Child brushing teeth When people think of the most common health problems in young children, they often think of ear infections, rashes, viruses, asthma — indeed, all quite common. Yet arguably the single most common health problem of childhood can slip by unnoticed: tooth decay. Approximately 42 percent of U.S. children between ages 2 and 11 have cavities in their teeth, and the problem is becoming more common.

Many people think of oral hygiene as something that will be important once a child gets older, but in fact as soon as a child has teeth, it’s time to care for them. Pain in the mouth can be a big distraction from learning at a time when children’s brains are developing rapidly. Oral pain and rotten teeth can affect a child’s ability to eat, and in extreme cases, lead to malnutrition. Not only can tooth decay delay growth and development, but it can also lead to infection, early loss of baby teeth, and even risk of crookedness or
decay in permanent teeth.

The American Academy of Pediatric Dentistry (AAPD) recommends adding oral hygiene to a child’s daily routine no later than the time his or her first tooth appears. For children 6 and under, parents should brush (or assist with brushing) the child’s teeth twice daily, using a soft toothbrush appropriate for the child’s size. Kids under 3 should use a smear of fluoride toothpaste, and for kids ages 3-6, use an amount the size of a pea.

While past guidelines have suggested non-fluoride toothpaste for young children, the AAPD now recommends fluoride toothpaste for kids of all ages. The risk of too much fluoride is small when compared with the large effect it has on preventing dental disease. Guidelines also recommend that if a home’s water has a fluoride concentration less than 0.7 parts per million — check with your water company — children should begin taking fluoride supplements (drops for younger kids, chewable tablets for older kids) beginning at 6 months. Those can be prescribed by your primary care doctor or pediatric dentist.

You and I brush our teeth before bed so that bacterial plaque doesn’t sit on our teeth overnight, eating away at our enamel. The principle is the same for babies and toddlers, and that’s why doctors advise against letting a child fall asleep with a baby bottle full of milk, formula or juice. As the baby sleeps, the sugars in that bottle of milk or juice eat away at the enamel on his baby teeth, leading to a form of cavities often called baby bottle tooth decay. Putting a child to bed with a bottle may seem like a good way to soothe him, but it leads to dental problems that can be quite serious.

Another way to prevent early cavities is to do something dentists have long advised: avoid sugary snacks or drinks between meals. These sugars feed the bacteria that cause tooth decay, not to mention the effect they have on a child’s weight and overall health.

Recently the U.S. Preventive Services Task Force, an independent panel of experts who examine the available medical research, added a recommendation that clinicians should apply fluoride varnish to the teeth of all infants, beginning with the earliest baby teeth. Older children benefit from fluoride varnish as well. That’s something your pediatric dentist can do, and we
recommend children make their first dentist visit between the time their teeth emerge and the age of 12 months.

While this may sound like a lot of rules, it quickly becomes routine, ensuring that the tiniest smiles keep going strong.