Tooth Decay in Toddlers

Some dentists believe the key to preventing tooth decay in toddlers and young children is to stop breastfeeding. For a full discussion on this topic including other possible causes of early cavities see Breastfeeding and Tooth Decay. There does not seem to be any evidence that stopping breastfeeding will prevent or stop dental decay but it is important to keep children’s teeth clean and minimise all the other risk factors that contribute to early decay.

Preventing tooth decay in toddlers

Ideas for keeping teeth healthy taken from Early Childhood Caries, LLLI, 2006 include:

• Clean little teeth properly to remove traces of food, reduce the levels of Strep mutans (bacteria that cause cavities) and slow the decay process.

The best way to avoid cavities is to wipe or brush your child’s teeth thoroughly at least twice a day. it might help to encourage him to swish with (or at least sip) water after eating. It makes sense not to offer any carbohydrates after bedtime teeth cleaning. But there’s no need to keep your child from nursing at night since human milk by itself actually helps protect against cavities.

• Check teeth regularly including under the top lip and visit your dentist regularly. White spots on the upper front teeth or whitish lines at the base of the teeth along the gum line are signs of Early Childhood Caries which may still be reversible with prompt treatment. If not treated the white spots can lead to general tooth decay.1

• A healthy diet helps build strong teeth. While fruit and vegetables are healthy—be aware that acidic food and drink (e.g. oranges, fruit juice, fizzy drinks) have the potential to damage tiny teeth by reducing pH and coating them in sugar. Cheese may help prevent cavities by causing salivary glands to keep calcium and phosphates, which are needed for remineralization of the tooth surfaces. Cheese may also promote saliva flow which is helpful against clearing food particles and controlling the acidity in the mouth (Schafer and Adair, 2000).

• Avoid sharing spoons or dummies to reduce the risk of passing decay causing bacteria from parent to child. Xylitol is a natural carbohydrate sugar substitute that helps stop bacteria sticking to teeth. Reducing the level of bacteria in a mother’s mouth may lower the risk of passing them on to her baby. Xylitol is in some chewing gum or ask your dentist for advice about products or mouth washes that may achieve the same result.

• Fluoride is said to increase the quality and strength of tooth enamel and help to re-mineralize teeth and repair early decay.2 Ask your dentist for further information about treatments and toothpaste and see the section on fluoride below.

Brushing your baby’s teeth

The NHS (National Health Service) in the UK has a little video to show you how to brush a baby’s teeth.

Fluoride in toothpaste, yes or no?

While a little fluoride is said to aid healthy teeth, too much can cause its own problems including marks on teeth. Is it OK to use fluoride toothpaste on a baby’s new teeth? See below for the opinions of The American Academy of Paediatrics, UK’s National Health Service (NHS), The American Dental Association and Dr Sears 3

Tiny amounts

In the following article the American Academy of Paediatrics advise carefully weighing the benefits of using fluoride toothpaste against the risk of enamel fluorosis4 in very young children particularly under two years. They recommend using tiny amounts of toothpaste i.e. a “smear” for children up to age two years who are at moderate to high risk of dental caries and a “pea-sized” amount for children aged two to five. Other suggestions include limiting brushing to twice per day and finding out the current levels of fluoride your child might get via drinking water or supplements.

In the video (above), the United Kingdom’s NHS mention using age appropriate fluoride toothpaste. On their website they clarify the levels of fluoride that they recommend and stress that only very tiny amounts of toothpaste are needed:

  • Children up to three years of age should use toothpaste with a fluoride level of at least 1,000ppm (parts per million).
  • After three years of age, children should use toothpaste with a fluoride level of 1,350-1,500ppm. The level of fluoride can be found on the pack.
  • Children should be supervised when brushing their teeth until about seven years of age.
  • The amount of toothpaste your child uses is important. Up to the age of three, a smear of toothpaste is sufficient, and from age three to six, a pea-sized amount is recommended.
  • Encourage your child to spit the toothpaste out after brushing their teeth rather than swallowing it.

Check with your dentist

The American Dental Association5 and Dr Sears’ website recommend checking with a child’s dentist if you are considering using toothpaste before your child is two years old. Dr Sears has lots of tips on brushing tiny teeth in the following article. On fluoride toothpaste he says:

Toothpaste isn’t necessary, but if your toddler enjoys the foamy grins, use a dab of mildly flavored toothpaste. Before using a fluoride containing toothpaste, check with your dentist. If your child is already getting fluoride supplements or drinks a lot of fluoridated water, don’t use fluoridated toothpaste. If your dentist recommends fluoride toothpaste, only use a pea-sized dab. Children swallow toothpaste and too much fluoride can damage the teeth by causing fluorosis.

Fluoride supplements?

Jay Gordon MD, paediatrician and professional advisor to La Leche League has written about the risks of children being “over-fluoridated” with fluoride supplements and treatments in the following article:

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