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Save Your Child's Smile

My baby sucks her thumb. Does that mean she's destined for braces?
baby brushing teeth

Contrary to popular myth, a baby's thumb-sucking or pacifier use is unlikely to have an impact on how adult teeth grow in. But if your child doesn't break the habit by age 4, she may be creating work for an orthodontist. "A child that age who sucks her thumb or uses a pacifier can throw her teeth out of alignment," says Jed Berman, D.D.S., a dentist in City Island, New York. Persistent sucking leads to a condition known as "open bite," which occurs when certain teeth -- usually the front two -- don't make contact with the lower ones. "You may need braces to correct this," he says.

Do you need to have a cavity filled if it's in a baby tooth?

Yes. "You should care for primary teeth as if they were permanent ones," says Victor Avis, D.D.S., a dentist in Staten Island, New York. "Repairing cavities prevents pain and infection, and keeps primary teeth healthy and intact." That's important, because baby teeth preserve space for their permanent replacements, guide adult teeth into the proper position, and help ensure normal growth and development of the jaw. What's more, poorly cared-for baby teeth can negatively affect eating and chewing habits, your child's speech, and her smile.

What is fluoride? And how can I tell whether my child is getting enough?

Fluoride is a naturally occurring chemical that's absorbed by the teeth, strengthening them and preventing weak spots that can develop into cavities. "The best way for children to get fluoride is through tap water," says Larry Kronenberg, D.D.S., a pediatric dentist in Mount Kisco, New York. Call your local public-works department to find out whether there's fluoride in your H20. If there is, you're in luck: Using tap water for drinking and cooking will deliver enough of the chemical to keep your child's teeth healthy. For added insurance, you can use toothpaste containing fluoride. If your town's water supply is not fluoridated, talk to your dentist about options such as fluoride supplements or specially treated bottled waters, mouthwash, and gels. (But be careful not to give your child too much, since excess fluoride can lead to fluorosis, a condition that causes spots on permanent teeth.) Whether or not your water is fluoridated, some dentists recommend a fluoride treatment as part of a regular checkup and cleaning.

When are kids old enough to brush their own teeth?

Children really can't do an effective job of brushing independently until their fine motor skills are developed. "That's typically around the time they're able to tie their own shoe-laces, somewhere between 4 and 6," Dr. Kronenberg says. But a child as young as 2 can -- and should -- be encouraged to use a soft-bristled, toddler-size brush. (You'll need to follow up by doing a thorough brushing for him.) Make sure your child knows not to swallow toothpaste and not to use too much. "A pea-size amount on the brush is plenty," Dr. Kronenberg says. It's also important to floss your child's teeth to fully remove the food particles and plaque that get trapped between teeth and cause decay. Do it in the same way you do your own -- gently gliding the strand up and down. Flossers -- small, disposable plastic devices threaded with floss -- can make maneuvering around a child's mouth a lot easier.

At what age should we take our child to the dentist?

There's no compelling reason to take an infant to the dentist. You can have your pediatrician look at his teeth and mouth during routine checkups. But by the time a child is a year old, it's a good idea to schedule a thorough dental exam. At her first visit, the dentist will review your child's medical history and examine her teeth, gums, oral tissue, and facial bones. The dentist or a hygienist will also demonstrate proper tooth care.

Our dentist is recommending sealants. What are they?

Dental sealants are a plastic coating applied to teeth. "They prevent decay by making the surface of the teeth smoother and by sealing out food and plaque," explains Charles Czerepak, D.D.M., a pediatric dentist at Children's Memorial Hospital, in Chicago. The American Academy of General Dentistry says they are very effective in reducing cavities. Most dentists don't recommend sealants for baby teeth, and opinions vary on which adult teeth need them. Some think all permanent ones should be "sealed" as soon as they come in, while others recommend the technique only for molars. Getting sealants is quick and painless: The dentist cleans and dries the tooth, applies the sealant, and hardens it with a special light. It costs about $40 per tooth.

Help! My daughter fell and knocked out a tooth. WHAT SHOULD WE DO?

If it's a baby tooth, there's no need to panic. Find the pearly white, and get in touch with your dentist. "The main concern is whether the permanent tooth beneath has been damaged," Dr. Avis says. Your dentist can determine whether that's happened and, if so, what to do next. If your child loses a permanent tooth, you need to act quickly. Put the tooth back in its socket to keep it moist. If you're worried your child will swallow it, place it in a cup of warm salt water. Try not to touch the root, and don't attempt to clean it: The bits of gum tissue that are attached will help with reimplantation. Then get to the dentist right away. The sooner the tooth gets treated, the more easily it can be fully repaired.

I rarely let my 5-year-old have candy, but he still got a cavity. What happened?

Even kids who don't eat candy are at risk for tooth decay. "Certain healthy foods can lead to dental problems more quickly than an occasional piece of chocolate," Dr. Czerepak says. Foods that are sticky, such as raisins, can get stuck in tooth crevices. Complex carbohydrates (found in foods like chips, crackers, and cereals) are quickly broken down by chewing, but the sugars that get caught between the teeth aren't dissolved by saliva. Obviously, it's impossible to eliminate these foods from your child's diet entirely, but regular brushing and flossing can help remove the particles and reduce the risk of cavities, Dr. Czerepak says. Ideally, your child should brush after every meal. If he can't do that, teach him to rinse his mouth thoroughly when he's done eating. Habits like these will keep his smile bright in the years ahead.

Copyright © 2004 Emily Haft Bloom. Reprinted with permission of Parents magazine May 2004 issue.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. 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.