FAQ

DECAY THEORY
The decay mechanism is known as The Acid Theory of Decay. Certain bacteria, streptococcus mutans, that live in the oral cavity use sugars for their energy source. These sugars can come from obvious and not so obvious sources. Table sugar is sucrose. Milk has a natural sugar called lactose. Fruits and fruit juices have a sugar called fructose. All three of these sugars can cause cavities equally. Unfortunately, milk also provides a nutrition rich medium for caries causing bacteria to grow.

When the bacteria consume the sugars, they metabolize the carbohydrates and give off acid as a waste product. The presence of the acid on tooth enamel leaches the mineral component (calcium) out of the enamel. After repeated and long exposures of this acid, enough calcium is removed that it leaves the protein portion of enamel behind. This shows up as the brown soft material that comprises the “cavity.”

1. How early should parents begin cleaning their child’s teeth? What is the easiest way to do this while they are still very young?
Basically when children erupt teeth, they need some form of cleaning. Three things are necessary for decay to occur. Obviously, we need teeth, then bacteria and finally refined carbohydrates. Therefore, when the teeth begin presenting themselves, parents should be concerned about oral hygiene. This could be initially in the form of using a washcloth wrapped around the finger and rubbing the teeth and gums. Eventually, a soft bristled toothbrush with a small head can be used to massage the gums and stimulate the tissue of the palate.

A toothbrush also makes a nice teething instrument. Allowing the child to chew the brush will massage and stimulate the oral tissues as well as get them familiar with the brush itself for later use.

2. When should they get their first dental visit?
The American Academy of Pediatric Dentistry states that a child should have their first dental visit six months after they get their first primary (baby) tooth. A parent should take their child to a pediatric dentist no later than age 2. Clinical statistics had shown that at age 2, 15% of the children had at least one cavity at their first visit. At age 3, 50% of the children will have at least one cavity at their first dental visit. This increase is due to the fact that between the ages of 2 and 3, the average child will get their baby molars. Molars have the grooves that can trap bacteria and food that makes them more cavity-prone.

An advantage of early visits also relates to the fact that the pediatric dentist can give proper advice for nutritional considerations. These considerations include the use of bottle, sippy cups, nursing, pacifier use and fluoride protection.

3. How can a parent make the first visit easier on the child?
“Get the child to the pediatric dentist before 2, before it is too late.” Again, early visits can ultimately make life much easier for the child. Get the child to the dentist before anything has to be treated.

The parent also needs to be optimistic about the first visit. Kids can pick up on parent anxiety. If they feel that the parent is nervous about the dental visit, then they too are going to feel something is wrong. Don’t make a big deal out of it. Make it positive and exciting.

There are children’s books about going to the dentist. Reading these to the child ahead of time will decrease the “unknown” and make both the parent and child feel better. It is human nature to be afraid of the unknown. The more we know, the better. In our office, we provide a book that is a story about coming to our office and what to expect.

4. For children who fight having their teeth brushed, what can parents do?
Foremost, the parent must be in charge. Just because the child doesn’t want to have their teeth brushed, doesn’t mean it is okay to not do it. If the child were diabetic and needed insulin injections, the parent would do it because it was necessary. They would do it whether the child wanted it or not. We tell parents that it is better to put the child through “stress” at home trying to prevent problems than putting them through stress getting something done in the dental office.

Sometimes it takes both parents to help with this situation. The parents can sit knee-to-knee placing the young child on their laps on his/her back with the child’s legs straddling the waist of one parent. This person also holds the hands from grabbing and resisting. The other parent at the head does the brushing. This may seem extreme at first, but when the parent realizes that no psychological harm will come of this and they are preventing dental disease, it makes more sense.

Another method to use, if alone, would be to sit in a chair and have the child lean back between your legs with his/her back against your stomach. Cradle the head with one arm, holding the head tilted back so you can see directly in the mouth; brush with the other hand and visualize where you are placing the brush. If the child tends to resist, place their arms behind them and squeeze your legs together to hold them still.

5. Should parents limit sweets to their children?
If one considers the theory of decay, it may be easier to explain the answer to this question. The ideal method would be to not let the child eat sweets at all. However, being realistic, this would be next to impossible. The important thing to remember is that it is the frequency of sugar exposure that causes the problem. The more times a day a child gets sugar, the greater the tendency for decay problems.

When we eat something sweet, the bacteria in our mouths give off acid as a waste product. Our saliva will buffer this acid back to normal levels within about 20 minutes. This result occurs if we eat a teaspoon or a cup of sugar. To illustrate the point of frequency, let’s say a child has 10 pieces of candy. He would be better off from a dental standpoint to eat all 10 pieces at one time and get about 20 minutes of acid exposure. Now let’s compare taking those 10 pieces and giving the child one piece every hour for 10 hours. Now that same amount of sugar is 200 minutes of acid exposure.

