: Yes, definitely.
Melanie: Once their teeth start to come in, then what? Do we start brushing their little teeth with our finger? Do we take them to a dentist? What do we do then?
Dr. Dubail: Once their first teeth come through, I would recommend starting to brush them with a finger brush or a small infant toothbrush in a circular motion. I would also recommend the use of fluoridated tooth paste even in children under the age of two or three years old. They recommend--they being pediatric dentists--using a grain of rice size amount of fluoride toothpaste which is safe to swallow in children that can’t spit it out.
Melanie: When do we take them to their first dentist?
Dr. Dubail: They should see the dentist at one year old. Many family dentists in Maine will recommend waiting until three years old but, really, by the age of three kids will have up to 20 teeth at that point and it’s important to start early to get children used to going to the dentist, to teach children and families appropriate dental hygiene, to show families how to floss the teeth, to be counting the teeth and looking for any problems and signs of decay.
Melanie: What about the toothpastes that are out there, Dr. Dubail? Are the ones that are bubble fruit tasting and that sort of thing okay to use for little kids?
Dr. Dubail: As long as they contain fluoride in them and, as I said before, a small grain of rice size would be what I would be aiming for children under three or children that can’t spit it out. Once they’re able to spit, usually around three years old, then we go to a larger size, similar to the size of a pea and there are multiple different flavors. Children tend to like the bubble gum and fruity flavors over the cinnamon or mint or other harsh flavors.
Melanie: So now, the dentist usually wants to do fluoride treatments. Is that recommended?
Dr. Dubail: It is and not only will the dentist want to do fluoride treatments but the pediatricians office should also be offering fluoride treatments starting at, really, the eruption of the first tooth. So, most babies would be between the six month well-child check and the nine month well-child check.
Melanie: What about sealants? If your dentist offers you sealants for your children and maybe they haven’t even lost all their baby teeth, should you say ‘yes’ to that?
Dr. Dubail: Sealants really protect the adult molars and that’s a thin kind of plastic coating on those molars. Really, those are appropriate for children in the school-aged years. between 6-12 years old. Even if you still have baby teeth it’s appropriate to do sealants on those adult molars that will have erupted.
Melanie: Dr. Dubail, some children’s teeth are set far apart. Do they still need to floss?
Dr. Dubail: They should still be in the habit of flossing. Tooth decay can happen between teeth that touch but still being in the habit of flossing can be very helpful as both a habit and it’s unlikely that all of their teeth will be set apart. More often, just those front teeth whereas the side teeth and the molars will more likely be touching.
Melanie: Give parents some good advice on teaching their children to be good brushers and how long we should stand over them while they’re brushing and make sure they’re doing it correctly.
Dr. Dubail: I would say my number one piece of advice would be to be a good role model. Show your children that you’re brushing your teeth twice a day and reinforce that it’s important, not only as a child, but throughout your life to be a good brusher. Parents and children should brush as a team up until about the age of 8 years old and even after that parents should be checking in with their children to make sure they’re brushing, to make sure they’re brushing twice a day, to make sure they’re brushing for two minutes at least at each time, to make sure they’re flossing still. Parents should really play an active role in oral health for many, many years.
Melanie: What about mouth rinses and mouth washes, Dr. Dubail? Should we be encouraging our children to use these or is it not necessary?
Dr. Dubail: They can add a little bit of extra protection but they shouldn’t substitute other things such as the fluoride varnish application at the doctor or at dentist’s office. They shouldn’t substitute using fluoride toothpaste. They shouldn’t substitute fluoride supplements for children who are drinking well water that is not fluoridated. It would be an addition that may offer a small added benefit but shouldn’t replace other oral health care.
Melanie: What would you like parents to tell their children about nutrition and their teeth? Is candy still considered bad and what about cavities?
Dr. Dubail: I would want parents to stress that not only is candy bad but other sticky foods are also bad for your teeth. Parents often will feed their children raisins as a good finger food but raisins are very sticky and can be stuck in the teeth. Many children like to eat fruit snacks, especially when you that there’s 100% fruit in them and those sorts of things, but they still contain just as much sugar and they’re just as sticky. I would avoid or limit those kinds of foods in addition to candy as well as fruit juices. Even 100% fruit juice has so much sugar in it and leads to a risk of tooth decay.
Melanie: Kids are going to get cavities. Some kids are more prone than others, so what do we tell our children who say, “I’ve been doing everything right. I brush my teeth, mom, and yet I had two cavities at the dentist,” and they’re terrified to go get those filled.
Dr. Dubail: Well, I think reinforcing the importance of continuing to brush and not losing the confidence and not getting out of that habit, even if there is a cavity would be the first step. In terms of pain and fear associated with getting a cavity filled, that would be a good conversation to have with the dentist about what do they do, how do they do it, what are the tools going to look like, what is it going to sound like, and something to sort of pre-plan the visit with the dentist.
Melanie: In just the last few minutes, Dr. Dubail, give your best advice about really good oral health for children throughout the years and even include the teenage years when we want to make sure that our children are practicing really good oral health.
Dr. Dubail: My best advice would be to say that oral health starts from the beginning. Women, when they are pregnant, should be watching their own oral health. They should be visiting their dentist routinely. Parents of new babies should try to limit exposing their babies to the germs that live in their own mouths. Parents should avoid things like cleaning pacifiers in their own mouths and then putting it into the baby’s mouth. Families should get comfortable wiping off the gums and then working on brushing twice a day. Families should discontinue bottle use at the age of one. They should never prop the bottle with the baby. They shouldn’t be putting juice into baby’s bottles. They shouldn’t be putting babies to bed with bottles. The same goes with pacifiers. Families should really work towards getting rid of pacifier use by a year old. As children get older, parents need to continue to work on brushing as a team and role modeling good oral health behaviors as well as limiting those snacks that we talked about earlier such as raisins and fruit snacks and candy and sugar sweetened beverages like juice. After kids hit the age of eight years old, they should be brushing independently but parents should still have an eye on them. Those are around the age where families should be talking to their dentist about sealant applications. As children enter sports, they should be wearing appropriate mouth guards and headgear to protect their teeth from sporting accidents. They should limit their use of sugar sweetened bubble gum and they should be brushing twice a day as well as flossing once a day.
Melanie: That’s great advice beautifully spoken. You took us right up through the years. Thank you so much, Dr. Dubail, for being with us. You’re listening to MMC Radio. For more information, you can go to MaineMedicalCenter.org. MaineMedicalCenter.org. That’s MMC.org. This is Melanie Cole. Thanks so much for listening.