Keeping your child's teeth healthy

The bottom line here is: Keeping teeth healthy is a lot cheaper, less painful and less of a hassle than it is to treat them once a problem does arise. Here are all the tips you'll need to keep your children's teeth healthy.

• Brushing

The most effective method of brushing is to point the brush (using a soft-bristled brush) at a 45 degree angle towards the gums and perform circular motions with the brush. You should apply light pressure at all times to avoid taking off enamel (abrasion) and to prevent soft tissue injury. This circular motion should be performed on all 3 accessible surfaces of the teeth (the surfaces facing the lips/cheeks, those facing palate/tongue and the chewing surfaces.) The recommended total brushing time for a full dentition is 2 minutes (which will of course, be less if your child has 2 teeth in their mouth) and brushing should be done a minimum of twice a day (once in the morning and once before bedtime)

Tooth brushing should begin after the first tooth erupts in the child's mouth. Even though the bacteria that cause cavities do not really populate the mouth till 15-24 months of age, brushing at an early age allows the child to become accustomed to brushing by the time they are old enough to get cavities. During the period of time when the child is still adjusting to the change, the parent should sit behind the child, preferably in front of a mirror, as this allows for more control and makes a child more comfortable.

As an interesting side note, children who come from "more loving" homes tend to have the cavity causing bacteria populate their mouth at an earlier age because of transmission from the parents (usually the mother.)

• Flossing

Floss should only be used in areas where there is no space between two teeth (as shown in picture.) The floss should be stabilized between your fingers and moved in a vertical motion along the sides of each of the two teeth. Do not simply place the floss between two teeth and take it out. The actual surfaces of the teeth need to be scraped with the floss all the way below the gumline (without causing pain) if possible. Flossing is also recommended in the morning and before bedtime.

• Mouthwash

Rinsing with any kind of mouthwash should be avoided until about 6 years of age to avoid any harm caused by swallowing. Up until approximately 12 years old, children should be closely supervised during rinsing to avoid swallowing.

There are two main types of rinses important for children. One is a fluoride rinse and the second is an antiseptic mouthwash. Fluoride rinses are important for strengthening enamel and therefore preventing cavities and even the "whitespot" lesions caused by braces. Listerine and Crest Pro-Health are two of the most popular antiseptic mouthwashes on the market right now. They appear to have similar efficacy in preventing gingivitis, bleeding gums and cavities Listerine has a high concentration of alcohol, which has many irritating effects to the oral soft tissues and many children dislike the "burning" sensation it leaves in the mouth. Crest Pro-Health is alcohol-free, yet there have been some tooth staining issues reported with it. Fluoride rinses work by using a completely different mechanism to prevent cavities than antiseptic rinses do and therefore both should be used when possible. If using both was not an option and I had to choose one to give a young child, I would recommend a fluoride rinse (such as ACT.)

Update: For those that have questions regarding Scope. I really never recommend it to anyone because it has very few beneficial properties other than getting rid of bad breath (halitosis.)

• Dental visits

The first time your child should see a dentist should be at approximately one year of age. This visit serves to allow the dentist to spot any issues requiring attention at an early stage as well as educating the parents about the child's oral health and gives the child an early start on getting used to coming to the dentist for regular visits. Upon the first visit, the dentist will usually assess the oral hygiene and the general condition of the mouth and inform you (the parent) how often your child should come back for follow-up appointments.

• Sealants

A Sealant is a type of plastic material which is put on the chewing surface of posterior ("back") permanent (adult) tooth to prevent cavities. Sealants are conventionally placed as soon as these teeth fully erupt. The first permanent molars typically erupt at six years of age. Sealants provide a physical barrier to the cavity-causing bacteria. They are placed in the areas where there are pits and fissures (small crevices and holes where bacteria love to live and can easily break through the enamel.) Smooth surface (such as between the teeth) cavities are typically prevented with fluoride.

• Diet

I can write several long articles (and maybe I will...) with some tips to keep those choppers happy, but I will just mention some of the main ones here.

• Never let your child go to sleep with a bottle of anything that contains sugar (which includes milk) in their mouth
• Frequency of carbohydrate (e.g. sugar) consumption is the most important diet factor in controlling cavities. It is much better for your child's teeth if they drink a glass of juice over the course of five minutes as opposed to sipping it here and there for two hours.
• Try to avoid juices and non-diet sodas as often as possible and if your child does drink juice, try diluting it with some water
• Some of the worst foods to eat are the sticky ones (such as raisins) because the sugar contained in these foods stays on the tooth structure for a long amount of time and allows the bacteria to do their dirty work. Therefore, a pure dark chocolate candy is better for teeth than raisins.
• Brush after meals as often as possible or at least wipe your child's teeth with some cloth
  
• Give your child some water after meals
• Once you child is old enough to chew gum, sugarless gum with Xylitol is a fantastic way to keep cavities at bay
• Cheese has anti-cavity properties.

