7 Essential Tips in Baby Tooth Care

Most of us love the first glimpse of baby teeth when they appear. That's when the toothless smile, gets brighter and better. 

Although accompanied by irritation, grinding, crying and sometimes fever, baby teeth when start to appear are a milestone that all of us look forward to.

As parents we often know what to do when it comes to baby's teeth, what paste to use, how to brush, etc. However, it can be possible to miss some things, and before we know, something might have been overlooked, causing a little black spot to appear on your child's teeth that doesn't seem to be going away.

These 5 tips, are therefore compiled to give you a reference guide on what is important to keep track of, what are the absolute must-do's to ensure that your oversight or negligence doesn't cause harm to your child's teeth and often avoidable procedures at the hands of the pediatric dentist.

1. Begin even before baby teeth erupt - Even though baby teeth may not have appeared, your baby is drinking milk, and this leaves residues which should not be allowed to remain on the teeth or in the mouth.

Wiping the gums after every feed, with a soft, wet washcloth or gauze wrapped around your finger, or thimble-like rubber finger glove, will remove the excess food stuck on the teeth.

2. Care for them immediately when they appear - Once teeth erupt, take care of them immediately. Many parents think baby teeth are unimportant, since they will drop off eventually. However, these first teeth actually create the space for permanent teeth to grow and also help babies chew food and learn to articulate or talk. If left uncared for, they decay, causing gum infection or gingivitis, and mess up the space between teeth.

3. Avoid Cavities - Cavities in baby's teeth show up as discoloration or yellowing and pitting or dents in the teeth. Often, putting baby to bed with a milk bottle in the mouth is the main cause of this. 

Leaving an infant with a milk bottle in the mouth for long periods causes food collection and must be avoided. Comfort feeding or bottle chewing should also be stopped.

4. Finish meals with water, either drink or gargling - Since infants usually eat pureed food or drink milk, this can be washed off with a few sips of water. However, a good soft bristled toothbrush must be used as soon as possible so that the baby can get used to using it and it becomes a habit. A good brush will only be handy when the baby starts feeding on solids at or around 18 months. Sticky or sugary foods must be cleaned immediately with a soft brush or cloth in small babies and not left overnight.

5. Toothpaste must be used at 2 years of age - A drop sized amount of non-fluoride toothpaste must be used when toddlers begin eating semi-solid or solid food. Fluoride toothpastes must not be used until the child is much older, at 4 years or above, so they understand spitting out the paste rather than swallowing it.

Fluoride: What parents need to know - Part 2

In Part 1 we discussed the benefits of fluoride and the risks of over-exposure to fluoride.

Fluoride can be useful in strengthening teeth and protecting them from decay, if used in the right way. 

As we discussed in the previous section, there is a risk of dental fluorosis, or mottling of teeth, if children swallow too much fluoride.

In this second part we will look at the uses of fluoride and safety guidelines.

Products which contain fluoride

Fluoride Toothpaste 

This is the most common application of fluoride as it can easily be used regularly at home. Regular use of fluoridated toothpastes has been shown to reduce tooth decay by up to 50%. 

Safety guidelines for using fluoride toothpaste:

• Young children who cannot spit out should use either plain drinking water or a training toothpaste which does not contain fluoride for brushing.
• Children generally learn to spit out from around 5 or 6 years old. At this stage fluoride toothpaste can be introduced with adult supervision.
• It is best to use a lower fluoride toothpaste up to 7 or 8 years old, when children still tend to swallow some paste and their developing teeth could still be at risk of fluorosis.
• The amount of fluoride is usually shown on the toothpaste packet in parts per million (ppm). In India, most adult toothpastes contain 1000 ppm and toothpastes designed for children often contain 500 ppm or less of fluoride. 
• No more than a small pea-sized amount of toothpaste should be used. Instruct your child to spit out after brushing and not to swallow it. 

• Keep toothpaste out of the reach of young children. Swallowing large amounts can cause stomach problems and other health issues. Seek immediate medical attention if a child swallows a large amount of toothpaste. 

Fluoride Mouthwash or Rinses

Mouthwashes are not recommended for children. If a teenager or young adult is at a high risk of cavities, or wearing braces which make their teeth more difficult to clean, their dentist may recommend a fluoride mouth rinse to be used at a different time from brushing. This should of course not be swallowed. Avoid mouthwashes that contain alcohol.

