Care starts from day one.
Teeth start growing in the fetus during pregnancy. A mother’s good nutrition and health are important for her child’s teeth to be strong and healthy.
Teeth are needed for a lifetime, so taking care of them from the beginning is essential. Primary or baby teeth help a child learn to chew properly, give shape to the mouth for speaking and hold space for permanent teeth. Permanent teeth grow right below the gums during early childhood and begin replacing primary teeth at age five or six. Taking care of teeth becomes even more crucial then because there are no more teeth to replace permanent teeth (except false teeth).
You should begin dental visits with your child early — usually within six months of the first tooth eruption, but definitely before the first birthday. Establishing a regular dental home will help to ensure good dental health. The American Academy of Pediatric Dentistry (AAPD) recommends well-baby dental checkups. At these visits, children and parents learn how to care for teeth, the dentist checks for any decay, and bad habits such as having bottles in bed or thumb sucking are discussed. Teeth are at high risk for injury and cavities when they are first coming out of the gums because they are soft and can be damaged more easily.
Cavities are caused by tooth decay over time. The mouth contains many types of bacteria. Some bacteria grow on food and drinks that contain sugar. When sugar stays on teeth, bacteria start eating the sugar and then produce acids. This process creates a sticky film (plaque) on teeth where bacteria can hide.
Plaque feels like short fuzz on teeth. Acids in plaque start to remove the minerals that make your teeth hard, the tooth’s enamel gets tiny little holes in it and cavities start. When the enamel is gone, bacteria just keep eating sugar and making acids until the cavity goes through to the dentin of the tooth. This layer is soft and more easily damaged by bacteria. The damage then spreads to other teeth. Eventually, the damage can go all the way through to the inner tooth (the pulp), where there are nerve roots and blood vessels. Infection in this area can cause a tooth abscess, which is very painful.
Cavities in baby teeth are preventable. Primary teeth are exposed to what parents give their baby to drink and eat. Babies should be fed while being held. Bottles of formula, milk or juice should not be propped in a baby’s mouth, and babies should not take a bottle to bed.
Pacifiers that are soaked in sugary substances or rinsed off in an adult’s mouth can also cause tooth decay. Saliva from a parent’s mouth that has cavities can transfer bacteria to a baby’s mouth. Baby bottle tooth decay usually affects the front teeth of infants and toddlers and is caused by having a lot of contact with sugary liquids and foods. If primary teeth have cavities, permanent teeth are at greater risk for cavities. Adolescents are at particular risk for dental problems because of increased foods and fluids that cause cavities, and because they tend not to take the best care of their teeth.
How to Care for Teeth From the Beginning
Encourage healthy eating. Avoid sugary drinks and foods. Never allow your baby to have bottles in bed. Your child should drink from a cup by age one.
Have a dental home. From the eruption of the first tooth, your child should see a pediatric dentist or a general dentist who sees kids, every six months. Find a dentist who works well with your child.
Brush. Your child should brush twice a day. Initially, wipe your child’s gums with a soft cloth or gauze pad after each feeding. Once teeth start coming in, brush them with a child-sized toothbrush and a smear of fluoride toothpaste. When your child turns three, increase the fluoride toothpaste to a pea-sized amount. You should be responsible for tooth care until your child is old enough to understand the importance of brushing correctly, usually age six or seven. As your child grows, you can use appropriate-sized toothbrushes with a larger amount of fluoride toothpaste. The goal is brushing for two minutes and reaching every tooth.
Floss. Once your child has more than one tooth, use dental floss to clean between teeth with each brushing, and other times as needed. Flossing helps to keep teeth and gums healthy.
Learn about fluoride supplementation. Fluoride helps to prevent, inhibit and reverse cavities. Supplementation needs may be based on the amount of fluoride added to the drinking water in an area. Fluoride applications can start in infancy and continue through adolescence. The AAPD has guidelines for fluoride supplementation.
Chew sugarless gum: Chewing sugarless gum (which contains aspartame, xylitol or mannitol) for 20 minutes after a meal can help prevent tooth decay. Chewing increases the flow of saliva in the mouth, which washes away food debris, neutralizes acids that are produced by bacteria, and transports calcium and phosphate to strengthen tooth enamel.
Avoid foods known to damage teeth:
- Hard candy is full of sugar, and can break teeth
- Chewing ice (which can indicate anemia) damages enamel and breaks teeth
- Citrus erodes enamel, makes teeth more susceptible to decay over time and should be limited
- Sticky foods (chips) get stuck in teeth, are full of starches and make flossing difficult
- Coffee and tea dry out the mouth and stain teeth
- Soda dries out the mouth and contains acid that damages enamel
- Sports drinks are full of sugar
- Alcoholic beverages (for mom and dad) are full of sugar
Use protective gear. Prevent injuries with a mouth guard/mouth protector. A custom-fit mouth guard — which can protect teeth and any appliances or braces on teeth — is best. Stock mouth guards may not fi t very well and can make breathing and speaking more difficult. Boil and bit guards can give a good fit. Mouth guards require care: Brush with toothpaste and rinse thoroughly; store in a sturdy container when not in use; don’t leave the guard in the sun (it will melt or change shape); check for wear and tear with each use, and replace when necessary.
Making sure children have healthy teeth from the beginning is very important. From infancy to adulthood, there are many strategies that protect and preserve teeth. There are also many things that can damage teeth. A smile is often the first thing other people see. Let’s make sure your child’s teeth are the best they can be.
Ann Petersen-Smith, PhD, RN, CPNP-AC, is an Assistant Professor at the University of Colorado Anschutz Medical Campus College of Nursing.