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Seek An Oral Health Risk Assessment
Establish A “Dental Home”
Prevent Dental Caries

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.

Seek An Oral Health Risk Assessment

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:

Have special health care needs
Have a mother with lots of cavities
Already have obvious cavities, plaque, loss of enamel, and/or staining (discoloration)
Sleep with a bottle or are breastfed throughout the night
Have older brothers or sisters
Are from a low-income family

Establish A "Dental Home"

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.

Prevent Dental Caries

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:

Brush thoroughly twice daily and floss at least once every day.
Drink fruit juices only at meals and avoid all soda (carbonated beverages) during the first 30 months (2 ½ years) of the child's life.
Use a fluoride toothpaste approved by the American Dental Association and rinse every night with an alcohol-free over-the-counter mouth rinse with 0.05% sodium fluoride.
Visit a dentist for an examination and have any cavities treated as soon as possible.
Prevent early colonization of dental bacteria in babies by not sharing utensils (spoons, forks), not cleaning a dropped pacifier with saliva, etc.
Consider chewing xylitol gum. Some evidence suggests that chewing four pieces per day decreases the rate of caries in a child.

Follow these guidelines for infants and toddlers up to the age of 3 years:

Wipe off an infant’s gums and mouth with a damp cloth after feedings.
Brush a child’s teeth as soon as they appear, twice daily: morning and evening (after the last feeding).
Floss between the teeth once every day as soon as teeth touch one another.
Serve fruit juices only during meals and do not give soda (carbonated beverages) to young children.
Do not put babies to bed with a bottle or cup that contains milk or juice. If your child must have something in bed, water is OK.
Use fluoride, but cautiously. All children need to have some fluoride, but speak to your doctor about how much and which form to use. Children who drink well water or filtered or bottled water may need fluoride supplements.

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.

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