Dental caries (cavities or tooth decay) are one of the most common infectious diseases in children today. It is estimated that more than 40 percent of children have tooth decay by the time they start kindergarten; cavities are several times more common than asthma or hay fever in children. Cavities in young children can cause pain, swelling, and abnormalities in the coming together of bottom and top teeth, and also can cause serious infections and even poor growth.
How are cavities formed? Our mouths are home to many normal bacteria germs. Eating or drinking too many sugary foods, or not brushing or flossing our teeth allows these bacteria to grow too much and make acid that slowly breaks down a tooth's hard enamel, forming a cavity. Interestingly, these germs usually are not present in babies until at least 6 months of age (some time after the first tooth appears). However, they can be passed at any time from mothers or other care providers to the infant, for example, when sharing a spoon or cleaning a dropped pacifier in their mouth. Cavities tend to run in families, and children of mothers with lots of cavities have a greater risk of tooth decay.
Therefore, it is critically important to start thinking about oral health during infancy. In order to promote dental health (and overall health), the American Academy of Pediatrics (AAP) recently has released a policy statement to help doctors and parents understand the importance of assessing the risk of oral health problems and establishing a "dental home" early in childhood.
According to the AAP, every child should receive an "oral health risk assessment" by 6 months of age from a qualified pediatrician or other child health care professional. This can be done by taking a dental history from the mother, which can help to identify infants who are likely to get cavities. Infants who are higher risk should be referred to a dentist as early as 6 months of age and no later than 12 months of age. This includes children who:
Children need to have a "dental home," or a primary dental care provider who can care for all their dental needs. Similar to the AAP concept of the medical home, this care should be "accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective." Ideally, the AAP recommends that all children be referred to a pediatric dentist within six months after the first tooth appears or by 12 months of age. Early referral to this dental home will help to ensure that children receive information about ways to prevent dental problems, as well as comprehensive dental care and referrals to other dental specialists as needed.
Although risk assessment and the establishment of a dental home are very important, there are some simple steps that parents can take to help reduce the risk of cavities for their children.
Because cavity-causing germs can be passed from their mouths, mothers (and other close caregivers) should follow these simple preventive guidelines:
Follow these guidelines for infants and toddlers up to the age of 3 years:
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.