Prevention

As soon as the first tooth erupts, begin brushing with a soft-bristled toothbrush and fluoride toothpaste.  Place the brush at a 45 degree angle toward the gums and brush in a circular motion.  Supervise your child's brushing until the age of 8 years or they can tie their own shoe laces with ease.  Flossing is a supervised event as well.  When your child has baby teeth that contact with each other, hand-held floss sticks can work well.  As permanent teeth begin to erupt, switch to string floss that can be wrapped around the tooth into a C-shape.

Start to floss when the adjacent tooth surfaces are touching and cannot be reached by a toothbrush alone.

You may start using fluoridated toothpaste as soon as your baby gets teeth.  A “smear” of fluoridated toothpaste for children less than 2 years of age decreases the risk of any adverse effects of too much fluoride (fluorosis).  A “pea-sized” amount is appropriate for children aged 2 to 5 years.  Parents should always dispense the toothpaste onto a soft age-appropriate brush and assist with brushing in preschool-aged children.  To maximize the effects of fluoride in the toothpaste, rinsing after brushing should be minimal or eliminated.

The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) encourage the use of fluoride to prevent and control cavities.  It is documented to be safe and highly effective to remineralize enamel and alter the bacterial metabolism of the microbes that cause cavities.

Fluoride is an element that has been proven to be beneficial to teeth.  However, too little or too much fluoride can be detrimental to the teeth.  Little or no fluoride will not strengthen the teeth to help them resist cavities.  Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth.  Many children often get more fluoride than their parents realize.  Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.  Some of these sources are:

• Too much fluoridated toothpaste at an early age (before the age of 4 years)
• Inappropriate use of fluoride supplements
• Hidden sources of fluoride in the child’s diet.

Two- and 3-year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing.  As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing.  Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis. Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis.  Fluoride drops and tablets, as well as fluoride-fortified vitamins, should not be given to infants younger than 6 months of age.  After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for, as well as a caries risk assessment of the individual child, and upon the recommendation of Dr. Stacey or your pediatrician. Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products.  Please read the label or contact the manufacturer.  Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities. Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use only a smear of fluoride toothpaste in children under the age of 2 years.
• Place only a pea-sized amount of paste (the size of your child’s pinky finger nail) on the brush of children aged 2 to 5 years.
• Account for all the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or dentist.
• Obtain fluoride-level test results for your drinking water before giving fluoride supplements to your child (check with local city or county health departments).

The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on improving the oral health of infants, children, adolescents, and persons with special health care needs.  Xylitol reduces plaque formation and bacterial adherence, inhibits enamel demineralization, and has an inhibitory effect on the bacteria that causes cavities.

The use of xylitol gum by mothers (2 to 3 times per day) starting 3 months after delivery and until the child is 2 years old, has proven to reduce cavities up to 70% by the time the child is 5 years old.  Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries.  Xylitol provides additional protection that enhances all existing prevention methods.  This xylitol effect is long-lasting and possibly permanent.  Low decay rates persist even years after the trials have been completed.  Xylitol is widely distributed throughout nature in small amounts.  Some of the best sources are fruits, berries, mushrooms, and lettuce.  One cup of raspberries contains less than one gram of xylitol. Studies suggest that xylitol intake consistently produces positive results ranging from 4 to 10 grams per day, divided into 3 to 7 consumption periods.  Higher amounts did not result in greater reduction and may lead to diminishing results.  Similarly, consumption frequency of less than 3 times per day showed no effect. To find gum or other products containing xylitol, visit your local health food store or search the Internet to find products containing 100% xylitol.

Sealants work by filling in the crevices on the chewing surfaces of the back teeth, where four out of five cavities in children are found. This protective coating acts as a barrier to food, plaque, and acid.  Sealants do not require anesthesia but must be placed on dry teeth, so a child must be able to cooperate in the dental chair in order to place sealants.

Healthy eating habits lead to healthy teeth.  Like the rest of the body, the teeth, bones, and soft tissues of the mouth need a well-balanced diet.  Make sure your child eats a variety of foods from the five major food groups.  Most snacks that children eat can lead to cavity formation.  The more frequently a child snacks, the greater the chances for tooth decay.  How long food remains in the mouth also plays a role.  For example, hard candies, like mints or Lifesavers, stay in the mouth for a long time, which causes longer acid attacks on tooth enamel.  If your child is a “grazer,” choose nutritious foods such as vegetables, low-fat yogurt, and cheese and nuts, which are healthier and better for your child’s teeth.  Limiting the servings of sugars and starches will also aid in protecting your child’s teeth from decay.

A mouth guard should be a top priority on your child’s list of sports equipment.  Athletic mouth guards are made of soft plastic and fit to the shape of your child’s upper teeth.  They protect a child’s teeth, lips, cheeks, and gums from sports-related injuries.  Any guard is better than no guard at all, but a custom-fit mouth guard made in our office is your child’s best protection.