By Rocky L. Napier, DMD
It’s been a quiet week in my hometown of Aiken, SC… located in the west central region of South Carolina. Oh yes, South Carolina, “Where smiling faces meet beautiful places,” is a slogan still familiar with so many here today.
However, in children today, in Aiken and across the nation, dental disease remains the most common chronic disease, five times more common than asthma, seven times more common than hay fever, and more common than obesity. Children miss more than 51 million hours of school annually due to excessive dental disease, a disease that is best prevented and managed at home prior to and after a child enters school. To cause more concern, in its report on children age 2–5, the CDC in Atlanta notes that the decay rate in small children has remained at roughly 25% for the past 30 years. Unfortunately, this has happened at a time when we would have hoped that rate would have dropped significantly. So, here are a few of the very most important steps that we as dental professionals can advise to protect the oral health of our patients’ anticipated or most recent addition.
Encourage new moms and dads to wipe the mouth and gums after each feeding and before bedtime. Babies like a clean mouth too! When the teeth arrive, an infant toothbrush and “rice-grain” amount of fluoridated toothpaste can be introduced per your recommendation. Never put a baby to sleep with a bottle, sippy cup, or other container containing formula, soda, milk, or juice, even if it is diluted. This can cause the teeth to decay as they erupt into the mouth. If a bottle must be used, most pediatricians prefer a small amount of water.
Also, parents should avoid carrying around bottles, sippy cups, straw cups, and any type of covered container that contain various types of sodas, flavored waters, and juices (SSBs or sugar sweetened beverages, whether naturally occurring or added sugars). Fruit juice offers no nutritional benefit to children under age one and should not be included in their diet. Human milk or infant formula is typically sufficient for infants. The constant and at-will feeding of these sweet and/or acidic liquids will substantially increase the child’s risk for decayed teeth at a very early age (i.e. 12–15 months). There is absolutely no accepted dilution rate for juices or other SSBs in “day long” or “nighttime” bottle, sippy cup, or covered cup usage. The professionally accepted recommendation is 100%, preferably fluoridated, water.
Consumption of unpasteurized juice products should be strongly discouraged for children of all ages to avoid the risk of potentially serious foodborne illnesses. Children who take specific forms of medication should not be given grapefruit juice, which can interfere with the medication’s effectiveness. In addition, fruit juice is not appropriate in the treatment of dehydration or management of diarrhea.
By reducing the transfer of decay-causing bacteria to the child prior to age three and their more fully-developed immune system, we can try to minimize decay in the developing child. The sharing of straws and utensils are highly discouraged, as are those big fat juicy (saliva exchanging, germ sharing, decay causing) kisses straight to the baby’s smacker. And for goodness sake, parents, please don’t ever pick up the baby’s pacifier from the floor, lick it, and place it back in the child’s mouth! And if you dare do, please don’t tell anyone! Instead clean the pacifier under hot running water, at the least.
The first and most important rule of all is this: “The parents and caregivers are responsible for the child’s brushing, flossing, and food choices into adolescence.” A child may be eight to ten years old before they possess the fine motor skills necessary to brush and floss their teeth properly. A full understanding of the concept of keeping their natural teeth 80–90 years may take even longer.
Parental supervision is a must. It is so important to remember the level of oral health care rendered 364 days and 22 hours or so “at home” annually by the parent or caregiver can very easily trump anything a dental team can do over a couple of one-hour visits six months apart. Professional dental care is important and should begin every six months starting with the eruption of the first tooth and no later than 12 months of age. However, what the parents and caregivers do at home the balance of the time is of utmost importance.
Encourage your patients to brush their child’s teeth after breakfast and before bedtime every day and have them spit. A “rice grain” amount for children age two and under, and a “pea sized” amount for children age three and above are the current recommendations. Rinsing is not mandatory. Brushing after lunch or after school is good too. Floss the child’s front and back teeth that are touching each other before bedtime every night.
Encourage drinking plain water between meals, after dinner, and during the evening before bedtime. Save the 2% milk and the SSBs (non-100% fruit juices, soda, sweet tea, sports drinks, and other Gatorade type products, etc.) for limited use at the table during meal times only. Advise parents to focus on healthy foods like fresh fruits, vegetables, cheese, and plain water between meals and in the evening. Remember the concept of a well-balanced meal. Include dessert at mealtimes only as a treat for eating well and behaving well the rest of the day, but not for snacking in between as part of a normal diet.
Children should be encouraged to eat whole fruits and be educated about the benefits of the fruit as compared with juice, which lacks dietary fiber and may contribute to cavities, excessive weight gain, which can be a precursor to diabetes, high blood pressure, heart disease, stroke, and other gastrointestinal and metabolic issues. One of the other main problems with drinking too much juice or milk is that it is filling and will decrease your child’s appetite for other more nutritious foods. Intake of juice should be limited to, at most, four ounces daily for toddlers age 1–3. For children age 4–6, fruit juice should be restricted to 4–6 ounces daily. I prefer that occur at the breakfast table only, and from an open cup, if at all possible. Low-fat/nonfat milk and water are sufficient for older children.
Avoid sugars and starches as snack foods between meals. Candy, chips (potato and tortilla), crackers, cookies, cakes, cereals, and chewing gum can be made part of a meal or given as dessert. It has been shown that chewing certain ADA-approved sugar-free gums for 20 minutes only immediately following a meal may help reduce decay. As a pediatric dentist, however, I personally think gum chewing is a habit to be avoided for the most part in children.
Finally, starting at about five or six years of age, if the child can rinse and spit reliably, have them use an anti-cavity fluoride rinse before bedtime every night. Do not use if the child swallows any of this product. Not rinsing after brushing is an alternative to daily fluoride rinses.
I hope you enjoy these tips on counseling new moms and dads about children’s oral health care from conception up to age six. If they follow these daily instructions, they can go a long way towards establishing a cavity-free lifetime of excellent oral health in their children.