Therefore, the limitation should be in regards to frequency rather than the amount. This should be kept in mind when considering the use of a bottle or sippy cup with the juice or milk. If a child is allowed to “at will” feed on a bottle or sippy cup, there are sure to be problems.

6. How often should children brush their teeth? Does this change as they get older?
Once teeth present themselves, brushing should start in some form or another at least twice daily. Academically, three times a day is ideal. This relates to brushing after each meal. Realistically, twice a day is more the norm. The most important time to brush is before bedtime. This basically should be the last thing done before climbing into bed.

An adult should brush the child’s teeth until that child can write their name in cursive. This proves that the child is capable of dexterity that will allow them to control the brush to guide it where they want and where is needed. Until that time, the parent should never discourage their child from brushing on their own. Let the child brush, then finish for them.

As the person gets older, still at least twice a day is important. As an adult, the person should realize proper times to brush, i.e., after meals and snacks.

If, as a child or adult, it is not possible to brush after meals and snacks, a technique called “Swish and swallow” should be used. This involves taking water into the mouth and swishing it around and between the teeth to loosen food particles, then swallow. This does two things. First, it obviously rids the teeth of leftover food particles and secondly helps to dilute any acid that has formed. This is not as efficient as brushing but does give some benefit.

7. At what age should they begin flossing?
Flossing is a great aid to oral health when done correctly. With a child, brushing sometimes can be very challenging. Most often, there is little cooperation. As a result, we recommend that until children get into a strong routine of brushing and cooperation, flossing should be put off. It takes good coordination to floss. If not done correctly, one can injure gums that contribute to more resistance from the child when you want them to help. A good rule of thumb is the more permanent teeth a child has, the more flossing should take place. But, until you have established a strong brushing program, delay the flossing.

8. What is the most common mistake you see parents make with their children’s teeth?
The biggest mistake or problem that we feel is the parent not understanding the problems of using the bottle and sippy cups. They feel that the child is drinking milk or fruit juice and getting vitamins and nutrition that is important for their growth. In doing this, the parent gives the bottle or sippy cup many times to pacify the child. They also allow them to have unlimited use which takes us back to the frequency of the sugar exposure scenario. Under NO circumstance should a child be allowed to take a bottle or sippy cup to bed with them.

9. In areas where there is not fluoride in the water, are fluoride pills necessary for children to take in order to have strong teeth?
Enamel that is formed in the presence of the fluoride ion is the strongest enamel. This is why it is recommended that systemic fluoride be available to children during their enamel-forming years. This could be as old as 12 years since the second and third molars are in the process of mineralization. Ideal range of fluoride is 0.6 ppm to 1.3 ppm in drinking water.

Very few cities fail to provide fluoride in public drinking water. The need for fluoride would relate to the lack of drinking fluoridated water. As infants, if Mom breast-feeds or uses packaged formulas (not mixing with water), there should be fluoride vitamins given. Once the child starts drinking water or eating food mixed with the water, supplemental fluoride consumption can stop.

If a family lives in a rural area with no fluoride available, fluoride supplementation should be given after the water has been tested for natural fluoride content. Fluoride is a naturally occurring element. Fluoride levels vary from well to well. If the level is below 0.6 ppm, fluoride vitamins should be given. If the levels are above 1.3 ppm, another source of water should be considered.

When living in rural areas, fluoride vitamins should be given until the child starts preschool or public schools that provide public fluoridated water.

10. Are their gums kids can chew that actually help clean teeth?
Any gum children chew should be sugarless. There are some gums on the market that have Zylitol (ex. Trident) that help decrease the amount of cavity causing bacteria. An associated benefit would be that gum causes increased salivation. Saliva is helpful in buffering acids produced by oral bacteria. Therefore, if you child is going to chew gum, we recommend a sugarless gum with Zylitol.

11. What toothpaste and toothbrush is recommended?
Toothpaste that is approved by the American Dental Association is recommended. Many children complain that the adult pastes are too “hot or minty” flavored. As a result, I recommend a children’s paste that is manufactured to have a bubblegum or fruit flavor. Children are more likely to brush if they like the flavor of the paste that they use.

Using a soft bristled brush is ideal. This prevents gum injury and tooth damage from stiff bristles.

12. Are there any other suggestions you would like to make to parents?
If parents get the basic knowledge of what causes tooth decay and how to prevent it, then using common sense will go a long way. Remember that kids will imitate their parents. A parent cannot expect their child to brush and take care of their oral health if he or she doesn’t. Have a positive dental attitude. Don’t complain and tell “war stories” about going to the dentist within earshot of kids. They will pick up on it and develop their own fears.

Dental disease is the most prevalent disease known to man. However, it is the most preventable.

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