Mighty Mouth: 6 Tips for Better Baby Teeth

When Julia James took her daughter in for a first dental checkup, she got some news that would set most parents' teeth on edge: little Juliet, age 4, had 13 cavities. That's quite a shocker, particularly when you consider that children have only 20 baby teeth. "I was surprised to hear that her teeth weren't the worst the dentist had seen," says James, of Claremont, California. Indeed, tooth decay is extremely common in kids--largely because many parents think first teeth are "just baby teeth" and therefore expendable. "We really need healthy baby teeth," says Arthur J. Nowak, DMD, executive director of the American Board of Pediatric Dentistry. "They prepare the mouth for permanent teeth and help with language development." Brush up on how to keep that sweet smile cavity-free for years to come.

Start caring for that little mouth at around age 1. Use gauze or a soft infant toothbrush and water to gently rub the gums once or twice daily. Early care might prevent brushing battles down the road and could also be the golden ticket to easing teething pain. "I introduced a toothbrush to my son when teething was at its worst," says Morgan Eklund, of Durham, North Carolina. "He now thinks of brushing as an amazing source of relief." Also try cool chewing rings or washcloths when baby is cutting his teeth.

Like many parents, James thought she could wait until Juliet was older to schedule a first dental visit. But in fact, the American Academy of Pediatric Dentistry (AAPD) recommends an exam within six months of the first tooth's appearance and absolutely no later than baby's first birthday. Even if the dentist doesn't do much at that first meeting, it's an opportunity to address potential problems before they crop up. "At the initial appointment, we go through a cavity risk assessment," Dr. Nowak says. "We decide on fluoride treatment, dietary modifications, and the frequency of checkups." If you can, see a pediatric dentist. While some general dentists care for babies, pediatric ones have special training and equipment designed for little bodies--and often fun decor that puts kids at ease. Click on the "Find a Pediatric Dentist" link at aapd.org.

Mom and Dad brush twice a day, and baby should too. Brush each tooth as it comes in, using water or a smear of non-fluoridated paste. Aim for about two minutes (place a kitchen timer by the bathroom sink) at least twice daily, ideally after breakfast and right before bed. Nighttime is most important because that's when we produce less saliva, making us more susceptible to cavities. There's rarely a need to use fluoridated paste until after age 2, but your dentist can help you decide. Buy a large-handled brush with a small head and soft, rounded bristles. To help your child feel that she's part of the experience, take her shopping and let her choose, say, the princess brush or the one with the fire engine handle. And toss the brush at least every three months; frayed bristles can harm gums.

Letting your child help brush his own teeth can establish good dental habits--so long as you handle the real cleaning duties. A kid can't effectively brush until he's coordinated enough to tie his own shoes, typically by age 7.

If brushing is a battle, singing can ease the way (try Raffi's "Brush Your Teeth"). Or get your child to open up by telling him to roar like a lion. You can also play "dentist." "I let my son brush my teeth first," says Laura Silverthorn, of Philadelphia. "He's much more inclined to sit still if I go first." And Liz Garland, from Mobile, Alabama, sets out her son's favorite toy trains on the sink: with this audience in place, 2-year-old Gabriel is good to go. The most important thing you can do is make the experience pressure-free--and not something you're fighting about.

What causes cavities? "Everyone thinks they're just holes, but those holes don't happen on their own," Dr. Nowak says. Bacteria in the mouth (aka plaque) feed on certain carbs and make acid, which eats away at teeth. But how does plaque get into baby's mouth in the first place? It's usually passed from Mom or Dad. You might try a bottle or spoonful of food before giving the same object to baby. Some parents even "clean" a pacifier with their own mouth. Any of this back-and-forth equals an exchange of bacteria. So really, the best first step in preventing tooth decay is keeping your saliva to yourself. Make sure your mouth is clean and consider chewing gum with artificial sweetener xylitol; studies show this can help inhibit production and transmission of harmful bacteria.

Another way to keep cavities at bay: starve plaque of its favorite food. That doesn't mean putting baby on a no-carb diet--it simply means limiting the amount of time sugars spend on teeth. Sugar at mealtime is okay, but constant sweets can be harmful. This is why the AAPD insists that parents don't let baby fall asleep with a bottle containing anything other than water and recommends against nighttime bottles or at-will breastfeeding after teeth have come in. Breast milk and formulas contain sugar and can cause cavities if their residue sits on teeth all night.

Save juice for mealtime only; sipping for a long period of time can harm teeth. And cut out soda or make it a special-occasion treat--its acid eats away at tooth enamel, says Linda Ciampa, RN, a nurse at Milford Regional Medical Center, in Massachusetts. Meanwhile, if a food is gummy or sticks to teeth (think cookies, white bread, chewy vitamins, and raisins), follow consumption with a prompt brushing.

On the flip side, there are lots of foods baby should eat often. Dairy can fight plaque and strengthen teeth. In fact, studies show that American, Swiss, and mozzarella cheeses help cut the risk for cavities. And citrus fruits stimulate saliva production, helping wash away substances on which plaque feeds.

Ultimately, good dental health is all about sensible choices and preventive care. Establish these habits early and your family will have plenty of reason to smile.

Too much fluoride can cause fluorosis, a condition damaging tooth enamel. That's why infants under 6 months don't need supplements--and most babies won't ever need them. Hold off on fluoride toothpaste until age 2 unless advised by a dentist.

• CHECK YOUR WATER. Your dentist should know if your drinking water is at the optimal fluoride level of 0.7 to 1.2 parts per million to reduce tooth decay. If not, check your local report at epa.gov/safewater. Well water should be privately tested.
• DON'T OVER-FLUORIDATE. For bottlefed babies under 1 year, mix powdered formula with water containing little or no fluoride. Good options: tap water within the optimal range or Nursery Water, which has a fluoride level of 0.7 ppm or less.
• BRUSH. Use a fluoride-free option: water or a training toothpaste, such as Baby Orajel Tooth & Gum Cleanser.

My Dentist's Choice Tooth Tissues: Check out these wipes containing bacteria-fighting xylitol ($14 for 60 wipes, target.com).

Sassy Mam Teach Me Toothbrush Set: A long-handled brush is for Mom; and there's a short-handled one just for baby ($10, amazon.com).

Earth's Best Toothpaste (by Jason): Fluoride-free, this kid-friendly toothpaste contains calcium lactate to strengthen your toddler's teeth ($6.50, diapers.com).

Originally published in the December 2009 issue of American Baby magazine.