If you hear blood-curdling screams coming from my house at 7 a.m. or 7 p.m., don’t fret: I’m just brushing my 2-year-old’s teeth. It’s a traumatic endeavor for us both, and I admit that I’ve sometimes wondered: Is this really worth it? Baby teeth are just, like, temporary teeth, right?
Then I saw some statistics on cavities in young kids and spoke with a couple of pediatric dentists, and was surprised to discover that caring for your wee one’s teeth isn’t optional—it’s essential. So is taking kids to the dentist at a very young age. Don’t worry; you can learn from my mistakes, because I’ve been doing pretty much everything wrong.
Let’s start with the stats: Numbers of cavities among kids have been going down in general, but cavities in baby teeth have become more common over the past 20 years. Today, a whopping 60 percent of 5-year-olds have had at least one cavity; many have had five or even 10. Dental decay in kids isn’t just a nuisance—it can cause a lot of pain, and decayed teeth often have to be repaired or pulled using general anesthesia, which, as I’ve previously reported, isn’t risk-free. And when baby teeth are pulled, they can no longer do the important job of holding space for the budding permanent teeth—some of which don’t come in until age 12—so the American Academy of Pediatric Dentistry recommends that dentists fit “space maintainers” in their stead when baby teeth are lost early. Cavities in baby teeth can also harm the permanent teeth directly, if the tissue in the central portion of the baby tooth gets infected.
There is good news, though: “Dental decay is preventable,” says AAPD president Jade Miller. When dentists see a cavity forming, they can actually reverse the process—which is in part why the organization recommends that parents bring their children to the dentist when they get their first tooth or by the time they turn 1, at the latest. (If these recommendations don’t mesh with what you’ve heard, that’s probably because the American Academy of Pediatrics used to recommend the first dental visit by age 3. But since 2003, the AAP and the AAPD have both recommended this timeline.)
To understand how dentists work their magic, you first need to know how cavities are formed. Bacteria in the mouth feed on the sugar and carbohydrates your kids eat, releasing acid in response. This acid breaks down tooth enamel and leads to tooth decay, explaining why dentists aren’t fond of kids consuming candy and juice; sugary foods provide feasts for mouth bacteria and lead to a buildup of cavity-causing acid. (Whole fruit, though, is fine: Chewing it stimulates saliva production, which helps to keep teeth clean, and its fibrous texture stimulates the gums.)
One way pediatric dentists can reverse burgeoning cavities is by applying a fluoride varnish to kids’ teeth, which causes fluoride to be released when the pH of the tooth drops as a result of the acid. The fluoride then helps rebuild the tooth enamel. When I finally brought my daughter to a pediatric dentist last week—those statistics on cavities really rattled me!—he didn’t even try to clean her teeth, because (surprise!) she was so uncooperative. But he did apply a quick fluoride varnish. Fluoride from drinking water and toothpaste can also get incorporated into the tooth enamel itself as it grows, thereby protecting it from future decay.
Of course, pediatric dentists do more than just deal with cavities in young toddlers; they can determine whether kids are doing things that might put them at risk for future cavities. For instance, if you’re letting little Jaden take a bottle of milk or juice into the crib with him at night, that’s a red flag for future cavities, and a dentist would likely tell you to stop. (This is so common it has its own name: baby bottle tooth decay.) The dentist can also check kids for signs of bigger dental or jaw problems. I got a talking-to about my daughter’s pacifier use, which is causing her to develop a gap between her upper and lower teeth. He advised me to nip her pacifier and periodically trim it more, to make it less damaging and appealing and hopefully prompt her to stop reaching for it.
Infant visits also give dentists the chance to educate parents on what to expect during teething and how best to care for kids’ teeth. If I had taken my daughter in when she got her first tooth, I might not be suffering through daily tooth-brushing battles, because I would have been told to wipe her teeth with a washcloth each day as an infant (which I didn’t do) and to start brushing with a toothbrush at age 1 (didn’t do that either). These are habits that establish oral care as a routine early on, making kids more compliant when they hit the terrible twos. Other important advice you might not have heard: brush your kid’s teeth for them at least once a day until they turn 8 or 9—oops, my 5-year-old son has been brushing solo for at least a year!—because the fine motor skills that make for good brushing “don’t really develop until about the age when a child can begin to tie shoes or write in cursive,” Miller explains; and start flossing when your child’s teeth no longer have space between them, because then the toothbrush isn’t able to reach plaque and debris between the teeth. (Yup, cavities can form between teeth, too.)
OK, but what if you, like me, have a kid who just won’t let you near her pearly whites? Jessica Lee, a pediatric dentist at the University of North Carolina at Chapel Hill School of Dentistry, suggests experimenting with different types of toothbrushes—maybe little Anna would prefer an electronic toothbrush to a manual one, or vice versa. IPad apps like Brusheez, a brushing timer with characters and music, may also make the task more fun. Or, try letting your kid brush your teeth while you’re brushing hers. If you still can’t get in there for more than a few seconds, Lee suggests that you put a rice grain–size amount of fluoride toothpaste on the brush or your finger and at least just get a little bit of fluoride on her teeth. (Generally, a child shouldn’t use fluoride toothpaste until she knows not to swallow it, but it’s OK, Lee says, to use a tiny amount in this way.)
Don’t fret over what kind of dentist to choose, a pediatric dentist or a general/family dentist. Pediatric dentists do have some advantages, in that they get extra schooling on how to care for the dental problems that affect kids and are also trained in child psychology. They understand, in other words, that some kids will be deathly afraid of the sound of the suction tube, and they also know how to work with kids who have special needs. But “if it’s easier for a parent to take kids to a family dentist, then that’s absolutely fine,” Lee says. Many family dentists are great with kids. My son loves ours; I suspect it has something to do with the chocolate-flavored toothpaste on offer.
To sum up: Baby teeth aren’t permanent, but they are important. And dentists can do a lot to keep them healthy in the early years. The 10 seconds during which the pediatric dentist brushed fluoride on my daughter’s teeth probably did more for her smile than my last 18 failed tooth-brushing attempts. And that smile, I assure you, is worth a lot. It makes up for all the screams.