Caring for Your Child's First Teeth

So much is happening in the first six years of life as children are rapidly growing and developing. It is a team effort between caregivers, children and oral health professionals to develop a self-care routine that works.

Teething

It is recommended that children have their first dental visit by age 1. This is usually within six months of the first eruption of the first tooth. For many children, tooth eruption begins at about 6 months and continues until age 3, with an average of one tooth erupting per month. 

Eruption can bring with it an immune response triggering pain and fever, irritation at the eruption site, sleep disturbance, loss of appetite and upset stomach. This discomfort can last four to eight days prior to eruption and four days after. No wonder our kids can be irritable!

Teething rings, pacifiers and gum massage may be used to sooth the gums. The U.S. Food and Drug Administration (FDA) has advised against homeopathic remedies, like teething tablets or prescription or over-the-counter teething gels that are rubbed on the gums.

Gels are quickly washed away by saliva and are ineffective and potentially hazardous. These recommendations are particularly relevant for children younger than age 2 who could experience a dangerous severe reaction after single application of a gel containing benzocaine.

To manage discomfort, the American Academy of Pediatric Dentistry (AAPD) recommends firm teething rings vs. ones that are frozen, which can cause trauma and injury to the gums. A child’s physician should be consulted before providing any pain medicine for teething.

Protecting Those Precious First Teeth

Teeth are vitally important for infants, toddlers and children for adequate biting and chewing of food, for maintaining space for the permanent teeth, for sounding out words correctly and even for their self-esteem. Even young children are aware when they do not have the same white toothy smile of other children their age. And we certainly don’t want them experiencing the pain associated with decaying teeth.

Unfortunately, dental decay (cavities) is the number one chronic disease of childhood, even though it is preventable. Prevention strategies must start as soon as the first tooth erupts.

Children are not born with the bacteria that causes decay. It is acquired, usually within the first two years of life from the primary caregiver through sharing of utensils, wet kisses and infant hands in a caregiver’s mouth. As a caregiver, taking care of our own mouth can prevent this bacterial transmission. 

Cavity risk assessment is part of every pediatric dental appointment. Caregivers can discuss prevention strategies such as fluoride, plaque control and healthy diet choices with their oral health professional.

Oral Hygiene

A biofilm is continually forming on teeth. Controlling this biofilm is a twice daily task. For an infant, a soft washcloth to gently wipe the gums is recommended. A finger brush or infant toothbrush is recommended upon eruption of the first tooth. 

Flossing is recommended for teeth that touch one another because toothbrush bristles are unable to access these tight spots. The AAPD recommends assisting children with brushing and flossing up to age 3 and supervising until a child is at least 8 years old. Once a child can tie shoelaces, they are also likely to independently and effectively brush teeth.

Effective brushing and flossing techniques for biofilm removal are critical. Ask your oral health professional to demonstrate proper technique for cleaning your child’s mouth. And then practice with your child while still at the dental appointment. This is more effective than any verbal instruction or printed material. 

Fluoride

A smear (rice-grain size) of fluoride toothpaste is recommended beginning at age 6 months. The amount increases to a pea size between ages 3 and 6.

Children older than 6 may use a .05 percent sodium fluoride mouth rinse daily to decrease decay risk. At this age it is expected a child will be able to spit out the mouth rinse. Repeatedly swallowing fluoride mouth rinse puts a child at risk of staining the teeth (fluorosis).

Children at high risk for decay will benefit from fluoride varnish applications beginning upon tooth eruption. Many practices are switching from acidulated phosphate (ACP) fluoride gel in trays to fluoride varnish for children ages 6 and older due to ease of application and effectiveness.

Silver diamine fluoride (SDF) can arrest decay and prevent decay spreading to adjacent teeth. However, it does leave a dark stain on decay. SDF has come into regular use as is it is easily applied and nontraumatic — no sedation, needles or drills.  If your child is experiencing decay, ask your oral health professional about this treatment option. 

For children at moderate to high risk for decay who do not have adequate levels of fluoride present in their drinking water, fluoride supplementation is recommended. Research has shown .7 milligrams fluoride per liter is effective in preventing decay without causing fluorosis. All fluoride levels of drinking water including well water will need to be determined prior to an oral health professional prescribing supplementation.

Non-Fluoride Decay Prevention

Sealants may be applied to the chewing surfaces of premolars and permanent molars where 90 percent of decay occurs. Effectiveness increases when placed shortly after eruption. Sealants do wear away over time and should be evaluated for retention at each dental visit.

Baking soda in toothpaste, mouth rinses and chewing gum penetrates biofilm to prevent an acid environment and the growth of bacteria causing decay.

Xylitol is a five-carbon sugar that inhibits bacteria, increases saliva and reduces bacteria transmission from mother to child. It is recommended both for pregnant women, women and children at moderate to high risk and for children who have experienced decay. It is available in chewable tablets and chewing gum. Due to the risk of choking, chewing gum is not recommended for children under age 5 or those with swallowing disorders.

Additional preventive agents are available that may be discussed with an oral health professional. These include chlorhexidine, iodine, arginine, calcium phosphate, triclosan and sialogogues.

With loving concern and attention paid to their oral health early, it is possible for our children to grow into adulthood without ever experiencing decay and to retain their beautiful smiles for a lifetime.

Susan Rand is a retired dental hygienist. This article is taken from Dimension of Dental Hygiene, November 2018;16(11):10,11-12.