Dental caries (cavities) are preventable for most children. To keep those pearly whites pearly it takes being thoughtful about eating habits, brushing habits, drinking habits, and being knowledgeable about your child’s water supply. Although physicians are making robots to perform surgery and putting tiny cameras in our bodies to explore the inside, we may sometimes lose sight of easy, affordable ways to improve the lives of millions. Maybe we simply retreat from those prevention efforts…or maybe it’s something else.
The CDC reported this spring that for the first time in 40 years, preschoolers have more cavities than they did 5 years ago. And many children have so many cavities that they show up at the dentist with double-digit numbers requiring general anesthesia for repair. In one month alone, I’ve done a number of pre-op visits for dental anesthesia for patients in my clinic.
Many national headlines have covered this data over the last few months. And I would suggest there is one thing to stress here. Part of this increase in cavities may be a cultural issue, a parent-culture issue. That is, many parents may not be brushing their children’s teeth because of push-back from their children and a goal to maintain harmony at home. And many parents believe bottled water is safer than that from the tap. When it comes to teeth, that isn’t the case.
Sometimes we really have to act like adults and do the flossing.
I think this bump in cavity numbers is a parenting issue more than anything else. Although factors influencing the development of cavities include access to affordable dentistry, misunderstandings about the safety of fluoride in drinking water, babies going to bed with bottles, and familial risk factors (bacteria in our mouth, for example), we parents clearly play a part, too. There are a few things we can do:
5 Tips To Prevent Cavities In Children:
- Take your baby or toddler to the dentist for a check-up before or around their 1st birthday, even if they only have 2 teeth! The American Academy of Pediatric dentistry suggests you start check-ups no later than 1 year (not 3 years). If your dentist sends you away and tells you to return at age 3, find a new dentist.
- Don’t make formula with bottled water. Use tap water. Filter it or boil it if you like, but don’t buy bottled water for baby or for your children. Water with fluoride is protective for your child’s teeth. Further, get milk off your baby’s or child’s teeth prior to bedtime. Never leave a bottle in the crib with your baby, and do your best to brush their teeth after their last feed.
- You heard about Alicia Silverstone’s feeding session on Youtube, I assume. The one where she pre-chews her baby’s food (premastication) and transfers it back to his mouth? My advice: don’t do this. You transfer all the cavity-causing bacteria from your mouth to your baby’s mouth and increase their risk for early cavities. I feel strongly that parenting like a celebrity isn’t aways the right way. And another thing: don’t “clean” your baby’s pacifier with your mouth. Ever.
- Toothpaste! Use fluoridated toothpaste as soon as your baby gets teeth. You can buy the infant toothpaste if you’d like, but it doesn’t assist with cleaning better than water. As soon as your baby gets a tooth, use a smear of children’s toothpaste (think rice kernel amount) until they are around 2 years of age and can spit. After they know how to spit, use a pea-sized amount of children’s toothpaste thereafter.
- My Rule of 2’s: Brush your child’s teeth every day, 2 times a day, until they are in 2nd grade, for 2 minutes at a time. Get an egg timer to help because as I learned, that 2 minutes can feel like an eternity with a restless toddler. And if your child wants to try brushing on their own first, fine. But then you clean up the job thereafter.
Flossing every day earns you and your child an A plus. I’m still working on it…
Our pediatrician and dentist said that we should not use toothpaste for our son (almost 14 months now) but you suggest to do so. Any ideas why these discrepancies?
Wendy Sue Swanson, MD, MBE says
That’s what I was originally taught as well. The recommendations have changed. Here’s a quote from the Amer Academy of Ped Dentists:
An “exception proves the rule” caveat to your no-bottled-water recommendations: when my daughter was 1, we lived in a house that had well water. We went out and bought bottled fluoridated water for her, athough the grownups made do with the stuff out of the tap.
Wendy Sue Swanson, MD, MBE says
There is always an exception….:-)
Craig Canapari MD says
Wow, I didn’t know about the fluoride toothpaste for our 20 month old. Thanks, Wendy Sue!
Any advice for a flouride toothpaste that doesn’t taste overly sweet, nor minty, nor gritty? I just can’t find one that my daughter likes, which makes it a struggle. Currently using non-flouride toothpaste but swishing with flouride nightly…
Wendy Sue Swanson, MD, MBE says
Have you tried Tom’s natural toothpaste in strawberry?
