Dental caries, usually known as tooth decay, is the most common chronic disease in children in the U.S., ranking above asthma and hay fever. The American Academy of Pediatrics (AAP) reports that 59 percent of children 12 to 19 years of age have at least one documented cavity.
Dental caries is caused by acid-producing bacteria that destroy the tooth’s enamel, its protective barrier. With tooth decay, there is a greater risk of tooth loss, dental abscess and pain. Caries in children causes not only discomfort, but difficulties with chewing, which may lead to poor weight gain and inhibit growth and development. Another concern is that untreated caries may cause a systemic infection, abscess of the gums, cellulitis and the risk of infecting the permanent teeth.
According to the AAP, dental caries contributes to the 51 million hours of school absenteeism and parental loss of work hours annually. Children often miss school because of mouth pain. This pain may be reflected in poor school performance, anxiety, fatigue, irritability or withdrawal from normal activities. Tooth loss from dental caries may affect a child’s jaw development and impact the development of the permanent teeth.
Establishing Healthy Habits
You can help prevent caries in your kids by exposing their teeth to fluoride, practicing good oral hygiene and limiting carbohydrates (especially sugary, gummy foods, sodas and nighttime bottles with milk and juices). Delaying the introduction of external bacteria into your child’s mouth (e.g., not kissing your child on the mouth, not cleaning a pacifier by using your mouth to wipe it clean, and not using utensils handled by others) will also promote good oral hygiene.
It’s important to take a proactive role in caring for your children’s dental hygiene. Dental hygiene should begin in infancy with gum care and tooth brushing as the teeth erupt. The first dental visit, per the AAP, should be in the first year of life. Then biannual dental visits should become part of your children’s routine preventative health maintenance.
As kids grow, they should be responsible for daily tooth care. Be sure that your children have the appropriate soft-bristled toothbrushes, and replace toothbrushes as they wear. Also, fluoride toothpaste, dental floss and appropriate fluoride mouth rinse (for children six years of age and older) should be located where kids routinely do their daily oral hygiene. Establish and encourage a daily routine of brushing teeth in the morning and before bedtime. You may need to remind your children and even have an incentive in place to maintain daily oral healthcare.
Taking Healthy Measures
Preventative measures against cavities have been promoted in dental and medical communities. One of the most effective measures is the addition of fluoride to community water supplies. According to the Centers for Disease Control and Prevention, about 75 percent of the U.S. population is served by community water systems that contain enough fluoride to protect teeth. Grassroots efforts are needed to encourage all communities to have fluoride added to their water supplies.
You should know the current level of fluoride in your community water supply, and can find out by calling your local water company or having your water tested.
Fluorosis, a cosmetic condition in which teeth are stained by overexposure to fluoride, does not endanger teeth. In fact, it may be more protective. Fluoride supplementation is most effective in kids younger than eight years of age, when the mineralization of the teeth is still occurring. If your water supply does not have fluoride and other sources of fluoride are low, contact your provider about fluoride supplementation for your children.
The use of fluoridated toothpaste in infancy is now recommended instead of fluoride supplements if there is a concern about the amount and sources of fluoride in children’s diets. The amount of fluoride in a one-inch strip of fluoridated toothpaste contains 1 or 1.5 milligrams of fluoride. Children under three years of age and after the first tooth erupts should have a smear (or the size of a grain of rice) of fluoride toothpaste placed on their toothbrushes. Kids ages three to six years of age should have a pea-size amount of fluoridated toothpaste on their brushes. It is acceptable for children to not rinse (most children will swallow the rinse water) after brushing but to spit out the excess toothpaste. This will give kids the necessary fluoride coating on their teeth from the saliva and a reduction in the amount of fluoride swallowed.
The application of fluoride varnish (a concentrated topical fluoride) is another preventative measure to consider to prevent dental caries. Application of fluoride varnish is a non-invasive procedure done in the child’s pediatric practice or clinic. After an oral examination by your provider, fluoride varnish is brushed on the surfaces of the teeth to prevent new cavities from forming. It is well tolerated by most kids.
After application, eating soft foods and avoiding brushing should follow. Children should resume their normal twice-daily brushing the next day. Fluoride varnish should be applied at least every six months to both primary and permanent teeth. If there is a high risk for cavities or limited access to a dentist, varnish should be applied every three months. Fluoride varnish is covered by Medicaid as well as by many private dental insurance plans. Your pediatric practice can verify billing requirements for treatment.
Preventative dental care is an important part of a child’s well-being. Establishing a dental routine and appropriate dental assessment for your kids leads to cavity-free smiles and happy children.
Jo Ann B. Serota, DNP, CPNP, FAANP, IBCLC, is co-owner of Ambler Pediatrics, Ambler, PA. She is president of the NAPNAP Foundation, past president of NAPNAP, corresponding editor of primary case studies for the Journal of Pediatric Health Care and a Ready, Set, Grow advisory panel member.