Dental Care in Childhood
Every year thousands of children ages 1-4 suffer from extensive tooth decay. The major culprits are sugar containing liquids found in the baby's bottle - especially during the night.
Baby Bottle Tooth Decay
Just like an adult's mouth, a baby's mouth contains bacteria. These bacteria feed on sugars found in the liquids we drink and in the foods we eat. Bacteria feed on this sugar creating acid as a by-product. It is this acid which attacks the tooth enamel and causes cavities.
Many parents put their children to sleep with a bottle. They often find that this helps the baby settle down and after a long and hard day of parenting, this "time off" could not have happened sooner. Unfortunately, studies show that babies keep the bottles in their mouths for many hours during the night and that the sucking action produces a constant flow of fluid into the mouth throughout the night.
If there is sugar present in the fluid, bacteria on the teeth are continuously nourished with this sugar. This sugar provides the bacteria with the energy they need to multiply and also allows the bacteria to create a steady stream of acid that damages teeth.
Given enough time the acid breaks down the tooth enamel.
Underlying layers of the teeth get infected with the bacteria and a cavity forms. When this happens night after night for months or years, the entire tooth can and has been shown to be eaten away. This is especially critical in children since their teeth are more susceptible to tooth decay than an adult's tooth.
A common question asked by many parents is : Even if my baby does unfortunately get dental cavities won't this problem be solved when the baby's permanent teeth come in? The reason it is important to make sure that even these "temporary" baby teeth remain healthy and cavity free is that baby teeth serve several important functions.
- They serve as spacers which maintain the proper spacing and alignment of the teeth so that permanent teeth have enough room to come in.
- They are important in helping the baby learn how to speak and talk properly.
- Healthy and nice looking teeth are important in building self-confidence and self-esteem. This is especially important at such an early age.
In addition, constant sugar in the mouth can lead to bacteria build-up to a point where the bacteria toxins invade surrounding gum tissue causing gingivitis. In severe cases the bacterial toxins can attack bone structures supporting the teeth resulting in permanent damage - periodontal disease (see following chapter).
What can parents do to protect their children's teeth from decay?
We suggest that after every bottle feeding you take a wet cloth or gauze pad and gently wipe your child's gums and teeth. This will remove any bacteria containing plaque and excess sugar that may have built up (a q-tip can also be used).
What liquid should you put in your baby's bedtime bottle? Natural juices such as grape juice or apple juice contain natural sugars which bacteria can use to create acids. Milk contains a sugar called lactose which bacteria can also use to create acid. If you give you child a bedtime bottle, the liquid of choice inside of the baby's bottle is water.
Also try to never give your baby a pacifier dipped in any type of substance containing large amounts of sugar. Many parents, for example, give their children pacifiers dipped in honey. This can be very bad for the baby's teeth.
Many people think of periodontal disease as an adult problem. However, studies indicate that gingivitis (the first stage of periodontal disease) is nearly a universal finding in children and adolescents. Advanced forms of periodontal disease are more rare in children than adults, but can occur.
Types of periodontal diseases in children
Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily. Gingivitis is both preventable and treatable with a regular routine of brushing, flossing and professional dental care. However, left untreated, it can eventually advance to more serious forms of periodontal disease.
Aggressive periodontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.
Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.
Periodontitis associated with systemic disease occurs in children and adolescents as it does in adults. Conditions that make children more susceptible to periodontal disease include
- Type I diabetes
- Down syndrome
- Papillon-Lefevre syndrome
Signs of periodontal disease
Four basic signs will alert you to periodontal disease in your child:
- Bleeding: Bleeding gums during tooth brushing, flossing or any other time
- Puffiness: Swollen and bright red gums.
- Recession: Gums that have receded away from the teeth, sometimes exposing roots.
- Bad breath: Constant bad breath that does not clear up with brushing and flossing.
Evidence shows that periodontal disease may increase during adolescence due to lack of motivation to practice oral hygiene. Children who maintain good oral health habits up until the teen years are more likely to continue brushing and flossing than children who were not taught proper oral care.
Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
As a teen progresses through puberty, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good at-home oral hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.
Advice for parents
Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children receive a periodontal examination as part of their routine dental visits. Be aware that if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.
Many medications can dry out the mouth or pose other threats to oral health. Be sure to tell your dental professional about any medications your family members are taking.
Monitor your family to see if anyone has the habit of teeth grinding. Grinding can increase the risk of developing periodontal disease, in addition to causing cracked or chipped teeth. Dentists can make custom-fitted night bite guards to prevent teeth grinding at night.
Researchers suggest periodontal disease can pass through saliva. This means that the common contact of saliva in families may put children and couples at risk for contracting the periodontal disease of another family member. If one family member has periodontal disease, all family members should see a dental professional for a periodontal evaluation.
The most important preventive step against periodontal disease is to establish good oral health habits with your child. There are basic preventive steps to help your child maintain good oral health:
- Establish good oral health habits early. When your child is 12 months old, you can begin using toothpaste when brushing his or her teeth. However, only use a pea-sized portion on the brush and press it into the bristles so your child won't eat it. And, when the gaps between your child's teeth close, it's important to start flossing.
- Serve as a good role model by practicing good oral health care habits yourself.
- Schedule regular dental visits for family checkups, periodontal evaluations and cleanings.
- Check your child's mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.
If your child currently has poor oral health habits, work with your child to change these now. It's much easier to modify these habits in a child than in an adult. Since your child models behavior after you, it follows that you should serve as a positive role model in your oral hygiene habits. A healthy smile, good breath and strong teeth all contribute to a young person's sense of personal appearance, as well as confidence and self-esteem.