Baby Bottle Tooth Decay

Maintaining the health of primary (baby) teeth is exceptionally important.  Although baby teeth will eventually be replaced, they fulfill several crucial functions in the meantime.

Baby teeth aid enunciation and speech production, help the child to chew food correctly, maintain space in the jaw for adult teeth, and prevent the tongue from posturing abnormally in the mouth.  When baby teeth are lost prematurely due to decay or trauma, adjacent teeth shift to fill the gap.  This phenomenon can lead to impacted adult teeth, years of orthodontic treatment, and a poor aesthetic result.

Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months.  For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well baby check up” with a pediatric dentist around the age of twelve months.

What is baby bottle tooth decay?

The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers.  Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.

If baby bottle tooth decay becomes too severe, the pediatric dentist may be unable to save the affected tooth.  In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.

Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can completely prevent baby bottle tooth decay.

How does baby bottle tooth decay start?

Acid-producing bacteria in the oral cavity cause tooth decay.  Initially, these bacteria may be transmitted from mother or father to baby through saliva.  Every time parents share a spoon with the baby or attempt to cleanse a pacifier with their mouths, the parental bacteria invade the baby’s mouth.

The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweetened liquids.  These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.

Especially when sweetened liquids are used as a naptime or nighttime drink, they remain in the mouth for an extended period of time.  Oral bacteria feed on the sugar on and around the teeth and then emit harmful acids. These acids attack tooth enamel and wear it away.  The result is painful cavities and pediatric tooth decay.

Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay.  Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake.  Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.

What can I do at home to prevent baby bottle tooth decay?

Baby bottle tooth decay can be completely prevented by a committed parent.  Making regular dental appointments and following the guidelines below will keep each child’s smile bright, beautiful, and free of decay:

  • Try not to transmit bacteria to your child via saliva exchange.  Rinse pacifiers and toys in clean water, and use a clean spoon for each person eating.
  • Cleanse gums after every feeding with a clean washcloth.
  • Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge.  Fluoride-free toothpaste is recommended for children under the age of two.
  • Use a pea-sized amount of ADA-approved fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste.  Though fluoride is important for the teeth, too much consumption can result in a condition called fluorosis.
  • Do not place sugary drinks in baby bottle or sippy cups.  Only fill these containers with water, breast milk, or formula.  Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.
  • Do not dip pacifiers in sweet liquids (honey, etc.).
  • Review your child’s eating habits.  Eliminate sugar-filled snacks and encourage a healthy, nutritious diet.
  • Do not allow the child to take a liquid-filled bottle to bed.  If the child insists, fill the bottle with water as opposed to a sugary alternative.
  • Clean your child’s teeth until he or she reaches the age of seven.  Before this time, children are often unable to reach certain places in the mouth.
  • Ask the pediatric dentist to review your child’s fluoride levels.

If you have questions or concerns about baby bottle tooth decay, please consult your pediatric dentist.



Care for Your Child’s Teeth

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home.  Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth.  Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups.  In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can a pediatric dentist care for my child’s teeth?

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents.  In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist, the child’s mouth will be fully examined, the teeth will be professionally cleaned, topical fluoride may be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed.  The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the ages of two and three), the pediatric dentist may coat them with dental sealant.  This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles and acid.  Dental sealant may last for many months or many years, depending on the oral habits of the child. Dental sealant provides an important tool in the fight against tooth decay.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

Diet – Parents should provide children with a nourishing, well-balanced diet.  Very sugary diets should be modified and continuous snacking should be discouraged.  Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food – emitting harmful acids that erode tooth enamel, gum tissue, and bone if left unchecked.  Space out snacks where possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign.  If the child must use a pacifier, choose an “orthodontically” correct model.  This will minimize the risk of developmental problems like narrow roof arches and crowding.  The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

General oral hygiene – Sometimes, parents cleanse pacifiers and teething toys by sucking them.  Parents may also share eating utensils with the child.  Harmful oral bacteria are transmitted from parent-to-child in these ways, increasing the risk of early cavities and tooth decay.  Instead, rinse toys and pacifiers with warm water and avoid spoon-sharing wherever possible.