Any one else with an idea?
Colgate makes a watermelon flavored toothpaste that my son loves. Anything with mint he claims is “too spicy”. Thank you, Wendy Sue for a great post. I particularly like your comment about parenting like a celebrity. Thanks for all that you do to give reasonable people a voice in the media!
Natalie's advocate says
There is a lot more to cavities than brushing. I have a nine year old nonverbal daughter with autism who, as a toddler, had horrible teeth. I’m talking brown, rotting, baby root canals in all the back ones at four and mercury fillings put in the front ones at the same time. She also has horrible sensory issues that makes it extremely hard to get her back teeth brushed, has had them all her life. I felt terrible when all her back teeth were bad because I figured that that was why – because I could never get the back ones brushed very well because she fought me so much.
Fast forward to a year after she got those, she was five years old and we had moved here from another state and I wanted to explore dietary changes and chelation for her. I began the dietary changes (we did the SCD diet for over a year, which is completely grain-free and uses no other sweeteners except honey) and also began the process of seeking a pediatric dentist who could replace her amalgams with composites as it is not safe to attempt chelation with mercury fillings in your mouth. It took me over a year and a half to find one who could safely do this, at this point she was nearly six and a half years old. Coincidentally she got an infection in one of her teeth WITH AMALGAM just two weeks prior to the scheduled date to get the fillings out. The date of the filling removal, the dentist pulled the infected tooth and replaced all her mercury fillings with composites. Six months after the amalgam removal I took her back for a checkup and the dentist was shocked to discover there was no new decay. Mind you, she still has her sensory issues and her back teeth still very rarely see a toothbrush because of them, yet the chronic tooth decay stopped when I put her on a strict organic no-junk diet with very little sugar and limited starches AND removed the poisonous mercury fillings from her mouth. It has been three years since the removal (and two years since we began chelation) and brushing is still a struggle, but her teeth are still in much better condition than they should supposedly be with her lack of brushing, and her gums, which used to be very red and enflamed, are now a healthy pink. I also never give her fluoride as she is very sensitive to a lot of things, and yet her teeth remain strong. My experience taught me that everything I thought I knew about keeping teeth healthy was wrong. I think the problem of chronic tooth decay in young children is just another example of how unhealthy and chronically ill our children are in general these days (autism, asthma, food allergies, seizures, even things such as kidney stones are being seen more frequently in children) and I think it’s high time we start asking why that is. Mineral status and how it affects the entire body’s ability to function is never acknowledged in mainstream medicine.
As an aside, I had my own four mercury fillings out about a year after I got my daughter’s out, and noticed a whole slew of problems I once had disappear afterwards. I used to get coffee stains on my teeth, I thought that was my own fault because I love coffee so much, well, I still love it but never get the stained teeth anymore. The horrible itchy sores I had on my head for years that would flare up completely went away, as did the frequent mouth sores I had. That’s another thing – if you are getting your children’s teeth filled, stay away from amalgam fillings, it is no question that they are bad. I won’t even take myself or my children to a dentist that still does those poisonous amalgam fillings, period.
Teeth Geek says
I am a dental hygienist and I encourage parents not to use toothpaste with fluoride until children can spit. This is to prevent dental fluorosis, as they are more likely to get it if they are swallowing the toothpaste. Fluoride is more concentrated in toothpaste than it is in water. If they are drinking fluoridated water they will usually meet the recommended fluoride guidelines. I would not even recommend a smear of toothpaste- it is not really necessary. The mechanical action of brushing and removing plaque and food debris is more important at that age. Once they can spit, it is great for them to have fluoride. I am a very strong advocate for it! This is when I would start to use just a smear for them.
Also, your children’s dietary habits have a huge impact on whether they get cavities or not. If your child has a sippy cup of juice or a cup of crackers all day this is very harmful. Each time you take a sip of juice it makes your mouth more acidic, which makes it easier to get cavities. So, it is better to drink a cup of juice or soda all at once during a meal than to sip all day long. Same goes for snacks, eat a bag of crackers or candy all at once instead of snacking. Follow these snacks and beverages with a sip of water to neutralize yours or your child’s mouth.
