Protecting Those Little Pearly Whites

   With all the demands of caring for a new baby, most parents don't think about making an appointment with a dentist — usually not until the little one starts to experience teething issues and the first teeth appear. 

   The first primary (baby) tooth erupts at approximately six months, with the bottom teeth usually appearing before the top. Most babies will experience some teething problems, such as drooling and irritability. Teething is associated with an intense itchiness on the gums; the baby gets relief by chewing on things, from keys to table ends and toys. Giving the baby a teething ring that is clean and frozen will help ease discomfort, due to its topical numbing effect. Occasionally, babies will experience a rise in temperature and possibly some gastro-intestinal upsets — symptoms that often result because the items the baby has been teething on are dirty.

   The American Academy of Pediatric Dentistry and the American Academy of Pediatrics encourage all babies to have their first dental visit by age one. This was recently changed from three years of age, as considerable damage can occur in the child's mouth by age 3. The following is also recommended to ensure good oral health:

—Babies should be weaned from the bottle by 12 months of age, and parents should be cautious about the use of a sippy cup as a camouflaged bottle.

—Babies should not be put to bed with a bottle or kept at the breast all night, as they tend to pool the milk in their mouth, which can cause extensive cavities.

—If the baby needs to be fed at bedtime or during the night, hold him in your arms. Once he is done feeding, wipe his mouth down with a wet washcloth to remove any pooled liquid, and then put him back to bed.

—Babies' mouths should be wiped down after every feeding with a washcloth and brushed with an infant toothbrush once the first tooth has erupted.

   These early habits encourage the baby to get used to having his mouth and teeth cleaned regularly as he grows. It is important to brush twice daily for at least two minutes once the teeth emerge. Electric toothbrushes are a great way to motivate your child to brush; many have two-minute timers that encourage brushing for the appropriate amount of time. The use of fluoride toothpaste is not recommended in children who are unable to spit unless the dentist recommends it, and in that case, no more than a pea-sized amount of toothpaste should be used.

   Parents should brush their children's teeth for them until the age of 6-8 years, depending on the child's manual dexterity. Even if they can brush on their own, parents should follow up and brush for them as well.
 
   Flossing should be initiated once there are areas in your child's mouth where teeth are close enough to touch each other. These are areas where food can get trapped and cavities can develop silently and quickly. There are also many mouthwashes and rinses on the market. Alcohol-based mouthwashes, such as Listerine, are not recommended for children, however. It is a good idea to use rinses with fluoride if your child's dentist recommends it.

   Cavities are caused by foods that are high in carbohydrates, such as refined sugar, and the presence of the right bacteria that are allowed to grow and multiply on the teeth undisturbed for long periods of time. The human mouth is a perfect incubator — its warmth provides an excellent environment for the bacteria to thrive.

   Research has shown that babies get these bacteria from caregivers (parents, babysitters, siblings) by sharing utensils, kissing, etc. The longer these bacteria are kept out of a baby's mouth, the fewer cavities the baby will have. It is very important that mom has a healthy mouth and that all decay is treated, even before pregnancy. An unhealthy mouth in an expectant mother can cause low birth-weight babies and pre-term labor.

   Bacteria need sugar to multiply and create an acidic environment that dissolves the teeth. Therefore it is imperative that parents and caregivers monitor baby's intake of sugars via foods and juices, and to discourage baby from having sweetened beverages from a bottle or sippy cup. Apart from the sugar content of a baby's diet, the frequency of exposure to sugar also plays a role in the formation of cavities. The more the child sips on a beverage, the higher the cavity rate, so it is better for them to drink the entire amount at one time if possible.

   Most kids get dental checkups every six months, but this frequency can change based on individual needs. There is a lot a pediatric dentist can do to prevent cavities, such as the application of topical fluoride in the form of gels or the newer varnishes. Sealants are another effective preventive procedure that can protect your child's teeth as they get older. By teaching your child good dental habits early on, you can help him maintain his oral health for a lifetime.

KAVITA KOHLI, D.D.S., is a Board-certified pediatric dentist, and an associate professor and director of the Pediatric Dentistry Residency Program at Columbia University-New York Presbyterian Hospital. She trains pediatricians and family medicine physicians about pediatric oral health nationally; and in her private practice in Ardsley, treats infants, children, adolescents and children with special needs. She can be reached at (914) 693-3650 or [email protected].