Sippy cup use – Sippy cups are an excellent transitional aid for the baby bottle-to-adult drinking glass period.  However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning continuous acid attacks on tooth enamel.  Sippy cup use should be terminated between the ages of twelve and fourteen months – or whenever the child has the motor capabilities to hold a drinking glass.

Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste.  Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth.  Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter).  For babies, parents should rub the gum area with a clean cloth after each feeding.

Flossing – Cavities and tooth decay form more easily between teeth.  Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other.  The pediatric dentist can help demonstrate correct head positioning during the flossing process, and suggest tips for making flossing more fun!

Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel.  Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay.  It is important to get the fluoride balance correct.  The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

If you have questions or concerns about how to care for your child’s teeth, please ask your pediatric dentist.



Eruption of Your Child’s Teeth

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children.  A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year.  By the age of three years old most children have a “full” set of twenty primary teeth.  The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges.  Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits – and the proper spacing and alignment of adult teeth.  Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.

In what order do primary teeth emerge?

As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months).  These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection.  The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months).  These teeth are lost next, usually between 7 and 8 years of age.  First molars, the large flat teeth towards the rear of the mouth then emerge on the upper and lower jaws (13-19 months).  The eruption of molars can be painful.  Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months).  Canine teeth can be found next to the lateral incisors, and are lost during preadolescence (10-12 years old).  Finally, second molars complete the primary set on the lower and upper jaw (23-33 months).  Second molars can be found at the very back of the mouth, and are lost between the ages of 10 and 12 years old.

What else is known about primary teeth?

Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption.  Lower teeth usually erupt before opposing upper teeth in both sexes.

Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once.  Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone.  Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.



How to Prevent Cavities

Childhood cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world.  There are two main causes of cavities: poor dental hygiene and sugary diets.

Cavities can be incredibly painful, often leading to tooth decay and childhood periodontitis if left untreated.  Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually, are all crucial factors for both cavity prevention and excellent oral health.

What causes cavities?

Cavities form when children’s teeth are exposed to sugary foods on a regular basis.  Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating.  A sticky film (plaque) then forms on the tooth enamel.  The oral bacteria within the plaque continually ingest sugar particles and emit acid.  Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay.  If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.

Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected.  It is essential that children brush and floss twice per day (ideally more), and visit the dentist for biannual cleanings.  Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.

How will I know if my child has a cavity?

Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all.  Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye.  Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.

Some of the major symptoms of cavities include:

  • Heightened sensitivity to cool or warm foods
  • Nighttime waking and crying
  • Pain
  • Sensitivity to spicy foods
  • Toothache

If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist.  Failure to do so will make the problem worse, leave the child in pain, and could possibly jeopardize a tooth that could have been treated.

How can I prevent cavities at home?

Biannual visits with the pediatric dentist are only part of the battle against cavities.  Here are some helpful guidelines for cavity prevention:

  1. Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation.  Replace sugary snacks like candy with natural foods where possible, and similarly replace soda with water.
  2. Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars.  Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water.  Make sure they consume enough water to cleanse the teeth.
  3. Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months).  The small amount of liquid emitted with each sip causes sugary liquid to continually swill around the teeth.
  4. Avoid stickiness – Sticky foods (like toffee) form plaque quickly, and are extremely difficult to pry off the teeth.  Avoid them where possible.
  5. Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby.  Rinse a dirty pacifier with running water as opposed to sucking on it, to avoid contaminating the baby’s mouth.
  6. Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news.  The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities.  Ensure the child has a last drink before bedtime, and then brush the teeth.
  7. Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child.  Do not be tempted to do this.  Use a blanket, toy, or hug to calm the child instead.
  8. Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old.  Before this time, children struggle to brush every area of the mouth effectively.
  9. Check on fluoride –When used correctly, fluoride can strengthen tooth enamel and help stave off cavities.  Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.
  10. Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines.  Keep to a regular appointment schedule to create healthy smiles!

