The Fight Against Cavities: How to Care For Big Kids' 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.

How to Care for Big Kids' Teeth

A Breakdown on Big Kids

By first grade, your child may have the dexterity to brush on his own. How do you know if he can go solo? Dr. Harvell says that if he can tie his own shoes, he's ready. Between 5 and 7, he'll begin to lose his baby teeth -- generally, the earlier they come in, the earlier they're lost. His four permanent molars will come in around age 6. Talk to the dentist about dental sealants, plastic coatings that can decrease the risk of decay on biting surfaces by as much as 89 percent. They're recommended for permanent molars because these teeth have grooves on the biting surfaces that significantly increase the risk of cavities. Sealants are typically covered by dental insurance for the permanent molars; many insurers cover other teeth as well. However, studies show that only 32 percent of kids have them. "I think parents should insist on them," Dr. Shenkin says. "That's how important they are."

You might want to have your child chew xylitol gum after meals too. (Trident is the one major brand that contains it, but other brands may be available at a health-food store or from your dentist.) Xylitol, a sugar substitute that protects the tooth enamel, has been shown to reduce the amount of decay-causing bacteria in the mouth. On the basis of a 2011 review of 70 studies, the ADA recommends that school-age children at high risk for cavities chew xylitol gum. (Gum is safe for kids 6 and older.)

Lastly, it's wise to make soda off-limits because it's high in sugar. Though Jake wasn't a big soda drinker, he drank juice all the time. Now he drinks more water than juice, and his daily gummy candy is also history. Jake hasn't made a fuss about the diet change, and he had no new cavities at his most recent checkup. Says his relieved mom: "I think we're on a healthy road now."

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.

Tooth Tools

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

• Buy flossers at drugstore.com.

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

• Buy Listerine Smart Rinse at soap.com.

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

• Buy Firefly Fluoride Foam toothpaste at target.com.

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

• Buy teeth stickers from orientaltrading.com.

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

• Buy the Oral-B Pro-Health FOR ME toothbrush from 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.