Dear Lisa,
My son is 16 months old and has 4 teeth. When are you supposed to start brushing a child’s teeth? At what age should a child see a dentist?
“Is it time to Brush Teeth?”
Dear “Is it time to Brush Teeth?”,
Dental problems in childhood many times start early, for some children as early as infancy. An infant who sleeps with a bottle or breastfeeds throughout the night after the first tooth eruption is at risk for tooth decay and other dental problems. (1) In order to prevent dental carries it is commonly recommended to wipe an infant’s gums with a clean wet washcloth at bedtime. (1) Once teeth erupt, they should be wiped with a clean wet washcloth at bedtime or brushed with a soft bristle toothbrush and water. (1)
Infant toothpastes such as Baby Oragel toothpaste can be used to make brushing more tasteful and enjoyable to the child. (1) It is not recommended to use Fluoride toothpaste until a child is over 2 years old. Children ingest toothpaste during brushing and if the toothpaste contains Fluoride the child can develop Fluorosis. Fluorosis occurs when a child ingests more than the recommended daily amount of Fluoride. Signs of Fluorosis include mottling of the teeth (the appearance of white spots on the surface of the teeth), brown stains on the teeth, and pitting and erosion of the enamel. (2)
Dental carries or cavities are one of the most common pediatric health problems. They are five times more common than Asthma and seven times more common than Hay Fever. (3) Food with a high carbohydrate content can lead to the development of dental carries. If teeth are exposed to foods high in carbohydrates for a long period of time, dental carries can occur. The practice of having a child drink milk before bedtime, without brushing puts him at risk for developing cavities. (1)
Other foods that may also contribute to the development of cavities include cookies, candy, ice cream, peanut butter and jelly sandwiches, dried fruit and raisins. (2) Sweet sticky snacks in particular pose a threat because they remain on the teeth for extended periods of time. Food stuck to the teeth overnight while a child is sleeping can not be washed away with drinking water. In addition a person’s saliva is dryer at night which only contributes to the stickiness of the food left on the teeth. (1)
The bacterium that causes cavities is called Streptococcus mutans. This organism is many times passed from a mother to her child. (1) Therefore sharing of items such as toothbrushes should be avoided. In addition, a parent should not clean off a baby’s pacifier or nipple by putting it in their mouth because this can potentially spread the organism from the parent’s mouth to the baby’s. (1)
There are different policies on when children should have their first visit to the dentist. The American Dental Association recommends that children see a dentist no later than their first birthday. (4) Each Pediatrician may have their own recommendation regarding when an infant should first see a dentist. You should ask you son’s Doctor or Nurse Practitioner what his or her recommendations are.
In general the first dental visit should occur between 1 and 3 years old, when a child has 6 to 8 teeth in place. (1) Children with craniofacial abnormalities such as cleft lip or cleft palate, delayed tooth eruption or tooth decay should see a dentist earlier rather than later. Cavities run in families, therefore it would be prudent for children with a family history of multiple cavities in childhood to also see a dentist earlier rather than later.
The purpose of the first dental visit is to identify any potential problems and to counsel parents on proper oral health. From my experience, most parents of one year olds complain that their child did not cooperate with the first dental exam. If this is the case, the Pediatrician or Nurse Practitioner can evaluate the child’s teeth and gums during the well child visits and educate parents on proper oral health until the child is ready for a visit with the Dentist.
References:
(1)Grassia T. Talking teething: Start good oral hygiene early. Infectious Diseases in Children. 2006. August:44.
(2) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 677-679.
(3)American Academy of Pediatrics. Children’s Health Topics. Oral Health. Available at: Http://www.aap.org/healthtopics/oralhealth.cfm. Accessed August 2006.
(4)American Dental Association. Oral Health Topics A-Z. Teething. Available at: Http://www.ada.org/public/topics/teething.asp. Accessed August 2006.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Infants
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