Fostering Dental Health—and Bright Smiles—in Children

• Dental Insurance—A Consideration
• Family Talk in previous issues

By Kris Imherr
Illustration by Joel Snyder

Health care for teeth begins in infancy and includes a proactive plan of protection.

Kylie Long's "special tooth" may have done her a special favor. Concerned that one of her upper front teeth "was coming in a little funny," her parents, Kelly and Rich Long of Redmond, Wash., took her to see their dentist. That was two and a half years ago, half a lifetime for the kindergartner, who has since returned regularly for checkups. Although Kylie doesn't recall details of her earliest visit, she does remember, "When I first went, it was scary, but as I kept on going, I got used to it."

A mouthguard helps protect the mouth of a child engaged in active sports like youth roller hockey.

Kylie's introduction at a young age to oral health care has not only put her at ease, it has also greatly improved her chances for preventing future dental problems.

Many other American children haven't been as fortunate. A recently released federal guide about children's dental care reports, "Tooth decay continues to be the single most chronic disease among U.S. children despite the fact that it is highly preventable through early and sustained home care and regular preventive services."

Tooth decay is five times more common than asthma, and seven times more common than hay fever, according to a report from the surgeon general that also states that "more than 51 million school hours are lost each year to dental-related illness."

While the American Academy of Pediatric Dentistry (AAPD) estimates that 90 percent of all cavities are preventable, the Centers for Disease Control and Prevention reports that "more than half of children age 5 to 9 have had at least one cavity or filling; 78 percent of 17-year-olds have experienced tooth decay."

Parents and adult caregivers can help reduce those negative numbers, experts say, by taking these steps:

Start oral care when children are very young.

Adults who first visited a dentist in elementary school may be surprised to learn that pediatricians and dentists now generally recommend infants have an oral health evaluation by their first birthday.

The process should begin with the parents providing a developmental history detailing family, prenatal, and current health conditions. Then comes a risk assessment, a checklist of questions about certain behaviors or lack of behaviors that can put a child at greater risk for tooth decay.

"Then we actually look in the child's mouth," checking for such physical risk factors as pits in the teeth; plaque; even decay, "because it can occur in kids as soon as they get teeth sometimes," says Columbus, Ohio, pediatric dentist Dr. Paul Casamassimo, a past AAPD president.

The gathering of information leads to "anticipatory guidance," he says, educating the parents to schedule regular dental visits and implement an oral health plan tailored to their child.

Make sure children brush and floss.

Many elements of any plan for maintaining dental health—like brushing after breakfast and before bed—haven't changed over the years. But specialists now say even babies just beginning to get teeth need an oral hygiene routine, and pediatric dentists recommend that adults continue supervising children's brushing until age 7 or 8 and flossing until age 10.

Supervision is necessary for flossing, Dr. Casamassimo says, because "kids don't really have good manual dexterity until about [age 10]."

With brushing, parents stand by to ensure children brush both thoroughly and long enough.

"The longer you brush, the more likely you are to remove [decay-causing] plaque off teeth," Dr. Casamassimo says.

Because Kylie Long, according to her mom, "has a tendency to speed" and "no concept of time," she now must turn over a small hourglass timer whenever she starts brushing and continue to brush until its sand runs out.

Include fluoride in your decay-fighting regimen.

Fluoride, a compound derived from the element fluorine, helps keep tooth enamel strong. Putting fluoride in drinking water "is the No. 1 way to prevent tooth decay," the AAPD says, but "40 percent of children do not have access to fluoridated water."

Kylie and her brother, Cartter, are among that 40 percent, so they take fluoride supplements prescribed by Cartter's pediatrician and Kylie's dentist.

Dentists recommend using other fluoridated products, including toothpaste. But because young children have a hard time spitting out—as opposed to swallowing—toothpaste, they're susceptible to ingesting more fluoride than necessary. That can lead to fluorosis, defects in tooth enamel, in the form of chalky white spots.

Parental supervision of toothbrushing helps minimize fluorosis. So does following dentists' recommendation to allow children age 2 and younger to use little or no paste, and those age 2 to 6 to use only a pea-sized amount.

Provide a healthy diet; minimize sugary and starchy snacks.

Most people know that sugars cause bacteria in the mouth which produce acid that can lead to tooth decay. But cooked starches, such as breads, crackers, pasta, potato chips, and pretzels, can do the same. Some dental research is now focused on how long various foods stay in the mouth and pose a threat.

Meanwhile, counsel remains the same: Children need a lot of calcium and phosphorous to grow healthy teeth and gums. They otherwise should eat nutritiously and snack no more than four times daily. Brushing after meals and snacks is best, but if that isn't an option, even rinsing the mouth with water will help.

Get sealants.

Consisting of a thin plastic film that dentists paint over the back teeth, sealants protect—for as long as a decade—the chewing surfaces, where, the AAPD reports, "four out of five cavities in children under age 12 occur."

Given that they cost less than half of what filling a cavity costs, sealants, says the AAPD, are "good value in view of the decay protection offered."

Use mouthguards.

Protecting the mouth should be a primary goal for anyone—including a child—who engages in a sport or activity that has the potential for falls or for head contact with other players or equipment. AAPD statistics show both that mouthguard use prevents more than 200,000 injuries yearly and that almost 75 percent of oral trauma in athletes takes place when they don't use one. Sporting goods stores sell pre-formed and adjust-to-fit guards made of soft plastic; dentists make custom-fitted protectors that are costlier but generally more comfortable.

By fostering oral health in children early on and in the most ways possible, parents and adult caregivers will provide youths with every reason to smile.

Kris Imherr, a freelance writer in Dallas, Tex., also wrote the January-February Family Talk column, "Helping Children Identify Areas of Intense Interest."

Editor's note: This column is designed as an educational tool only. For specific dental advice, please consult your dental specialist.

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