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The Fight Against Cavities: How to Care For Preschoolers' Teeth

boy brushing teeth

When Lisa Kiell of New York City took her 5-year- old son, Jake, to the dentist for a checkup, she was shocked. X-rays revealed that he had five cavities, including three in his molars that were so severe they couldn't simply be filled. The kindergartner would need considerable work, including treatments sometimes referred to as "baby root canals."

To avoid this extensive dental work -- requiring three appointments -- Kiell had asked about having the three molars pulled, since they'd be falling out anyway when his permanent teeth came in. But since primary molars last until a child is 12 or older, and losing baby teeth early can cause the permanent teeth to come in crooked, the dentist felt it was better to save all the baby teeth.

Although Jake received laughing gas and a shot of Novocain, the little guy was so freaked out that he cried almost the entire time he was in the dentist's chair. The next appointment was even harder for Jake and the third one, when he needed a restraining jacket, was the worst.

This story may sound like an extreme example, but dentists are seeing more and more children like Jake. The Centers for Disease Control and Prevention reports that cavities in young children have been on the rise, and that one in seven 3- to 5-year-olds have untreated tooth decay. Early tooth decay is now the most common childhood disease -- five times more common than asthma. (It's considered a disease because cavities are caused by bacteria that use sugar in a child's diet to produce acids that destroy the teeth.) Even if a cavity isn't painful, decay in baby teeth greatly increases the risk of cavities in permanent teeth. "When permanent teeth come into an environment where the baby teeth have already decayed, the same bacteria will attack the new teeth," says Parents advisor Burton Edelstein, D.D.S., M.P.H., professor of dentistry and health policy at Columbia University and founding director of the Children's Dental Health Project.

Causes of Cavities
Rates are rising in part because of what, and how often, kids are eating, say experts. They're consuming more processed carbohydrates like pretzels and crackers, as well as more sweets, juice, and soda, than in the past. (Kiell was told that Jake's fondness for gummy candies had contributed to his severe cavities.) The bacteria that feed on sugar erode the structure of teeth by depleting calcium. Once an area without calcium becomes big enough, the surface of the tooth collapses and your child has a cavity.

Many parents are surprised to learn that kids need help brushing their teeth until at least age 6. Young children simply don't have the manual dexterity to do the job well. "They tend to brush the same teeth in the front over and over again, but don't get to the back teeth or the inside surfaces," says Paul Casamassimo, D.D.S., chief of dentistry at Nationwide Children's Hospital, in Columbus, Ohio. That was the case with Jake. He'd insisted on brushing his own teeth at age 4, says his mom, who's now taken over the task.

Another reason for the cavity surge may be a lack of fluoride, as more families rely on non-fluoridated bottled water, and fluoridation of public drinking water has been discontinued in some communities. Fluoride strengthens tooth enamel, making it resistant to the acid produced by bacteria. In the last four years, at least 15 municipalities across the country have halted the practice due to tight budgets and skepticism about its benefits.

With cavities on the rise and healthy baby teeth so important, it's up to you to be proactive about checkups and early oral care. We've gone straight to the experts to get the latest advice and smart strategies for preventing dental problems in your preschooler.

Pointers for Preschoolers
A child who gets to age 4 without cavities has an excellent shot at having healthy teeth with no or just a few cavities throughout childhood, says Dr. Shenkin. And because cavities are largely preventable, instilling good dental-health habits now will serve her well later, when you'll have less control over her diet. It's a good idea to teach your child to spit without rinsing with water first, so that some fluoride stays on the teeth.

But the fluoride in toothpaste isn't enough to ward off cavities. Children also benefit from fluoridated drinking water, because it helps fend off cavities by fortifying enamel and reversing early decay. If your family uses well water or only bottled water -- which is typically non-fluoridated -- or if you live in a community where the tap water is non-fluoridated, speak to your dentist about supplements or fluoride varnish, which is a solution that's painted on a child's teeth.

Flossing before brushing will loosen the plaque and food particles that'll be removed by brushing. Floss anywhere the teeth are touching, though doing itall over is a good way to get your child used to the practice. Try big-handled flossers in a kid-friendly theme; they can be a good motivator for your child.

Consider going the high-tech route. In addition to making brushing less of a struggle, a battery-powered brush may clean better than a manual one, and it doesn't require as much manual dexterity. Many preschoolers love spin brushes that light up and play music, Dr. Harvell notes. One caveat: The FDA issued an alert because the brush head of the Arm & Hammer Spinbrush could pop off during use, potentially causing injury or choking. The AAPD recommends checking the brush head to be sure it's tightly attached and testing the brush before use. And make sure you take over for the back teeth and inside surfaces, areas your preschooler can't handle all by herself.

Is Your Child Scared of the Dentist?
As many as 20 percent of children have some fear about going to the dentist, says John E. Nathan, D.D.S., adjunct professor of pediatric dentistry at the University of Alabama, Birmingham, and an expert on dental anxiety in kids. Help things go smoothly with his tips:
Figure out the problem.
Understanding the origins of your child's dental fears will give you a way to find effective strategies for helping him develop coping skills.
Choose the right dentist.
Ask your child's doc for a referral or find one at aapd.org. You're looking for someone who can recognize and allay dental fears, a person you find easy to communicate with and who has a gentle manner with kids.
Talk to the dentist before the appointment. Prep him about your child's temperament, and find out what you can expect. Ask things like, "How do you work?", "Will I be allowed in the exam room?", "How do you handle uncooperative behavior?"
Control yourself. Kids can quickly pick up on a parent's anxiety, so if you're nervous about how your child will react, do your best to conceal it. And avoid statements like "it won't hurt too much" and bringing up shots or the idea of pain.
Use a step-by-step approach.
If your dentist is willing, make the first visit a "look-see," the second for the exam, and then a third for any procedure. It requires more time and money, but this approach can help.
Don't give up. Toddlers and preschoolers tend to outgrow their apprehensions by school age. And research shows that kids who go to the dentist for regular checkups (even those who have meltdowns at first) are less likely to have anxiety than kids who don't go as often.

Oral-B Stages Flossers

Help kids cultivate healthy teeth-brushing habits with these fun and functional products.

Your little one can clean out nooks and crannies with these easy-to-grip flossers shaped like Disney characters. $3; drugstore.com

 
Listerine Smart Rinse

Kids can swish and spit fluoride-filled Listerine Smart Rinse (in gentle mint, berry, or bubblegum flavors) to get rid of gunk. $4.50; soap.com

 
Firefly Fluoride Foam toothpaste

Forget countertop spills -- kids can squirt a quarter-sized dollop of Firefly Fluoride Foam toothpaste directly into their mouth. $2.50; target.com

 
Oriental Trading Company teeth stickers

Reward good brushing habits with sweet teeth stickers. $2.50 for 8 sheets; orientaltrading.com

 
Oral-B Pro-Health FOR ME toothbrush

Kids ages 8 and up can get a powerful clean with this adult-sized, budget-friendly -- and effective -- electric toothbrush. $29; walmart.com

 

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Originally published in the February 2013 issue of Parents magazine.