Pediatric Dental Care

Posted January 27th, 2008 by babycaremedicalteam

Dr. Shahnaz Ahmed
Pediatric Dentist, West County Pediatric Dentistry.

                       Contrary to popular opinion, the care of an infant’s mouth sets the foundation for a healthy dental future. The American Academy of Pediatric Dentistry (AAPD) recommends a first dental visit within six months of the eruption of a baby’s first tooth, and the significance of starting early and establishing a dental home for a baby cannot be understated.

                      Infant oral health care starts at birth. Mothers bond with their new baby through feeding and nurture. The nurture apart from the obvious displays of affection starts with the basic hygiene needs of giving the baby baths and changing diapers. Added to this routine, it is dentally recommended that a mother use a moist wash cloth (a handkerchief sized towel) after every feeding to cleanse the baby’s oral cavity. This maintains the health of the gums and massages them in preparation for the eruption of the baby’s first teeth. This basic care builds habits that will prove invaluable for the baby’s oral health care future.

                     The average age for the eruption of a child’s first two teeth is six months. Most likely, it will be the bottom central incisors that erupt first but if there’s a variation from this norm in your baby, do not sweat it. It’s OK too! A lot of parents are concerned with delayed eruption. Their child turns a year old and no teeth have erupted and in comparison with their friend’s babies of similar age, this creates a level of anxiety. It’s still OK! I’ve known patients who have cut their first teeth at the age of 16 months. From a dental point of view, if I had a baby, I would prefer a delayed eruption because that protects the tooth from coming in and being exposed early to the insults of the oral cavity. Also, it makes my oral health care job easier and my responsibility less.

                      Speaking of responsibility, as you were advised earlier to take care of your infant’s oral cavity from birth, the responsibility to take greater care starts with the eruption of the first tooth. Many parents have asked me if it’s possible for a baby to get cavities. Some have asked, “Do we need to brush his/her teeth?” The answer is an astounding YES. If there’s a tooth, there’s a possibility for a cavity. If there’s a cavity, there’s a possibility of infection. If there’s an infection, there’s a possibility of affecting the permanent underlying dentition. If there’s a continuous untreated infection, there’s a possibility of death in rare cases. And something significant can be prevented by something very simple i.e. a toothbrush. Once the baby’s first tooth erupts, a mother will need to start using a baby tooth brush or a finger cot tooth brush twice a day preferably morning and night.

                      I will state a principle that when remembered will be a good guide for dental care of all ages (birth through lifetime). Dental caries is an infectious disease that causes the hardest surface in the body (the enamel of the tooth) to weaken, soften and break. There are four major players to get a “cavity”. Firstly, you need a tooth. No tooth, no cavity! Secondly, you need bacteria. The oral flora (bacterial types) in a baby’s mouth is acquired primarily from the mother and other caregivers. Thirdly, you need sugars for the bacteria to convert into acids and fourthly, you need time. Given all four factors abundantly and concurrently, a baby can get a cavity and have a tooth break off necessitating extractions at the age of 15 months.

                    A lot of the care I advise is based of the four major players. I tell parents that a child cannot get a cavity if there’s no teeth, but that doesn’t mean we extract all teeth to protect from cavities. I also say that a child cannot get cavities if there’s no food in the mouth. I do NOT recommend starving a baby to death to protect from cavities! We all know that teeth are important as is eating healthy. So, the next step is protection. Cutting down the bacteria in the mouth involves brushing twice a day. The bacteria start re-growing the very second one stops brushing and hence the recommendation of brushing twice to cut down on the amount of plaque (soft bacterial deposits) on the tooth.

                  The third factor is significant, because some parents give their babies milk and fruit juices at will. Sugars are found in a lot of foods not just candy and juices. While milk is very healthy it contains enough sugars for the bacteria to metabolize into acids. Recommendation: cut down the number of times a baby feeds if possible so the exposure to the sugars is less. If you have to feed your baby several times due to health concerns or by recommendation of a pediatrician, I would recommend having your baby drink a small sip of water to wash down and dilute the mouth after every feeding. Any milk that stays on the tooth only provides food for the bacteria to metabolize into acids and destroy the teeth. NEVER PUT YOUR BABY TO BED WITH A BOTTLE OF MILK OR JUICE! I’ve known parents to do this because they are tired from sleepless nights and their baby just won’t sleep unless given the bottle of milk/juice. My suggestion: Try to switch to a bottle with water only. Do not dilute the milk or juice as it doesn’t help with the prevention of the cavity. Ideally, before bedtime, the recommendation is to brush your baby’s tooth and after that do not give them a bottle! The fourth factor of time is an obvious one. If one maintains care of the first three factors, it shortens the time to start a cavity process.

                   As I’m running out of room for this article, I will end with a famous proverb. An ounce of prevention is worth a pound of cure. I have had to extract all four front teeth in babies several times due to infections and the sadness and guilt I see in a parent is not worth it. Take basic steps to brush twice and watch diet with sugar and you are well on your way to establishing a healthy dental future for your new baby.

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