Yoo-Lee Yea says
I am a pediatric dentist that is pretty conservative regarding fluoridated toothpaste before the child knows how to spit. Why? Too much fluoride can cause fluorosis and cause intrinsic staining on the front teeth (incisors) and first permanent molars. I see fluorosis more and more in my patients and it is difficult to pinpoint the reason but children consuming toothpaste is a concern. I’m a parent of two young boys and am very strict about their toothpaste usage. I keep their fluoridated toothpaste out of reach too.
I believe that avoiding a high-sugar diet (juice intake, sticky sugary foods, etc) is the best thing a parent can do to prevent cavities!
Wendy Sue Swanson, MD, MBE says
So just to be clear, even though you are conservative about fluoride, do you agree with recommendations to use a tiny smear when teeth appear and a pea-sized amount when able to spit?
Thanks for tip–happy to move the toothpaste to the top shelf.
Yoo-Lee Yea says
Yes, I agree with the recommendations on toothpaste made by the AAPD. (My apologies, I thought that I had responded to your question on the toothpaste but I don’t see it listed.) A smear is sufficient until you can spit and a small pea size is a good amount for after you learn how to spit out your toothpaste. Xylitol is great when used multiple times throughout the day.
Lilburn family Dentist says
Great piece of information. This is what I was actually looking out for. Thanks for sharing
Our pediatric dentist recommends Spry tooth gel with Xylitol (you can buy at PCC or on Amazon.com). Our daughter has been seeing him since she was almost one and is now approaching three. We brush her teeth 2 times a day (and let her try as well). We don’t have to worry about spitting and she has gotten glowing dental reports at every visit. Any thoughts on this product?
The autism blog had a great interview with a pediatric dentist. Here is the link https://theautismblog.seattlechildrens.org/a-visit-with-the-dentist/
In my house hold we make brushing our teeth a family activity. I and my husband have eletric toothbrushes so my year old thinks it’s fun to make the humming noise with her tooth brush when we brush hers. But it took us awhile to find toothpaste that she liked and we approved of; we finally landed on Tom’s. My biggest struggle now is introducing flossing for her and getting over my anxiety of the dentist to be able to take her to the dentist confidently. Any advice is welcome for this!
I’m surprised you didn’t mention anything about the popular Gummy Vitamins that are popular among both parents and kids these days. I blame them, partly, on my son’s first-yr molar cavities that required crowns 🙁 Obviously, I also was not diligent enough about having him brush immediately after eating those darn things. Gold fish-like snack crackers (not an obvious “sweet”) and many cereals like Rice Chex and Kix are also notoriously difficult to remove from molars with deep pits.
My son also has a problem with two of his front bottom permanent teeth. They are substantially darker/yellowish-colored (not spotted, but just all-over off-white, unlike his baby teeth which were very bright white) than his other adult tooth (just one so far, on top). I have asked his pediatric dentist if this could be due to too much fluoride but only got a very non-committed vague response about everyone’s teeth being different colored, etc. Those two teeth also get horrible plaque/calcification between them also, that thankfully have not developed cavities, but need to be scraped off by the hygienist every visit. This is despite brushing 2x/day and flossing before bed, and rinsing with an anti-cavity fluoride rinse daily. I also just purchased a Sonicare for Kids brush and both my kids love it (it comes with 2 heads). It has really improved the quality and duration of their brushing and plays a tune, which they enjoy.
If there is concern over too much fluoride, why are most dentists and physicians encouraging use of fluoride toothpaste, fluoride rinses, and fluoride “paste” that they smear on our kids teeth every 6 months??? Plus most communities have fluoridated water, at least in WA (except Spokane and???). I suspect this is why my son’s front two bottom teeth are darker/yellowish colored. I think most kids get plenty of fluoride, and probably too much using today’s multi-pronged approach.
As far as anxiety and flossing, I use the “flossers” with my kids. I don’t like them because they are more plastic in the landfill, but they work well for small mouths. I take my kids to a pediatric dental practice, which is a 40 minute drive from our house, but they LOVE going to the dentist. It’s fun, they show movies or other shows, they have a great “no shoes/socks only” play area, and they have giant dinosaurs built into the room/building. It’s a hoot and we always start and end each dental visit with the play area. Yes, it’s more inconvenient and my husband thinks we should switch to a local family dentist, but I want my kids to have pleasant memories of the dentist, so feel it’s worth it.