Fluoride Varnish

Fluoride varnishes are useful for children who are at a higher risk of tooth decay. As they contain a very high level of fluoride they can only be used by dentists and applied no more than twice a year. 

The varnish is painted onto teeth and sets quickly, sticking to the tooth surface to minimize swallowing and maximize its effect. If a tooth has very early dental caries in enamel, it can help to stop the decay and prevent it becoming a cavity. Fluoride varnish is also beneficial for sensitive teeth.

Glass Ionomer Fillings

Glass Ionomer is commonly used for fillings and sealants in baby teeth. In addition to being able to adhere directly to tooth surfaces it also releases small amounts of fluoride over an long period of time. The level of fluoride released is too low to cause any health problems but helps to prevent decay and the need for future fillings.

In Summary

When used in a controlled way, the benefits of fluoride outweigh the risks. 

Parents and dentists need to take into account the overall fluoride exposure from all sources when making decisions about the use of products or treatments which contain fluoride. 

In areas with high levels of fluoride in drinking water, fluorosis  (mottling and staining of the teeth) is common. In these areas it is wise to minimise fluoride exposure as much as possible. 

Dental Fluorosis

In areas where the is no significant fluoride in water the appropriate use of some fluoride therapies will be important in preventing decay.

If you need more information and advice, please speak to your dentist.

If you live in Bangalore, you can contact us at Small Bites, Exclusive Dental Care Centre for Children (click for link) where we will be happy to help.

Fluoride: What parents need to know - Part 1

Many parents are confused about fluoride.

Is it good or bad for children?

What are the risks and benefits of fluoride?

In this blog post we will answer these and other questions.

What is fluoride?

Fluoride is the 13th most abundant element on the earth's crust. It is found naturally in rocks, soil, water and some foods. The level of fluoride in water varies greatly between different geographical areas. Fluoride can also be emitted into air and water as a waste product of some industries.

Is fluoride good or bad?

In low levels, fluoride is beneficial in protecting teeth from decay. 

If the right level of fluoride is available while teeth are forming it is incorporated into the developing enamel, making it more resistant to acid attack, which is the cause of tooth decay. Teeth that have developed under the influence of fluoride also tend to have shallower grooves, making them less prone to decay. Tooth enamel formation starts from 3 months after conception (in the womb) and is completed by around 8 years old, with the exception of the wisdom teeth.

Studies in both the USA and the UK have demonstrated the ability of an optimum level of fluoride in drinking water (either naturally occurring or added) to significantly reduce dental decay in both children and adults.

Fluoride is also beneficial after teeth come through. The surface enamel of teeth is weakened and dissolved by acid attacks which occur after consuming sugary or acidic food and drinks. However, enamel can remineralise, or repair, itself by taking in minerals from sailva. Low levels of fluoride present in saliva and dental plaque encourage remineralisation and therefore make it less likely that a cavity will be formed. The fluoride also becomes incorporated into the enamel surface making it stronger and more resistant to acid attack.

Recent scientific studies have also shown that fluoride is able to reduce the ability of plaque bacteria to produce acid.

Scientists now believe that the effect of fluoride after teeth erupt into the mouth is more important than during tooth development. These effects explain why the incidence of decay has generally decreased with the introduction of fluoride toothpastes.

So what's the problem with fluoride?

Like many other minerals, fluoride is toxic at very high concentrations, but it is very rare to be exposed to these levels. The problem with fluoride is when you swallow more than the recommended level over a long period of time. The most common problem that is seen with consuming moderate levels of excess fluoride is dental fluorosis.

Dental Fluorosis 

Individuals who are exposed to too high a level of fluoride in early childhood (up to 7 years old) are prone to dental fluorosis, or mottling of the teeth.

In its mildest form, the only sign of fluorosis may be white specks on the enamel surface. Teeth more severely affected show discolouration, often in bands or lines, and pitting. Although they are more resistant to decay, teeth with severe fluorosis have structurally weaker enamel. 

The amount of fluoride in drinking water varies greatly. The level of fluoride in freshwater, for example rivers and lakes, is usually low. However as water seeps through soil and rocks it becomes contaminated with various naturally occurring substances or pollutants. These contaminants also become more concentrated where the groundwater level dips. 

India has become increasingly dependent on groundwater, from wells or bore-wells, to meet demands for drinking water and in some areas, this contains much higher than the recommended level of fluoride.

