My new dentist recently told me -- as she stuck a horrible metal claw deep into my gums -- that if I didn't start taking better care of my teeth, I was going to lose some of them. Needless to say, I nearly choked. What was she talking about? My teeth are white and kind of pretty, I'd only had two cavities in my whole life, and my old dentist never rang any alarm bells ... well, at least not the last time I saw him almost two years ago. (Whoops.) It turns out that while I took my little vacation from dental care, I also developed full-blown periodontal disease. Now my mouth is a hellscape of plaque pockets and inflammatory bacteria -- and I am facing major time in a dental chair this year.
All of this immediately makes me worry about my 3-year-old daughter, Penny, and her 6-month-old sister, Gwen: Did I pass down my yucky gums to them? How many times a day are their teeth supposed to be brushed? When should we start them on flossing? What do you do if your city water supply -- like ours here in Portland, Oregon -- isn't fluoridated? Can you tell I've been a little panicked about all of this?
I reached out to pediatric dentists for some reassurance and a plan of action. Courtney Chinn, D.D.S., a pediatric dentist in New York City and associate professor at New York University College of Dentistry, said there will always be a genetic component to how strong our kids' teeth and gums are, but parents can still make a huge impact on their child's future dental health by modeling good behaviors right now. This is what I learned, and what will help your family too.
If you're like me, you made a point to buy that "safe if swallowed" non-fluoridated training toothpaste for your toddler. But earlier this year, the American Dental Association (ADA) changed its long-standing guidelines and now recommends that parents use fluoridated toothpaste as soon as a baby gets her first tooth. Just use a tiny grain-of-rice-size smear at first, then go with a dollop the size of a pea starting at age 3. Why? Tooth decay in young kids is epidemic these days, says Dr. Chinn, who has seen children as young as 2 needing treatment in the operating room under general anesthesia for extensive cavity repair. On average, one in four preschoolers in the United States has already had a cavity, and that number grows to 55 percent by the time they're old enough for kindergarten: "Tooth decay is the most prevalent disease of childhood -- it's five to eight times more common than asthma," says Dr. Chinn. What's more, the consequences are bigger than you might think. "It can interfere with a child's ability to eat, sleep, speak properly, learn, or pay attention in school," he says. Fluoride toothpaste can block cavities by helping to remineralize areas of teeth that have been bombarded by bacterial acids.
If you're one of the 25 percent of Americans whose city water supply isn't fluoridated (or you use well water), your child's pediatrician or pediatric dentist will likely prescribe a daily supplement -- each night Penny takes a chewable fluoride-plus-multivitamin before bed. There's a growing movement of people concerned about toxins who oppose fluoridating water supplies; but the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the ADA, and the American Academy of Pediatric Dentistry (AAPD) all fully support the practice.
Most adults need a dental checkup and cleaning two times a year. The same goes for kids, but how soon should that start? Both the AAPD and the American Academy of Pediatrics say you should take your child to the dentist by his first birthday. In addition to conducting a thorough oral exam, the dentist will obtain a dental history, guide parents on proper brushing habits and cavity prevention, and establish how often a child should visit, among other things. The visit also assesses risk, says Lezli Levene Harvell, D.D.S., a board-certified pediatric dentist in Newark, New Jersey (and mom of five girls ages 2 to 14): "If a mom tells me, 'I had a mouthful of cavities as a kid,' automatically I'm thinking her child may be at higher risk," she says. In addition, you'll establish a dental "home" for your kids where you'll get the latest information and can feel sure that problems will be spotted when they're easiest to fix. "If we're looking in a kid's mouth earlier, we can treat early decay with fluoride to harden the tooth and don't have to pick up the drill at all. Or we can do more shallow fillings that don't require a needle, so it's not as traumatizing," says Dr. Chinn. If you're worried about the cost, know that pediatric dental care is now required to be covered by most health-insurance plans, as well as Medicaid -- what's more, a study in Pediatrics found that kids who saw a dentist before age 1 have overall dental costs in their first five years that are 40 percent lower than those of kids who don't.
You can "brush" even before your little darling's teeth erupt by using infant tooth and gum wipes once a day. "I have so many parents who say, 'Really? Come on,' " says Dr. Harvell. "But the literature shows that even before a child has teeth, there are cavity-causing bacteria in the folds of the tongue." You can delay the bacteria from getting in your child's mouth by avoiding saliva-sharing behaviors: Don't share spoons or cups and don't clean his pacifier with your mouth. Once your child gets at least one tooth, graduate to brushing with a soft-bristled kids' toothbrush and fluoride toothpaste. (A child younger than 3 won't know to spit it out, though.) "Ideally you'll do this after breakfast and after dinner," says Dr. Harvell. And up until age 6, when their 6-year molars come in, make sure you're either doing it for him or brushing after he does it himself, because it's tough for kids to get all the way to the back.
Dr. Chinn has one word for the practice of aggressively brushing back and forth: "No!" That can damage the teeth and gums, he notes. Tilt the bristles a bit toward the gums and gently brush in tiny little circles, touching every surface of each tooth. The general recommendation is to brush kids' teeth for two minutes (30 seconds in each quadrant of the mouth), but Dr. Harvell puts a real-life spin on that advice: "If your child has two teeth, you don't have to brush for two minutes! And with your fussy 3-year-old, you may not be able to brush for two minutes." Even preschoolers with all their teeth still don't have their 6-year molars, so for kids 5 and under you should be able to get all the surfaces in a minute or so, she says. "What really counts is your technique and how much plaque you're getting off."
"I can't tell you how many parents think that flossing is something you do when the permanent teeth come in," says Dr. Harvell. (Guilty!) "But you want to start as soon as the teeth are touching each other. No matter how well you brush your child's teeth, if they are touching you're not going to be able to get all the food or plaque out." Technique is important here too. Those little-kid disposable flossers are fine, as long as you still pull the floss firmly against the sides of each tooth. "Sometimes you have to do whatever it takes," says Dr. Harvell. "My 2-year-old has bitten me before, and it hurts! Any way you can motivate your child, go for it." Well, except with candy.
Originally published in the February 2015 issue of Parents magazine.
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