Taking a Bite Out of Baby-Tooth Decay - A Parent's Life - Harvard Commentaries

Tooth decay takes place when sweetened liquids are left on infants' teeth for long periods of time. Infants' cavities are also known as "baby bottle tooth decay," which is named after the most common way that infants develop tooth decay — being put to bed with a bottle that contains sugar. Milk, formula and juice are common culprits in bedtime bottles.

Everyone should know that it's not just the type of liquid that makes a difference, but also how often and how long the liquids are in contact with the surfaces of the teeth. Baby bottle tooth decay can lead to damage of your child's baby teeth and may even affect permanent teeth.

Tooth decay in infants is so worrisome that some people believe it could be the next epidemic we face. Yet, amazingly, neither parents nor providers seem to be taking the dental health of infants seriously enough.

Dental cavities are the most common infectious disease in U.S. children. They are five times more common than asthma in children, and yet asthma receives so much more attention.

During 1999 through 2002, among children aged 2 through 11 years, 41% had dental cavities in their primary teeth. About 42% of children and adolescents aged 6 through 19 years (and a remarkably high 90% of adults) had dental cavities in their permanent teeth. Many of these cavities in children go untreated.

It also has been reported that only 44% of the total population over age 2 visited the dentist in the previous year, with differences according to race/ethnicity, education and income. For example, 55% of those with some college had a past-year visit, compared with 24% of those with less than a high school education. Underprivileged and minority children have even higher rates of poor dental health.

We need to do as much as we can to promote the oral health of children, such as with fluoride supplementation, proper hygiene practices and bottle weaning.

Dental health is a partnership between families and providers. Although there are proven ways to promote good dental health in your children, many parents may overlook them or may not receive the proper information on how best to care for their child's teeth. It is your responsibility as a parent to talk with your child's pediatrician about dental health at the child's next visit.

The American Academy of Pediatric Dentistry recommends that children visit the dentist for the first time when the first tooth comes in, usually between 6 months and 1 year of age. Visiting the dentist at such a young age helps to establish good dental habits and keep teeth healthy.

Don't be nervous about your child's first visit to the dentist, which can pick up any problems with your baby's teeth early and help correct them right away. Pediatric dentists are likely to be sensitive to your child's (and your) fears and anxieties. Prepare your child for the visit by explaining in simple terms what to expect. Avoid using potentially scary words (such as "pain," hurt" or "needles"). The dentist will explain any necessary procedures to your child in a way he or she can understand.

You also can help keep your child's teeth healthy at home. Practicing good dental hygiene is important not only in preventing tooth decay, but also in preventing negative effects on a child's daily life.

Wipe your baby's gums with clean gauze after each feeding to get rid of any extra sugar or little pieces of food.
Use water as a good substitute for sugary liquids if your child needs a bottle before bed.
Brush your baby's teeth and gums thoroughly with a soft infant toothbrush as soon as that first tooth pops through.
Use a toothpaste with fluoride for children 2 and older; talk to your dentist about the right toothpaste for children younger than 2. Fluoride is important for growing teeth.
Some tap water we drink may have the right amount of fluoride; be sure to check with your doctor about the fluoride levels in the drinking water near your home. Fluoride supplementation can be given to young children who do not get enough fluoride in their regular diet.

Healthy teeth can help children to chew food more easily, speak more clearly, and of course have a more beautiful smile. On the other hand, poor dental hygiene can cause severe pain, chewing difficulties, speech impediments, lowered self-esteem and an unwillingness to smile.

To prevent these problems, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry continually review recommendations to be sure that we are providing the very best care for our children's teeth and gums.

We will continue efforts to educate everyone about the value of each child having an established dental home for promoting healthy teeth and gums in all children. In addition, studies are being done to better understand what needs to be done and how best to do it cost-effectively.

Henry H. Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.