If you have questions or concerns about cavity prevention, please contact your pediatric dentist.


Good Diet

A child’s general level of health often dictates his or her oral health, and vice versa.  Therefore, supplying children with a well-balanced diet is more likely to lead to healthier teeth and gums.  A good diet provides the child with the many different nutrients he or she needs to grow.  These nutrients are necessary for gum tissue development, strong bones, and to protect the child against certain illnesses.

According to the food pyramid, children need vegetables, fruits, meat, grains, beans, and dairy products to grow properly.  These different food groups should be eaten in balance for optimal results.

How does my child’s diet affect his or her teeth?

Almost every snack contains at least one type of sugar.  Most often, parents are tempted to throw away candy and chocolate snacks – without realizing that many fruit snacks contain one (if not several) types of sugar or carbohydrate.  When sugar-rich snacks are eaten, the sugar content attracts oral bacteria. The bacteria feast on food remnants left on or around the teeth.  Eventually, feasting bacteria produce enamel-attacking acids.

When tooth enamel is constantly exposed to acid, it begins to erode – the result is childhood tooth decay.  If tooth decay is left untreated for prolonged periods, acids begin to attack the soft tissue (gums) and even the underlying jawbone.  Eventually, the teeth become prematurely loose or fall out, causing problems for emerging adult teeth – a condition known as childhood periodontal disease.

Regular checkups and cleanings at the pediatric dentist’s office are an important line of defense against tooth decay.  However, implementing good dietary habits and minimizing sugary food and drink intake as part of the “home care routine” are equally important.

How can I alter my child’s diet?

The pediatric dentist is able to offer advice and dietary counseling for children and parents.  Most often, parents are advised to opt for healthier snacks, for example, carrot sticks, reduced fat yoghurt, and cottage cheese.  In addition, pediatric dentists may recommend a fluoride supplement to protect tooth enamel – especially if the child lives in an area where fluoride is not routinely added to community water.

Parents should also ensure that children are not continuously snacking – even in a healthy manner.  Lots of snacking means that sugars are constantly attaching themselves to teeth, and tooth enamel is constantly under attack.  It is also impractical to try to clean the teeth after every snack, if “every snack” means every ten minutes!

Finally, parents are advised to opt for faster snacks.  Mints and hard candies remain in the mouth for a long period of time – meaning that sugar is coating the teeth for longer.  If candy is necessary, opt for a sugar-free variety, or a variety that can be eaten expediently.

Should my child eat starch-rich foods?

It is important for the child to eat a balanced diet, so some carbohydrates and starches are necessary.  Starch-rich foods generally include pretzels, chips, and peanut butter and jelly sandwiches.  Since starches and carbohydrates break down to form sugar, it is best that they are eaten as part of a meal (when saliva production is higher), than as a standalone snack.  Provide plenty of water at mealtimes (rather than soda) to help the child rinse sugary food particles off the teeth.

As a final dietary note, avoid feeding your child sticky foods if possible.  It is incredibly difficult to remove stickiness from the teeth – especially in younger children who tend not to be as patient during brushing.

If you have questions or concerns about your child’s general or oral health, please contact your pediatric dentist.



Pacifiers and Thumbsucking

For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life.  Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.

According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old.  Thumb sucking can be a harder habit to break and tends to persist for longer without intervention.  Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.

How can thumb sucking and pacifier use damage children’s teeth?

Pacifier and thumb sucking damage can be quite insidious.  Both can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time.  Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:

Jaw misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold.  Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.

Tooth decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance.  Oral bacteria feed on sugar and emit harmful acids.  The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.

Roof narrowing – The structures in the mouth are extremely pliable during childhood.  Prolonged, repeated exposure to thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device).  This can cause later problems with developing teeth.

Slanting teeth – Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results.  In addition, thumb sucking and pacifier use in later childhood increases the need for extensive orthodontic treatments.

Mouth sores – Passive sucking is much less harmful than aggressive sucking.  Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.

