Tooth Decay
Tooth decay is an infectious disease that can happen when bacteria in the mouth interacts with the sugars present in milk and fruit juices. This process produces acids that can be destructive to teeth.
When a baby is awake, the continuous flow of saliva in his mouth dilutes the sugars and washes them off the surfaces of the teeth.
Because there is much less saliva in the baby's mouth when he sleeps, the sugars can concentrate on the surfaces of the teeth. This environment is friendly to bacteria and acid production.
You can prevent tooth decay with proper hygiene: making sure you clean your baby's teeth after a feeding, rather than letting your baby fall asleep right after.
The bacteria that cause dental decay are already present in a baby's mouth before the first tooth breaks through the gums. This is why it's important to clean your baby's mouth after a feeding, even if he doesn't have any visible teeth.
Dental decay can happen to any baby. It doesn't matter how old the baby is, what ethnic group the baby's family is from, what job a baby's parents have or how much money they make.
Under certain conditions, baby teeth can start to decay as soon as they break through the gums, for example: putting a baby to bed with a bottle of milk, juice, or any other drinks containing sugar.
Oral Hygiene For Your Baby
One of the best ways to clean your baby's gums is to wipe them with a damp gauze sponge immediately after a feeding.
This removes food material from the gums, and reduces the amount of harmful bacteria in the mouth.
You should keep following this routine when your baby's teeth first start to erupt.
Since your baby will get used to this simple cleaning routine, it will be easier to introduce a toothbrush later on.
When at least four teeth in a row have broken through your baby's gums in the lower or upper jaw, you can start using a toothbrush for his oral hygiene. Use a toothbrush with a thicker handle; they are easier for small hands to hold. Your child will feel less frustration as he grows and wants to learn to brush his own teeth.
You should brush your child's teeth until he has enough strength and co-ordination to brush them himself. Even then, supervise him when he brushes his teeth.
Fluoride
We already know that toothpaste and tap water that contain fluoride reduce the incidence of dental decay. Fluoride is used widely in toothpaste and in municipal drinking water.
Too much fluoride, however, can cause unsightly discolouration on the enamel of your child's teeth. This is called fluorosis.
Mild dental fluorosis looks like white flecks on the surface of the tooth. In more severe cases, brown mottling appears on the teeth.
There are several sources of fluoride: municipal water supplies, toothpaste, vitamin supplements, and fruit drinks and juices (especially if they have been bottled with fluoridated water).
The Canadian Dental Association (CDA) recommends that no fluoride supplements be given to children under six years. Supplements should only be given if a child's dentist feels there is a high risk of dental decay.
Fluoride-free toothpaste is recommended for children under six years. This is because most children can't spit properly until then. They may swallow most of the toothpaste, which increases the risk of fluorosis.
If fluoride toothpaste is used to brush your child's teeth, make sure you use only a pea-sized amount at each brushing, and that you supervise your child if he is old enough to brush his teeth himself. Brushing should happen twice per day.
Tips for Your Child's Dental Health
Although dental decay remains a common childhood problem, it is a preventable one. Dental decay is a bacterial infection cased by the bacteria Mutan Streptococcal and Lactobacilli. The sugar and starch in our diet serve as nutrients to the bacteria and allow them to grow and multiply. The bacteria produce acids that attack the teeth and cause cavities.
Most children become inoculated with the cavity-causing bacteria very early on - often soon after the first teeth appear, at about the age of one. The source is often the mother or caretaker who transfers the bacteria in her saliva to the toddler through kissing and sharing utensils. Once the bacteria can obtain a foothold in the toddler's mouth, the decay process will begin if the diet is high in sugar or starch, and oral hygiene is neglected.
It is very important that you do not nurse your infant to sleep or put him to bed with a bottle of milk, formula, juice or sweetened liquid. While your child sleeps, any unswallowed liquid in the mouth will support the growth of bacteria that produce acids and cause cavities. Put your child to bed with nothing more than a pacifier or a bottle of water.
Many of us know that sweet foods cause cavities, but some of us do not realize that savory foods such as pasta, crackers, pretzels, and potato chips cause dental decay, too, because of their high carbohydrate content. These "starchy" foods tend to cling onto the tooth surface and are not easily washed away by saliva. Fruits, although they are very good for your health, can cause cavities because of their high sugar contents. Did you know a large banana has about eight teaspoons of sugar and an apple has five teaspoons?
