Health Tips

Isn’t it adorable when children show their sparse teeths while smiling? As parents, we certainly want what’s best for our beloved children, and that includes caring for their dental and oral health. Many oral health problems such as dental caries begin in childhood and can be prevented through early and periodic preventive dental care and counseling.

What puts children at risk for dental diseases?

The American Academy of Pediatrics Section on Pediatric Dentistry has identified the following factors that may increase the risk of developing dental problems in children:

• Mother or primary caregiver with active dental caries

• Low socioeconomic status

• Breastfeeding or bottle-feeding beyond 12 months of age

• Frequent consumption of sugary beverages and snacks

• Use of a bottle at bedtime, especially with sweetened beverages

• Use of liquid medication for longer than three weeks, as many of the liquid medication contains high level of sugar

• Exposure to environmental tobacco smoke (eg, a smoker in the household) - We wrote an article about the health impact of second-hand smoke onto children here

• Insufficient fluoride exposure

• Prolonged use of a training cup (sippy cup) throughout the day

• Children with special health care needs

• Visible plaque on upper front teeth

• Enamel pits or defects

If your child has one of the any risk factors mentioned here, you’re encouraged to bring your child to visit a dentist for check-up. The American Academy of Pediatric Dentistry, the American Dental Association, the American Public Health Association, and the American Academy of Pediatrics (AAP) recommend that the first dental visit occur at or near one year of age.

Photo by Mufid Majnun on Unsplash

Fluoride toothpaste: yay or nay?

As mentioned above, it was found that children who are exposed less to fluoride are at risk for dental problems. While it is true that fluoride is the primary prevention of dental caries across all age groups, excessive fluoride exposure in children can lead to dental fluorosis, which typically presents as white streaks in the enamel of permanent teeth. 

A mild form of dental fluorosis, as characterized by the white streaks/patches on teeth. Image credit: Matthew Ferguson 57, CC BY-SA 4.0 , via Wikimedia Commons

Hence, an important tip here is to use fluoride judiciously in children particularly during the critical months of enamel maturation (up to 48 months), when the developing anterior permanent teeth are most vulnerable to excessive fluoride that can cause fluorosis. In other words, be cautious with the amount of fluoride-toothpaste used in children between 1-3 years old. 

So how should I let my young child use fluoride toothpaste?

All children with teeth should have their teeth brushed twice daily for two minutes with small amounts of fluoride-containing toothpaste. The appropriate amount of toothpaste for infants and toddlers (younger than three years) is a "smear" (a very thin layer of toothpaste that covers less than half of the bristle surface of a child-size toothbrush or the size of a grain of rice. 

What it means to be a “smear”. Image credit: © 2021 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

The amount of toothpaste should be increased to no more than a "pea-sized" amount at age three years; older preschoolers can use slightly more than a "pea-sized" amount.

What it means to be “pea-sized”. Image credit: © 2021 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Other dental prevention strategies for children

If you’re the parent or caregiver to young children, various dental care strategies should be adopted based on the life stages of the children.

Before the eruption of first tooth – Nonnutritive sucking and the teething process

• Nonnutritive sucking (eg, sucking on a pacifier, thumb, or fingers) is a self-soothing behavior that is normal in early development but may become a learned habit if it persists beyond 12 to 18 months of age and should be discontinued at approximately 24 months. If not, it may contribute to the development of malocclusion (“crooked teeth”).

Malocclusion in a 10-year-old girl. Image credit: Suyash.dwivedi, CC BY-SA 4.0 , via Wikimedia Commons

• Teething happens when infants have their first tooth erupted. During this process, they tend to be cranky, chew on objects, and have excessive drooling. Some may also develop fever, diarrhea, or other systemic symptoms; however, no proven association exists between these symptoms and teething. 

As the primary tooth erupts – Feeding habits, the use of bottles and cups, and cleaning of the teeth

• If possible, infants should be breastfed exclusively for the first six months of life and breastfeeding should continue until the child is one year of age. Compared with water, breast milk and most infant formulas reduce plaque pH, have variable buffering capacity, and may support bacterial growth and dissolve enamel mineral when exposure is prolonged. This increases the risk of developing dental caries.

• To decrease the duration of exposure of newly erupted teeth to breast milk or infant formula, the use of a training cup can begin as soon as the child is able to drink from one (at approximately six months of age), and bottles should be discontinued as soon as possible after the first birthday. 

• Sweetened beverages, such as soda pop, fruit drinks (with added sugar), or flavored milks, should not be given to children younger than five years.

• Avoiding added-sugar beverages as much as possible throughout childhood.

• Consuming 100 percent fruit juice or added-sugar beverages (if consumed) from an open cup rather than a bottle or training cup, avoiding sipping these beverages throughout the day or in bed

• Rinsing the mouth with water immediately after consumption of sweetened items; for children in whom chewing gum is not a choking hazard, chewing sugar-free gum immediately after consumption.

For more information on how to properly introduce sweetened beverages to young children, read here.

A word from DOC2US

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Cover image credit: Photo by Stéphane Hermellin on Unsplash

Written by

Ms Joyce Toh