Update : Fluoride is also a very important part of oral health. My next post will discuss it in great detail.

Cavities

Believe it or not, dental caries is the most common childhood disease. This is the disease that causes cavities (which are basically holes) to form in teeth. Luckily, it is preventable with proper oral hygiene and some help from the parents (that means you!)

• Caries are caused by various types of bacteria (mainly Streptococcus Mutans) which live right on the tooth structure. This bacteria secretes acid after eating and digesting carbohydrates (e.g. sugar). The acid then slowly destroys tooth structure (forming a cavity in the tooth). As if this weren't bad enough, plaque (the white stuff you feel on your teeth when you get up in the morning) helps the acid stay close to the teeth, instead of getting washed out by saliva.

• Cavities may be within enamel, they may penetrate through to the dentin, or they can extend all the way to the pulp of the tooth. Refer to the post here regarding the structure of teeth.
  

• There are various treatments for different types of cavities. However, the best policy is always prevention.

• One rather disturbing phenomenon that occurs in some children is referred to Early Childhood Caries. This used to be referred to Baby Bottle Caries because the cavities, which form on the anterior (incisors and canines) upper teeth are a result of the child being put to sleep with a bottle (usually of milk or juice, which both contain sugar) in their mouth.

Primary (baby) teeth

Below are some basics parents need to know about primary teeth with regards eruption (coming in) times, exfoliation (shedding) times and about the structure of teeth.

• There are 20 primary teeth
• 8 Molars (chewing teeth)
  
• 4 Canines (vampire teeth)
• 8 Incisors (front teeth)
• They are named A through T
  

• The sequence of eruption is more important than the timing. Sometimes this order is different, but this does not necessarily mean that anything is wrong. It may just be a sign that you should check in with your child's dentist. Here is the normal sequence (keep in mind that it does vary from child to child) beginning with the teeth that should erupt first to the teeth that should erupt last:
• Lower central incisors
• Lower lateral incisors
• Upper central incisors
• Upper lateral incisors
• Lower first molars
• Upper first molars
• Lower canines
• Upper canines
• Lower second molars
• Upper second molars

• There are 4 main tissues that make up all teeth
• Enamel - The outermost, hardest, and most caries/cavity resistant tissue in teeth
  
• Dentin - The tissue directly under the enamel (or cementum when speaking of the roots.) This tissue is not as hard as enamel, it is still however harder than bone.
  
• Pulp - Consists completely of soft tissue. This is where all the nerves and blood vessels are.
  
• Cementum - The outermost part of the roots of the tooth. This tissue is responsible for connecting your teeth to the bone supporting them.
  

An introduction to your child's mouth

Having had the parents of many of my own pediatric patients ask me similar dental related questions, I decided writing a blog to answer some dental basics that all parents should know would be helpful. This is the first post and will therefore touch on just a few concepts. If you are interested in expanding your knowledge of any particular concept, my other posts may be helpful and of course, you are always welcomed to ask any questions, or request for me to write a post on a dental topic you are interested in learning more about.

• Primary (baby) teeth are important (even though they will fall out anyway)
  

They will fall out, but they serve very important functions while they are there. Other than the obvious reason (chewing) they maintain the space needed for the permanent (adult) teeth to erupt into proper position, without getting crowded. Primary teeth are also involved in the proper development of the facial muscles and jaw bones.

• Keeping primary teeth healthy

The proper methods of keeping those pearly whites happy will be discussed in a future post

• Brushing properly
• Flossing properly
  
• Sealants
• Mouthwash
• Diet
• Dental follow-ups

• Things can go wrong
  

Cavities may start to form and slowly destroy the tooth structure. Sometimes these cavities become large enough to reach all the way to the "living" part of the tooth (pulp), where all the nerves and blood vessels are. There are even times when the tooth must be taken out due to a size and location of the cavity.

• How are cavities treated?

After the infected tissue has been taken out, different types of fillings can be placed to restore the tooth. If a cavity gets too close to the pulp, two different procedures can be performed to fix the problem. The most common one is a pulpotomy, where some of the living tissue is taken out. A pulpectomy is a similar procedure to a pulpotomy, except that all living tissue must be taken out during a pulpectomy. After a pulpotomy or a pulpectomy, the most common treatment is to cover the tooth with a stainless steel crown (cap). If the tooth is lost prematurely, space maintainers must be used until a permanent tooth erupts into the position. I will write a post about each of these treatments in future posts