Dental Care for Infants and Children

In almost 20 years of general practice, some of the most common questions I’ve received have been from new mothers concerning their children’s dental health. When I field these inquiries, I try to stress that, although primary teeth will naturally fall out, they are extremely important for chewing, speech development, and holding space for the erupting permanent dentition.

In addition, if not cared for, primary teeth can decay and abscess in the same way as adult teeth. This can lead to significant pain and swelling and may have negative effects on the developing adult dentition.

It is very important that children develop good oral care habits from a very young age. It is paramount that all children visit the dentist every six to nine months for a dental examination, cleaning, radiographs or x-rays (to check for decay and proper tooth development), a fluoride treatment, and oral hygiene instruction. Proper brushing and flossing techniques should be stressed at home, and protective mouth guards must be worn while playing any contact sport. Trauma to a newly erupted adult tooth could lead to root or crown fracture, an abscess, and/or even tooth loss. We must convey to our kids a message: We are only given one set of adult teeth, and these teeth need to last us a lifetime.

Below are some of the most common questions I answer in my practice.

Q: I have an infant at home. When should I bring her to the dentist?

A: It is recommended to make a child’s first dental appointment after the first baby tooth erupts and before the child’s first birthday.
Q: How do I care for my infant’s teeth at home?

A: Before his or her teeth come in, an infant’s gums can be gently washed with a soft washcloth or a square of gauze. Once the primary teeth start erupting (around the five-month mark), the teeth should be brushed gently with a children’s toothbrush. A small amount of fluoridated toothpaste can be used (about the size of a grain of rice). Since there is no fluoride in the drinking water in our area, the fluoridated toothpaste will help prevent dental decay. The child should also become familiar with flossing. This skill can be practised once the full complement of primary teeth are present, which usually occurs before the age of three. Brushing should be done in the morning and – most importantly – before bed. Parents must supervise their children and ensure they are spitting out and not swallowing the toothpaste.

Q: My child has cavities that need to be fixed. He is terrified of needles and I doubt he will let you treat him. What should I do?

A: Local anesthetic is almost always required to restore decayed teeth. Many children are fearful of needles and dental treatment. Dentists are well trained in different behavioural techniques to make the appointment as comfortable as possible for your child. In addition, nitrous oxide sedation (laughing gas) or other oral medications can be prescribed to young patients to make their appointments stress free. In certain cases, where there is an extensive amount of work to be done or the child has extreme anxiety, we can refer the patient to a certified specialist in pediatric dentistry. The work may have to be done in a hospital setting under general anesthesia.

Q: Why does my child get so many cavities?

A: Cavities (decay) are caused by certain bacteria metabolizing fermentable carbohydrates (sugar) left on or between the teeth. Certain children have low counts of the cavity-causing bacteria and are at low risk of having decay. Other children have very high levels of this cavity-causing bacteria and, despite the best oral hygiene efforts, they still get decay. In general, the development of decay is multifactorial. Genetics, diet, and oral hygiene all play a role. In cases of rampant dental caries (extensive cavities), consultation with your dentist to determine the best course of action is advised. Perhaps a fluoride rinse needs to be prescribed. Alternatively, diet modification and/or a possibly increased frequency of preventative dental appointments is recommended. In addition, it may be prudent to have preventative dental sealants placed on the permanent molars when they erupt. Your dentist and hygienist will be more than happy to counsel you and your children on cavity prevention and oral health.

Q: My children’s teeth look crooked? Should we get a referral for braces?

A: Typically, children aren’t referred to the orthodontist until many of their permanent teeth are present in the mouth (usually between seven to 10 years old). Crooked or crowded baby teeth usually aren’t cause for worry.

In cases where children thumb suck or have tongue-thrust habits and the baby teeth have moved out of alignment, an early referral to the orthodontist may be necessary. Sometimes, “‘habit breaker” appliances are used to prevent orthodontic problems with the permanent teeth.

Orthodontic analysis and growth and development evaluations are done at all checkup and cleaning appointments for children. This is yet another important reason why your child should be on a regular schedule with his or her dentist. In this way, you can be assured that a timely referral to an orthodontist will be made before orthodontic problems worsen.

It is very important that your children get on the right path of oral health even before their first tooth is ready to poke through. We find that good dental hygiene habits in childhood translate to good habits in adulthood. As I’ve alluded to above, dental education, diet, regular dentist visits, and oral hygiene are all important factors in achieving optimum oral health. As dental professionals, we see ourselves as partners with you while on this journey with your young family.

Please do not hesitate to call us with any questions or concerns you may have about your family’s dental health.