Materials for this week:
- Case and discussion
- Peds in Review article on Fluoride and Dental Caries by our own local expert, Charlotte Lewis MD MPH
- AAP oral health resources
Take-home points for dental health:
- Who is most at risk for dental caries? Sadly, dental caries have become epidemic – they are now the most common diagnosis among otherwise healthy kids, with about one third of children with caries by age 3. Risk factors include children with special health care needs, parents with caries, especially during pregnancy, and low-income status. Parents’ oral health matters since they can transmit decay-causing bacteria like strep mutans to their children. Children can be colonized with the bacteria soon after birth, and earlier colonization increases risk for caries.
- When and how should we recommend fluoride? Use fluoride sources to protect teeth in 3 ways: brushing, fluoridated water, and fluoride varnish at the dentist and at well child checks (at least 2-3 times per year). Brush children’s teeth with fluoridated toothpaste 2 times a day as soon as teeth start erupting. Start with a grain of rice sized amount of toothpaste and move to a pea-sized amount about age 3 when kids can spit. Nighttime brushing is most important since we make less saliva at night to clean the teeth (my kids’ dentist has the motto “clean teeth before sleep”). Parents should help with nighttime brushing until children are about 7 or 8, and even a few times per week after that is recommended to monitor teeth. We should also recommend flossing once a day for teeth that are touching. I highly recommend the preloaded kids “flossers” – they were a game-changer for helping our kids to floss!
- What foods and drinks should we recommend to prevent cavities? The obvious ones are limiting sugary/high carbohydrate foods, especially sticky ones, and sugary drinks. When these are given, it’s best to offer at mealtime and let the pH come back into normal range between meals, which takes ~90 minutes. When children constantly have food/drinks in the mouth, such as with a bottle or sippy cup, the pH of the mouth never neutralizes, creating an ideal setup for cariogenic bacteria to collect and cause decay. That’s why it’s especially important to avoid grazing and offer tooth-friendly snacks between meals (whole fruits, veggies, protein snacks like cheese, water to drink). Once teeth are brushed, there should be no more bottles/breastfeeding at bedtime or overnight.
- What can we teach parents about how to check kids’ teeth? Baby teeth are important and decay can start as soon as the first tooth erupts. Decay is most likely to occur along the gum line of the upper incisors and also in the pits and in between the premolars and molars. Caries typically appear as white spots (decalcifications) and may progress to yellow/brown cavitations. Show parents how to “lift the lip” to check child for early signs of decay. Check out the AAP Flip Chart to learn more about oral health to review which teeth come in when and other topics. Did you know in a recent study of pediatric residents, only about 1/3 discussed sleeping at night with breast/bottle, only ~13% discussed the status of teeth, and <10% lifted the lip to examine front incisors. I know we can do better than that here!
- When should dental visits start? The ADA and AAP recommend children establish a dental home by 1 year of age, possibly earlier for children who are at very high risk of caries. Healthy teeth for parents is important, too. Encourage them to model good oral health and receive dental care as well.