Most foods have the potential to cause cavities regardless of whether they are nutritious, sweet, or savory so long as they contain carbohydrates. Few foods, such as cheese and nuts, are totally "tooth-safe" but they may not be appropriate snacks for toddlers. Moreover, children should not be deprived of sweets, which are an integral part of a normal childhood. Therefore, regardless of what you feed your toddler, brush his teeth regularly. Select and serve sweets wisely. Sweet foods are safer for teeth when served right after a meal, but sticky sweet foods, such as dried fruits and caramel should be avoided.
More tips for your toddler's dental health:
Maintain good oral hygiene yourselves as parents and there will be less bacteria from you to be transferred to your toddler.
Give your toddler three main meals and a balanced diet daily. A balanced diet is one that includes fruits and vegetables, bread and cereals, milk and dairy products, meat, fish and eggs.
Limit the number of snack times. One snack between meals is acceptable. Give your toddler nutritious snacks, such as fruits and vegetables
Brush your toddler's teeth twice a day and floss once a day. Use a brand of toothpaste that contains fluoride, but apply only a pea-size amount because young children, before the age of six years, tend to swallow most of the toothpaste. If your toddler insists on brushing his teeth, let him do it, but brush for him afterward. Children do not develop the dexterity to brush well by themselves until they are eight years old or more.
Fluoride is an essential mineral that is effective against dental decay at appropriate dosage. If your drinking water does not have fluoride, ask your pediatrician or pediatric dentist about the need to give your toddler fluoride supplements.
Soon after your child's first teeth appear, take him to see a pediatric dentist and have regular check ups. Like your pediatrician, a pediatric dentist specializes in taking care of children of all ages. If you do not know of a pediatric dentist, ask your pediatrician for a referral.
The First Visit
Nowadays children have little to worry about when visiting to the dentist. We like to see children when they are very young and it is helpful to bring them along when mum or dad have their own check-ups. It works well to take a few minutes of that appointment and let a young child have a ride in the chair often sitting on their parent's lap. Just letting them play in the corner and watch mum or dad having a clean allows them to get used to the surgery, the nurses and dentists and that mum or dad survive!!
Some children, even as young as 18 months, will jump up on the chair and open their mouth for a quick look with no problem at all. Others may take three or four visits. This is why we prefer, if possible, to tag them onto their parents appointment. This way no one feels under pressure to "perform". The first visit should be fun and rewarding (literally!). Once we do get to have a look and clean their teeth then they are nearly always good patients in the future.
Children need regular check-ups to not only check on any cavities but also jaw development (See our web page on Orthodontics).
Early Treatment
Early cavities can be treated very easily, often without the need for injections, and restored with tooth coloured materials. It is important to try and keep the baby teeth until they are due to fall out, as they help the path of eruption of the adult teeth and maintain jaw size and spaces. Early loss may cause the other teeth to move into the gaps and block out the un-erupted permanent teeth.
Prevention
Fizzy sugary drinks can be a dental disaster. Many popular drinks are also quite acidic (popular sports drinks) and this causes not only decay but gross erosion. Dummies used long term can cause a distortion in the shape of the jaws but if dipped in sugary mixes these also cause gross decay.
Tooth brushing is a gradually learned skill and most children are unable to do it properly without adult supervision. For very young children toothbrush shaped teething rings get them used to having something in their mouth. Gradually they can hold their own baby toothbrush and even if they just bite it it still helps to get them into the habit of cleaning their teeth after breakfast and before going to bed.
Most children under 10 are unable to use floss properly and generally they do not need to. (See our webpage on Gum Disease).
Accidents
It is rare to get through childhood without some tooth damage. Knocks on baby teeth can cause the tooth to darken, which is literally a bruise within the tooth. Most baby teeth have wide open ended roots and it is not unusual for these teeth to regain their colour 6-8 months later. However, we should check out the damage. In older children, when the front teeth are adult teeth, a knock may cause the tooth to die leading to the need for a root treatment. Again an x-ray will show up any damage needing treatment. Broken teeth can be restored in a number of ways. ( see our web pages on Crowns and Veneers ).
If a tooth is knocked out it should be found and brought straight to the surgery. If this is not possible then it should be washed and either replaced into the socket or kept in water or milk.
Mouthguards are essential wear in any contact sports including basketball. Well fitted mouthguards have saved many a patient from severe tooth damage or loss. Unless the mouthguard fits properly then they will not be worn.
Pregnancy and Teeth
Pregnancy is a special time to take extra care of your teeth and gums. During pregnancy your hormonal balance is altered and your gums become more susceptible to disease.