If you do intend to purchase a pacifier:

  • Buy a one-piece pacifier to reduce the risk of choking.
  • Buy an “orthodontically correct” model.
  • Do not dip it in honey or any other sugary liquid.
  • Rinse with water (as opposed to cleansing with your mouth) to prevent bacterial transmissions.

How can I encourage my child to stop thumb or pacifier sucking?

In most cases, children naturally relinquish the pacifier or thumb over time.  As children grow, they develop new ways to self-soothe, relax, and entertain themselves.  When thumb sucking or pacifier use persists past the age of five, a gentle intervention may be required.

Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use:

  • Ask the pediatric dentist to speak with the child about stopping.  Often, the message is heard more clearly when delivered by a health professional.
  • Buy an ADA recommended specialized dental appliance to make it difficult for the child to engage in sucking behaviors.
  • Implement a reward system (not a punishment), whereby the child can earn tokens or points towards a desirable reward for not thumb sucking or using a pacifier.
  • Wrap thumbs in soft cloths or mittens at nighttime.

If the above suggestions do not seem to be working, your pediatric dentist can provide more guidance.  Remember: the breaking of a habit takes time, patience, and plenty of encouragement!


Perinatal and Infant Oral Health

Pregnancy is an exciting time. It is also a crucially important time for the unborn child’s oral and overall health.  The “perinatal” period begins approximately 20-28 weeks into the pregnancy, and ends 1-4 weeks after the infant is born.  With so much to do to prepare for the new arrival, a dental checkup is often the last thing on an expectant mother’s mind.

Research shows, however, that there are links between maternal periodontal disease (gum disease) and premature babies, babies with low birth weight, maternal preeclampsia, and gestational diabetes.  It is of paramount importance therefore, for mothers to maintain excellent oral health throughout the entire pregnancy.

Why are perinatal dental checkups important?

Maternal cariogenic bacteria is linked with a wide range of adverse outcomes for infants and young children.  For this reason, the American Academy of Pediatric Dentistry (AAPD) advises expectant mothers to get dental checkups and counseling regularly, for the purposes of prevention, intervention, and treatment.

Here are some perinatal oral care tips for expectant mothers:

  • Brush and floss – Be sure to use an ADA approved, fluoridated toothpaste at least twice each day, and floss at least once each day, to eliminate harmful oral bacteria.  In addition, an alcohol-free mouthwash should be used on a daily basis.
  • Chew gum – Xylitol, a natural substance, has been shown to reduce infant and toddler caries (cavities) when chewed 3-5 times daily by the expectant mother.  When choosing gum, check for the “xylitol” ingredient – no other sugar substitute has proven to be beneficial in clinical studies.
  • Diet evaluation – Maintaining a balanced, nourishing diet is always important, but particularly so during pregnancy.  Make a food eating diary and look for ways to cut down on sugary and starchy foods.  Sugars and starches provide food for oral bacteria, and also increase the risk of tooth decay.
  • Make regular dental appointments – When seen regularly, the dentist can bolster homecare preventative efforts and provide excellent advice.  The dentist is able to check the general condition of teeth and provide strategies for reducing oral bacteria.

How can I care for my infant’s gums and teeth?

Many parents do not realize that cavity-causing (cariogenic) bacteria can be transmitted from the mother or father to the child.  This transmission happens via the sharing of eating utensils and the “cleaning” of pacifiers in the parent’s mouth.  Parents should endeavor to use different eating utensils from their infants and to rinse pacifiers with warm water as opposed to sucking them.

