The Fight Against Cavities: How to Care for Babies' Teeth

Tooth decay isn't something to brush off: It's actually the most common childhood disease. Save your kid's smile with these healthy habits.

Photo: Buff Strickland

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 baby dental problems.

How to Care for Baby Teeth

Baby-tooth Basics

Even before the first tooth appears (typically at 6 months), get into the habit of wiping your child's gums with a clean corner of a wet washcloth. This provides hygiene to the mouth and acclimates your baby to having her mouth cleaned. Caring for the new arrivals is important for chewing, speech, and normal development of the jaw bones. "A child can get a cavity even if she has only one tooth," says Jonathan Shenkin, D.D.S., a pediatric dentist in Augusta, Maine. Yet in a recent American Academy of Pediatric Dentistry (AAPD) survey, 45 percent of moms said they didn't regularly clean their babies' teeth and less than one third began brushing before age 1. An easy way to get into the habit: Make brushing part of the cleaning you do after each feeding, as much as possible. Experts are divided on whether babies should use fluoridated toothpaste -- the American Dental Association (ADA) says no, the AAPD says yes -- so check with your child's pediatrician or dentist.

Never put your baby to bed with a bottle. The natural sugars in breast milk or formula will cling to her teeth throughout the night, allowing bacteria to transform sugars into cavity-causing acid. Plus, the flow of cleansing saliva decreases during sleep.

Dentists consider decay in young kids to be a communicable disease for the most part; moms are the key culprits when a child's mouth gets colonized with bacteria. Studies show that kids whose moms have had lots of cavities are more likely to have tooth decay themselves, Dr. Casamassimo says. So avoid passing your own bacteria to your child by not tasting your child's food with the same spoon you then use to feed her. Try not to blow on her food to cool it. And don't allow your baby to suck on his finger after putting it in your mouth. You may feel like you're going a little overboard with these strategies, but if you have a history of cavities, they're worth implementing.

Although cavities in babies are relatively rare, early-stage tooth decay is not. The first signs of a cavity are discoloration along the gum line and depressions anywhere on the surface of the tooth. Untreated, the decay can worsen, turning into brown or black spots -- often on the upper front teeth, caused by excessive bottle drinking.

The AAPD and the ADA recommend a baby see a dentist for the first time by 12 months; the AAPD found that 97 percent of parents don't know this. This visit sets the stage for good dental health because you'll receive advice from the dentist or hygienist on how to best care for your baby's teeth and manage her diet. If you wait too long to schedule the first checkup, any decay can be well underway.

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 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.

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.

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