The optimum level of fluoride in drinking water - to provide dental health benefits and minimise side effects - is 1mg per litre. In India, the permissible level is up to 1.5 mg/l. 

The Indian Department of Drinking Water Supply reported that 203 out of 593 districts have higher than permissible levels of fluoride in water.

As this map shows,almost all states in India have districts where groundwater contains excessive levels of fluoride. Even in Bangalore, the level of fluoride varies between different areas and during different seasons. As water quality is not well regulated, it is not always easy to know the levels of fluoride in a particular area.

In some areas, the level of fluoride in water is excessively high. In these areas skeletal fluorosis may also occur. This causes pain and stiffness in the joints and, in more severe cases, bone deformities.

It is recommended to drink bottled or filtered water and, in high fluoride areas, to avoid food and products containing fluoride. Not all water filters remove fluoride, those which work by reverse osmosis and ion exchange resin are able to remove about 90% of the fluoride. Bone char filters have been found to be even more effective in removing fluoride. It is difficult and expensive to remove fluoride from the ground water supply and, in rural areas, other sources of drinking water are not always easily available. Recharging groundwater using harvested rainwater can be useful in reducing levels of contamination.  

Slides used from: http://www.schools.indiawaterportal.org/wq-test/fluoride-factsheet


In the second part we will look at how fluoride can be used safely to benefit dental health.

What causes dental cavities?

When you consume any food or drink containing carbohydrate, or sugar, the bacteria in the plaque on your teeth metabolise it, producing an acid attack which lasts for at least 20 minutes. The acid dissolves the outer surface layer of the teeth (enamel).

The acid attack will be much longer if the food remains stuck onto the teeth, or if snacking continues over a period of time, eg. eating a bag of sweets one by one, or continuously licking a lollipop. Also, If babies or toddlers fall asleep with a bottle, or whilst nursing, the milk will remain on their teeth for a longer period of time.

If food and drinks containing sugar are limited to mealtimes, with sugar free snacks and drinks in between, the teeth can recover from these short periods of acid attacks. In the early stages of decay (before a cavity is formed), the enamel can repair itself by taking in minerals from saliva. Fluoride also helps to strengthen the enamel in this process.

However, with frequent snacks and drinks containing sugar, cavities become much more likely to occur.

Once the enamel layer crumbles, a cavity is formed, bacteria enter and the decay process spreads rapidly.

To prevent dental decay, the aim should be to reduce the amount of time that any food containing sugar is present in the mouth. Drinking water or rinsing after eating can help. Try to make snacks and drinks, between meals, sugar free as far as possible. 

 

Regular, thorough brushing to remove plaque build-up from the teeth will also help but, as it is not possible to prevent plaque from building up again after brushing, diet is of extreme importance in preventing cavities.

Top Toothbrushing Tips

Tooth brushing is an important healthy habit to establish early on. 

For babies, you can use a clean, moist cloth to wipe the gums and the teeth once they start to erupt. Change to a soft brush or finger brush once they have at least two teeth. 

Finger brush

Parents should be in charge of brushing until their child reaches the age of 6 or 7, and older children will still need encouragement and supervision.

For children up to 3 or 4 years it is easier to see and brush their teeth if they lie down with their head on your lap. Try to make brushing fun - maybe by singing a song as you brush.

For children under 2 years, toothpaste is not advised. Once you start using toothpaste, use a small pea sized amount and encourage your child to spit it out. If your child is unable to spit out after brushing you can use a non-fluoridated toothpaste. Whilst fluoride is useful for preventing cavities, swallowing too much can cause fluorosis and staining of the developing adult teeth. Even after they learn to spit, young children will still swallow some paste so a toothpaste with a lower fluoride content is advised until around 7 years old. Ask your dentist for advice on which toothpaste is best for your child. 

Tooth brushing at twice a day should become part of the child's daily routine.  Let your child see you brushing. Small children love to copy what their parent or older sibling is doing. If your child sees you brushing regularly, it will set them a good example to follow.

It takes two minutes to brush teeth well. It may help to get a timer, or use one on your mobile phone. Make sure that all tooth surfaces are brushed.

Toothbrushes should be changed every three to four months, or sooner if they show signs of wear. Although not essential, a toothbrush with a favourite cartoon character on it may help motivate your child. You can use an electric toothbrush, if you find it easier, as long as it is one designed for children.

If you sometimes forget or your child is reluctant, you could use a reward chart, on which you place a star or smiley face, each time the child has their teeth brushed.