Parents should also adhere to the following guidelines to enhance infant oral health:

  • Brush – Using a soft-bristled toothbrush and a tiny sliver of ADA approved non-fluoridated toothpaste (for children under two), gently brush the teeth twice each day.
  • Floss – As soon as two adjacent teeth appear in the infant’s mouth, cavities can form between the teeth.  Ask the pediatric dentist for advice on the best way to floss the infant’s teeth.
  • Pacifier use – Pacifiers are a soothing tool for infants.  If you decide to purchase a pacifier, choose an orthodontically correct model (you can ask the pediatric dentist for recommendations).  Be sure not to dip pacifiers in honey or any other sweet liquid.
  • Use drinking glasses – Baby bottles and sippy cups are largely responsible for infant and toddler tooth decay.  Both permit a small amount of liquid to repeatedly enter the mouth.  Consequently, sugary liquid (milk, soda, juice, formula, breast milk or sweetened water) is constantly swilling around in the infant’s mouth, fostering bacterial growth and expediting tooth decay.  Only offer water in sippy cups, and discontinue their use after the infant’s first birthday.
  • Visit the pediatric dentist – Around the age of one, the infant should visit a pediatric dentist for a “well baby” appointment.  The pediatric dentist will examine tooth and jaw development, and provide strategies for future oral care.
  • Wipe gums – The infant is at risk for early cavities as soon as the first tooth emerges.  For young infants, wipe the gums with a damp cloth after every feeding.  This reduces oral bacteria and minimizes the risk of early cavities.

If you have further questions about perinatal or infant oral care, please contact your pediatric dentist.



Sippy Cups

Many pediatric dentists believe that frequent, prolonged sippy cup use contributes to toddler tooth decay.  Sippy cups are an excellent tool to help ease the transition between baby bottles and regular adult drinking glasses.  However, sippy cups have become so effective in preventing spills and leaks, that the majority of parents continue to use them – often well into late toddlerhood.  As a consequence, pediatric cavities (often called “baby bottle cavities”) are becoming increasingly prevalent in children between the ages of two and five.

The American Academy of Pediatric Dentistry (AAPD) advises parents to make a “well-baby” checkup with a pediatric dentist approximately six months after the first tooth has emerged.  At this visit, the pediatric dentist is able to educate parents about sippy cup use and general oral care routines – as well as provide strategies for eliminating unwanted oral habits.

When should my child use a sippy cup?

A sippy cup should be introduced when the child is first physically able to grasp it.  Its use should be discontinued as soon as the child has enough motor control to use an adult-sized cup – usually around one year of age.  Children are at risk for tooth decay as soon as the first teeth emerge from the gums, making it crucial to implement a good oral care routine as early as possible.

During the sippy cup period, pediatric dentists provide the following guidelines for parents:

  • Don’t fill sippy cups with sugary liquids (opt for water whenever possible).
  • Don’t let children sip continuously from a sippy cup (remove the cup when the child has finished drinking).
  • Don’t let the child take a sippy cup to bed (unless it contains water).
  • Don’t use sippy cups to comfort a distressed child (especially one containing sugary liquids).
  • Frequently rinse the sippy cup with water to eliminate germs.
  • If the child must drink sugary liquids, let them do it at mealtime (when saliva production is at its highest levels).

How do sippy cups cause tooth decay?

Sippy cups alone do not cause tooth decay.  Oftentimes, the real problem is that parents tend to fill them with sugary, decay-promoting liquids.  Examples of such liquids are: breast milk, baby formula, fruit juice, soda, and sweetened water.

Since sippy cups only emit a tiny amount of fluid at a time, the sugars in the fluids are continuously being swashed in and around the child’s teeth.  Oral bacteria feed on these sugars and produce harmful oral acids. Acids attack the tooth enamel, weakening it and rendering it susceptible to decay.  Sometimes cavities (caries) form between the teeth, which are hard to see.  Biannual appointments with the pediatric dentist are the best way to monitor the condition of the teeth, and to ensure that cavities are not developing.

Which sippy cup should I choose for my child?

All sippy cups are not created equal.  The American Dental Association (ADA) provides the following guidelines for choosing a good sippy cup:

Avoid “no-spill” valves – In essence, sippy cups with no-spill valves do not advance the child’s sipping.  They only release a tiny amount of liquid, meaning that sugars are swilling around the mouth more often.