There is no truth in the old wife's tale that says a tooth is lost for every pregnancy. Good oral hygiene procedures will ensure that you have healthy teeth and gums during pregnancy.
Oral Health Guidelines
Plaque is largely made up of bacteria. By using antibacterial products you can help control plaque formation.
Visit your dentist before you become pregnant and during pregnancy to make sure your teeth and gums stay strong and healthy.
Brush twice a day and floss thoroughly every day.
Use a soft toothbrush and a proven antibacterial fluoride toothpaste.
Change your toothbrush regularly.
Eat a nutritious diet from a wide variety of foods.
Increase your calcium intake.
Avoid frequent snacks that contain sugar.
If you are pregnant or suspect that you are, it is important to tell your dentist when you visit. Practitioners are careful in prescribing medicines to pregnant women and only advise those which are really needed. Certain medicines such as the tetracycline antibiotics can affect your baby's developing teeth.
If possible dental x-rays should be avoided during pregnancy, however, if your dentist considers it essential for you to have an x-ray, special care and protection will be taken.
Before you become pregnant
It is important to establish good oral hygiene practices now so that when you become pregnant you will already have established a daily routine.
Dental plaque (bacteria) needs to be cleaned from the teeth and gumline by brushing and flossing every day. Brush twice a day with a soft toothbrush and fluoride toothpaste. Use dental floss daily to clean between your teeth where the toothbrush cannot reach. You can check how well you remove plaque by using special plaque disclosing tablets or solution. These are available from your chemist.
Visit your dentist
It may be more comfortable for you to complete any dental treatment required before pregnancy especially as you may experience nausea and vomiting or become tired as your pregnancy progresses.
Now That You're Pregnant
Morning Sickness
The stomach contents are acidic and may dissolve some of the the tooth enamel. To avoid tooth damage after vomiting or gastric reflux don't brush your teeth if you have just vomited. Instead wipe a smear of fluoride toothpaste over the teeth and rinse with water.
Gagging can often occur whilst brushing your teeth. If this makes you feel sick, try to concentrate on your breathing as you clean the back teeth. Brushing without toothpaste can also help but return to using fluoride toothpaste as soon as possible.
Cravings may be experienced for certain foods. Frequent snacks and drinks, especially sweet ones, can lead to dental caries (decay). Choose a wide variety of snacks which are low in sugar, fat and salt and high in fibre. Drinks such as milk and water are recommended.
Your gums may be easily irritated by dental plaque. When you become pregnant, the hormones in your body change. These hormones can cause your gums to become inflamed, and bleed. Clean your teeth and gums by brushing and flossing each day to reduce the irritation and keep the gums healthy. During your pregnancy, ask your dentist to check the condition of your gums and advise you further on how to care for them.
Brushing is important, cleaning your teeth and brushing your gums twice a day will avoid plaque build up. Remember, each tooth has two five surfaces - a front, a back, two sides and a top. The only one sure way to prevent dental disease is to clean every surface.
Fluoride strengthens the teeth and prevents decay. Fluoride is found in most toothpastes and your dentist may recommend you also have a fluoride mouth rinse or have a professional topical fluoride treatment. For your baby there is no clear evidence that taking fluoride tablets during pregnancy will strengthen the baby's developing teeth or help prevent decay for the baby's teeth. If water supply is not fluoridated then your dentist may advise that the baby have a fluoride supplement.
Calcium is very important. When you are four months pregnant your baby's teeth and bones begin to calcify. The calcium and phosphorous needed comes from what you eat and, if necessary, from your bones. These minerals do not come from your teeth.
When you are 7-9 months pregnant your baby needs more calcium and phosphorous. These minerals are best obtained by eating more dairy foods.
Milk and milk products are an excellent source of calcium. Choose those that are low in fat and sugar. If you don't drink milk or eat milk products such as cheese and yogurt choose other products that are high in calcium. If you are having difficulty see your doctor or dietitian for advice. They may recommend calcium supplements. The recommended daily intake per day for women is 1,100mg during pregnancy, and 1,200mg while breastfeeding.
Looking Ahead
At first your newborn baby does not have decay causing bacteria in their mouth.
As the teeth come through the gum the bacteria that causes decay is passed to the baby by the main carer, usually the mother through kissing, food tasting or by cleaning the dummy in their own mouth.
It is important that carers thoroughly clean their own teeth and have all their own decayed teeth treated so they will have low levels of bacteria. This will reduce or greatly delay the transfer of these bacteria to the baby.