Important Pediatric Dental Topics for Your Infant and Toddler

Posted by: Jason Hui, DDS, on August 11, 2013

As discussed in a prior post, not only are early pediatric dental visits for infants and toddlers of paramount importance in building a trusting relationship with dentists, they also serve as an educational meeting with the parents to ensure all preventive measures are taken with at home dental care to promote healthy tooth development and maintenance. Below are a few important topics that are generally discussed throughout the many early regular pediatric dental visits for your children:

Oral Hygiene Home Care

  • Prior to the eruption of your infant’s first tooth, it is still important to begin oral hygiene by wiping your child’s gums with a damp 2×2 gauze wrapped around your finger. This will help keep the mouth clean, as well as introduce the idea of oral hygiene so that when the time comes for toothbrushing, it won’t be a foreign concept.
  • When the first tooth erupts into the mouth, begin brushing with a soft, baby toothbrush every morning and night. Do NOT use toothpaste until your child reaches two years of age. Early exposure to fluoride in toothpastes can be toxic and also lead to dental fluorosis.
  • After two years of age, introduce children’s fluoridated toothpaste with brushing every morning and night; use only a pea size amount of toothpaste and teach your child to spit out toothpaste and not swallow.
  • Flossing should be initiated every night prior to brushing when teeth come in contact with one another.

Cavity Formation Process

  • Bacteria in the mouth break down ingested sugars into lactic acid, which dissolve our tooth enamel. At this stage, dissolved tooth enamel is softened (demineralized), but good oral hygiene, fluoride, and saliva can help harden (or remineralize) the enamel back to its healthy state. Extended periods of enamel demineralization lead to cavity formation (that is, the softened enamel turns into a hole), which is irreversible and a dental filling will be required.
  • After our mouths are exposed to sugars (milk, juices, fruit, and other fermentable carbohydrates), the oral bacteria immediately begins breaking them down into lactic acid and the enamel begins to dissolve. This process occurs from the time the sugars are ingested to about 30 minutes after the eating stops. After 30 minutes of cessation of sugar exposure, the pH in the mouth becomes more neutral (less acidic) and our enamel will stop dissolving and begin remineralizing with the help of saliva.

Nutritional Counseling

  • Frequent snacking (candies, cookies, fruits, milk, juices, sodas, and anything else with sugars) significantly increases the risk of cavity formation. The more frequent the snacking, the more opportunity bacteria get to break down sugars into acid to dissolve teeth. There are many nutritious foods and beverages, such as fruits and milk, that contain a lot of sugar. We do not discourage eating healthy foods, but rather, we encourage eating them with a main meal (breakfast, lunch, or dinner). Almost everything we eat, healthy or not, will contain sugars, so while the bacteria is already breaking the sugars down during our main meal, it’s okay to ingest other supplementary nutritious food items at this time.
  • Eating a single meal for a long duration increases the chances of cavity formation. As an example, if we take one hour to eat a given meal, bacteria will be breaking down the sugars from our meal and dissolving enamel for about 90 minutes (60 minutes during the meal itself, and about 30 minutes after we stop eating). If instead, we eat the meal in 20 minutes, the demineralization process will only last about 50 minutes (20 minutes during the meal, and 30 minutes after we stop eating).

Oral Habits

  • Do not allow children to fall asleep with a bottle of milk or juice in their mouths. The sugars from the beverage will sit on their front teeth the entire night and enamel will demineralize all night, eventually leading to rampant cavity formation.
  • Wean children off sippy cups as soon as possible because the nature of a sippy cup encourages slow and extended periods of drinking. As stated above, the longer duration of sugar ingestion, the longer the period of enamel demineralization; the more demineralization that occurs, greater are the chances of cavity formation.
  • Ideally, pacifier use should cease by 1 year of age to prevent interference with speech development, and definitely should be discontinued by 2 years of age to prevent tooth alignment problems.  Prolonged sucking habits (including thumb sucking) can lead to an open bite in permanent teeth, where the front teeth do not come together when biting down.
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