Keeping children's teeth healthy begins early | Dr. Rich

The Center for Disease Control and Prevention reported an increase, the first in 40 years, in the number of preschoolers with cavities, in a study completed five years ago.

The study goes on to report that dentists are seeing more preschoolers at all income levels with 6-to-10 cavities, or more. Sometimes the level of decay is so severe that general anesthesia or sedation by a pediatric specialist is necessary, because young children are often unable to sit through hours-long procedures while they are awake.

Such extensive and expensive treatment is largely preventable.

Dental cavities are the No. 1 chronic disease in children, so it would be wise to seek out prevention information early from your own dentist or the child's pediatrician. Don't wait until your child comes to you with a toothache to take them to the dentist for the first time.

There are a number of reasons more preschoolers are beginning to suffer from such extensive dental decay. Constant snacking, drinking juice or other sweet drinks at bedtime, municipal tap water that is not fluoridated (including Auburn) and not obtaining a prescription for supplemental fluoride drops if your tap water isn't fluoridated are all reasons why the decay rate is increasing in children.

According to most pediatric experts, a child's first visit to the dentist should happen by their first birthday. They may have only a few teeth, but it is important that they be assessed for their overall cavity risk. That is also a great appointment for the parent to get any clarification needed or clear up any misunderstandings about preventing decay in the future.

Some suggestions

Here are a few tips to keep your toddler cavity-free:

In general, you should brush the teeth of children 2 or younger with a tiny bit of fluoride toothpaste twice a day. At 2, start to use a pea-sized amount. Fluoride is safe, like most other medications, when used in appropriate amounts. Do not leave toothpaste out where kids have access to it unattended. Young children have found and eaten a whole tube of toothpaste and had to be taken to the emergency room for treatment.

Reduce your child's access to snacking. Eating any starchy or sugary food causes the acidity of the mouth to increase sharply, which is very damaging to enamel for as long as 20 minutes, until their saliva dilutes the acid to more normal levels. The frequency of exposure to acid is actually more important than the sugar content of food and beverages.

Do not share eating utensils with a child at a meal, or "clean" a pacifier in your mouth before give it back to your infant. If you have active decay in your own mouth, you can literally pass the specific bacteria responsible for it to your children this way, putting them at increased risk for cavities themselves. The same thing applies to the specific bacteria that causes gum disease.

You should brush your preschoolers' teeth for them. They really don't have the dexterity or focus to effectively brush their teeth until they are at least 7 years old, in most cases. Since many young kids don't like tooth-brushing, some time-crunched parents don't push the issue. Honestly, it's much easier and far less expensive to have a young child cry a bit while you properly brush and floss their teeth than when a dentist has to fill a cavity that could have been easily prevented with proper home care and diet.

With a reasonably cooperative child, most cavities that do occur can be treated in a dentist's office with an injection of local anesthesia and some nitrous oxide, or "laughing gas" as it is often called. However, your dentist will usually recommend general anesthesia or sedation in a pediatric specialist's office or hospital for preschoolers with extensive problems. This is especially true in cases where they will not even let the dentist take a good look or get the X-rays they need for diagnosis. The cost to parents for a dental restoration under general anesthesia for a child can easily be several thousand dollars.

Some readers may have the mistaken idea that this is a socio-economic problem limited to children from households of low income and educational status. Although statistically those children do have higher rates of decay, the increasing decay rate is not limited to children from that group. Kids from financially stable, educated families are sometimes rewarded with snacks, fruit juice or other sweet treats throughout the day.

Some misconceptions about "healthy" snacks exist and have given some parents the idea that "natural" or "organic" means it is good for you. Fruit juices are more nutritious than things like High-C or Kool Aid, but they are also loaded with sugar and increase the acid attack on a child's enamel in a similar way.

I'm not suggesting that parents forbid sweets entirely. We all enjoy a little something sweet on occasion. However, it should be occasional, not every day, and be followed up by rinsing their mouth out with water right away, and brushing their teeth as soon as possible to help prevent cavities.

Developing a sweet tooth as a toddler only makes it that much harder to stay away from sodas, candy and the so-called "energy drinks" when they become teenagers. We owe it to our kids to educate ourselves on how to best care for them, including their teeth. If it's been a while since your child has visited the dentist, make an appointment today. Prevention is a much better strategy for your child's dental health and it may just be one of the nicest things you can do for them, as well as your wallet.

Dr. Stuart Rich is the owner of Simply Smiles, a general practice in Auburn. He and his associate, Dr. Jennifer Fields, and team treat patients of all ages. Feel free to visit their website at or call 253-939-6900 for more information.

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