Our ped dentist also said that no child should brush his or her own teeth until they are old enough to do laundry — perhaps a bit of an exaggeration, but I do agree that many parents might let their kids brush and floss unsupervised or without helping and that leads to poor quality cleaning.
Thanks for the excellent discussion on this all-to-important topic.
Hi — thanks for this great post! We do not have fluoride in our water supply, and though we use fluoridated toothpaste we’ve gone back and forth on whether to supplement with something like Poly-Vi-Flor. We’ve ultimately decided not to, but I’m wondering if you have thoughts on supplementing with fluoride in vitamins if it is not in the water supply? Thank you!
I think it’s important (and far easier) to focus on food choices and the whole snacking thing. Check out this recent NY Times article https://www.nytimes.com/2012/03/06/health/rise-in-preschool-cavities-prompts-anesthesia-use.html?pagewanted=all
We see a Pediatric Dentist. I’ve learned three things:
1) To use a toothpaste with Xylitol or simply apply Xylitol gel before the child can spit. Our water is fluoridated.
2) Avoid sipping/grazing as a previous poster mentioned. This also allows us to brush with water or rinse with water pick on lowest setting after each meal.
3) Parents need to care for their own dental health. We learned that a mother’s dental health is the most significant indicator of a baby’s future dental health. It indicate diet and lifestyle child is born into. More importantly, if mom has cavities, she is likely to transmit the bacteria that cause tooth decay to her child long before the child has teeth. Speaking to your Alicia Silverstone point, sharing utensils, cups, kissing child on mouth… all transmit potentially harmful bacteria into the child’s mouth.
Kim Heeter says
I am glad to see this post here, and enjoyed reading the comments. As a pediatric dentist I would love to see a second post on that addresses healthy dietary practices in more detail. Many commenters touched on the subject of avoiding sipping on sugary liquids, minimizing sticky foods and even starchy foods that get stuck in the pits of the molars (such as chips and crackers). All of the recommendations that I make to my patients about dietary habits are healthy not only for the teeth, but also for the body.
Ad libitum or “on demand” breast feeding past about 6-8 months can also be a problem for some children. I want to be clear that I am not discouraging breastfeeding past this age, but I am specifically talking about 24/7 use of breastmilk for non-nutritive feeding practice for a child who is also regularly eating solid foods.
Wendy Sue Swanson, MD, MBE says
That’s a great idea for a follow-up post. I’d love to spell out some of the information. Please feel free to share links you like.
Thank you for the opinion about non-nutritive nursing and oral health concerns. I spend a fair deal of time helping families wean trained night feeders and oral health is a big part of my argument!
I’ve been threatening for years to do a post on gummy vitamins….:-)
Thanks for the post! My daughter’s top two teeth just broke through and this is exactly what I was looking for! Do we still need to take her to our normal dentist for an exam? Thanks.
Ellen Mary says
FYI: I am nursing a 2 & 5 year old. They have wildly perfect teeth & I have avoided Fluoride. Telling mothers to prepare formula with Fluoride is not even necessarily recommended by the CDC @ this point & results in the infant getting 2-400x the Fluoride in BreastMilk!
I can’t really believe a Dr would spend time trying to get parents in the US to nurse LESS. (Altho it is like a dark Epidemic still). My children
have hardly if ever been sick & never needed Abx & nursing is the largest part of that! Tho avoiding questionable chemicals like Hydrosilafluoric acid play a part!
Using an industrial byproduct to chase poor nutrition, candy & juice is just a bankrupt strategy.
Bayou City Smiles says
Nice article. It’s never too early to make oral health a priority for your children. Parent’s can help convey the importance of tooth care by practicing these healthy habits with their children.
Lisa Gortler says
Interesting, I didn’t realize that it is better to make formula with tap water than with bottled water. I did, however, know the importance of getting milk off of kid’s teeth before they go to bed. Milk, while full of calcium, is also very acidic. I’m definitely going to try your “rule of 2s” thing. Establishing good teeth brushing habits is a necessity.
Dental anxiety in children has become increasingly common and is recognized as a major public health concern as well. Here’s what you can do to help your child combat dental anxiety.
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