Choose a spout – Cups with a snap-on or screwing lid with a spout are preferable to the alternatives.  These cups promote good drinking habits, as opposed to being “glorified baby bottles.”

Two handles are better than one – The goal of the transition is to make the child feel comfortable enough to grasp an adult-sized cup.  Since larger cups require the use of two hands, it is better for the child to get into this habit early.

If you have questions or concerns about tooth decay or the use of sippy cups, please contact your pediatric dentist.



Tobacco Use

Tobacco use is one of the leading causes of death in society.  Fortunately, it is also among the most preventable.  Aside from being a sociably undesirable habit, smoking can result in oral cancer, reduce smelling and tasting abilities, compromise recovery after oral surgery, stain the teeth, and increase the risk of contracting periodontal disease.  The American Dental Association (ADA) and all pediatric dentists encourage children, adolescents, and adults to abstain from all forms of tobacco use.

Almost all adult smokers have tried smoking before the age of nineteen.  In all likelihood, an individual who abstains from smoking throughout the teenage years will never pick up the habit.  Therefore, it is essential that parents strongly discourage preadolescent and adolescent tobacco use.

Is smokeless tobacco less dangerous for teens?

Tobacco use in any form brings the oral region into direct contact with carcinogens (cancer causing agents).  These carcinogens and other harmful chemicals cause irreparable damage to the child’s oral health.

Parents and teens often mistakenly evaluate smokeless tobacco as the “safer” option.  In fact, smokeless tobacco has been proven to deliver a greater concentration of harmful agents into the body, and to be far more addictive.  One snuff of tobacco has approximately the same nicotine content as sixty regular cigarettes.  In addition, smokeless tobacco causes leukoplakias in the mouth, which are dangerous pre-cancerous lesions.

What are the signs of oral cancer?

Oral cancer can be difficult to detect without the aid of the dentist.  In some cases, oral cancer is not noticeable or even painful until its later stages.  Parents of tobacco users must be aware of the following symptoms:

  • Changes in the way the teeth fit together.
  • Difficulty moving the jaw.
  • Mouth sores that don’t heal.
  • Numbness or tenderness.
  • Red or white spots on the cheek, lip, or tongue.

Oral cancer is treatable if caught early.  Disfiguring surgery can be avoided by having the child abstain from tobacco use and getting regular preventative dental checkups.

How can I stop my child from using tobacco?

There are several ways to discourage children and adolescents from using tobacco products.  First, talking to the child personally about the dangers of tobacco use (or asking the dentist to talk to the child) has proven an effective preventative strategy.  Second, parents should lead by example. According to research studies, children of non-smokers are less likely to pick up this dangerous habit.  Third, monitor the child closely.  If the child will not cooperate, screenings for tobacco can be requested at the dental office.

If you have questions or concerns about your childhood tobacco use, please contact your pediatric dentist.



Tongue Piercing

There has been an upsurge in the amount of teenagers getting tongue piercings.  Teenagers often view these piercings as a harmless expression of their growing individuality.  Oftentimes, parents allow teens to pierce their tongues because the metal bar is impermanent.  In addition, tongue bars are not as visually apparent as a tattoo or eyebrow piercing might be.

Unfortunately, tongue piercings can have a serious (even deadly) impact on health.  Pediatric dentists routinely advise adolescents to avoid intraoral or perioral piercings for a number of good reasons.

Why is tongue piercing harmful?

First, there are a growing number of unlicensed piercing parlors in throughout the country.  Such parlors have been recognized as potential transmission vectors for tetanus, tuberculosis, and most commonly, hepatitis.  Second, a great number of painful conditions can result from getting a tongue piercing – even in a licensed parlor.  These conditions include:

  • Bacterial infections
  • Blood clots
  • Blood poisoning
  • Brain abscess
  • Chronic pain
  • Damaged nerves (trigeminal neuralgia)
  • Fractured/cracked teeth
  • Heart infections
  • Hypersensitivity reactions (to the metal bar)
  • Periodontal disease/gum recession
  • Problems enunciating
  • Scarring

What are the most common tongue piercing problems?

To pierce a tongue, the body piercer must first hold it steady with a clamp.  Next, a hollowed, pointed metal needle is driven through the tongue.  Finally, the piercer attaches the tongue bar to the bottom end of the needle, and then drags it upwards through the tongue.  Two metal screw-on balls are then used to secure the tongue bar.

Most commonly, severe pain and swelling are experienced for several days after the piercing episode.  Moreover, the new holes in the tongue are especially infection-prone, because the oral cavity is home to many bacteria colonies.  In the medium term, saliva production may increase as the body responds to a completely unnatural entity in the mouth.

Are there long-term problems associated with tongue piercing?

Long-term problems with tongue piercings are very common.  The screw-on balls constantly scrape against tooth enamel, making teeth susceptible to decay and gums susceptible to periodontal disease.  Soft tissue can also become infected in specific areas, as the tongue bar continues to rub against it.

If the tongue bar is inappropriately long, it can get tangled around the tongue or teeth.  In a similar way to an earring getting ripped out of the ear, a tongue bar can be ripped out of the tongue.  This is extremely painful, as well as difficult to repair.

In sum, the American Dental Association (ADA) advises against any type of oral piercing, and so does the pediatric dentist.

If you are a concerned parent, or would like the pediatric dentist to speak with your teen about tongue piercing, please contact our office.



Xylitol – Reducing Cavities

Tooth decay is a common, yet preventable childhood problem.  Left untreated, cavities in primary (baby) and permanent (adult) teeth become painful and negatively impact the esthetics and functionality of the teeth.

Some children are particularly susceptible to tooth decay, even after receiving regular dental examinations and oral care at home.  The American Academy of Pediatric Dentistry (AAPD) has recently recognized the benefits of a substance called xylitol for reducing childhood tooth decay.

What is xylitol?

Xylitol is a natural substance that can be found in a variety of fruits and vegetables.  Some of the most common xylitol- rich foods include: berries, mushrooms, corns, and lettuces.  Study results indicate that 4-20 grams of xylitol each day, divided into three or more helpings, can reduce tooth decay and cavities by as much as 70%.  As a point of reference, a single cup of berries contains a little less than one gram of xylitol.

It can be difficult to encourage children (especially toddlers) to consistently eat four or more cups of fruit or vegetables each day.  For this reason, xylitol is also available as a sugar substitute, a gum, and as a concentrate in numerous health foods. No other sugar substitute has been shown to benefit young teeth in the same way.

It should be noted that excessive xylitol consumption does not provide “more” tooth protection.  Sticking to the recommended daily amount is enough to enhance other cavity-reduction efforts, and the effects will last well into the future.

How does xylitol work?

The combination of many factors increases susceptibility to childhood tooth decay and cavities.  These factors include: oral care habits, diet, carbohydrate consumption, sucrose consumption, salivary flow rate, and tooth resistance to plaque.

More specifically, harmful oral bacteria feed on sugars and carbohydrates, producing acids.  When sugary foods are consumed, these acids attack and destroy vulnerable tooth enamel. Xylitol works to neutralize the acids, reducing enamel destruction, and minimizing the threat of cavities in the process.  Xylitol also stimulates saliva production, meaning that food particles, plaque and bacteria are continually removed from the teeth.  When used in combination with fluoride, xylitol works to remineralize teeth, protecting tooth enamel and minimizing new cavity formation.

When should my child start using xylitol?

Although xylitol gum is not suitable for very young children, infants actually benefit from maternal chewing!  Mothers of children between three months and two years old who used xylitol gum several times each day, protected their child from tooth decay until the age of five years old.  In this case, xylitol reduced the amount of microorganisms transmitted from mother to child.

Once the child reaches toddlerhood, xylitol can be consumed as a sugar substitute, or as a natural byproduct of eating fruit and vegetables.  Older children can reduce the threat of new cavities by chewing xylitol gum.

If you have questions or concerns about xylitol or tooth decay, please contact your pediatric dentist.