Early pearly whites

From that first snowy kernel peeking above the gum to a seventh-grader’s grin, teeth give a child’s face unique appeal — no wonder toothsome means agreeable or attractive! But these nuggets of dentine and enamel are no idle beauties — they also help kids speak properly and grind up good, nourishing foods like fruits and vegetables. So how can you keep your child’s smile healthy and handsome? Today’s Parent asked five experts for the answers to this oral exam.

Q: How can I tell if my baby is cutting a tooth?
A: Classic clues include drooling (which can cause a rash around the mouth), irritability and restless sleep. Sometimes low-grade fever (below 101.3°F/38.5°C), diarrhea (which in turn, can cause diaper rash) and even vomiting appear around the same time, though the latter symptoms may not be caused by teething itself, since they don’t occur when larger permanent teeth erupt. Sahza Hatibovic-Kofman, chair of orthodontics and paediatric dentistry at the University of Western Ontario in London, offers one explanation. “The gums are very itchy during teething, so children put everything in their mouths,” which increases a baby’s chances of picking up viral infections. If vomiting, diarrhea or fever persists longer than 24 hours, contact your child’s doctor.

Soothe sore gums by gently rubbing them with a clean finger. Or give your baby something soft and safe to chew on — a chilled wet washcloth or teething ring is ideal. If these comfort measures don’t help, you can try children’s acetaminophen or ibuprofen. Over-the-counter teething gels should only be used in consultation with a health professional because these products occasionally trigger allergic reactions. Limit teething biscuits, which contain enamel-endangering sugar.

Q: Baby teeth fall out anyway. What’s the point of spending time and money caring for them?
A: It’s important to preserve those baby teeth for several reasons, Hatibovic-Kofman says. Firstly, they pave the way for permanent teeth: If your child loses one prematurely (either due to injury, or a tooth pulled because a cavity has grown too large to be filled), its neighbours can tip toward each other, not leaving enough space for the adult replacement. In such cases, dentists glue in a space maintainer to save a spot for the permanent tooth.

The development of teeth and underlying bone is interconnected, so losing primary teeth too soon can also interfere with normal jaw growth.

Primary teeth have thinner enamel shells than their adult counterparts, which means cavities can spread quickly, causing pain and even infection. (It’s common for baby teeth to linger until age 13. Some stubbornly hold on even longer, which sometimes indicates there’s no adult tooth waiting underneath. In such cases, it may eventually be necessary to replace the natural tooth with an artificial one.)

Finally, establishing good habits early may pay off later in life: Children who keep decay at bay are more likely to grow into adults with healthy teeth, than kids with cavity-riddled baby teeth.

Q: When should I start taking my child for checkups, and how frequently should I schedule follow-ups?
A: That depends on whom you ask. Paediatric dentists (who undergo two or three extra years of training) recommend scheduling that first visit within six months after baby’s first tooth appears, or no later than 12 months of age, says Kelly Wright, president of the Canadian Academy of Pediatric Dentistry. General dentists often suggest bringing kids in by age three (earlier if you spot problems or all 20 teeth haven’t appeared by about 2½), ideally when they can comply with instructions and sit quietly for five to 10 minutes. “Obviously kids vary,” observes Alfred Dean, a Sydney, NS, dentist and past president of the Canadian Dental Association: An easygoing one-year-old might be perfectly content to let the hygienist count and clean her teeth, while that might be too much to ask of a very high-energy three-year-old.

Dentists usually recommend spacing checkups six months apart. However, your dentist may suggest returning more frequently because of certain risk factors, including how cavity-prone your child is likely to be, based on family history (decay-causing bacteria can be transmitted from parents to kids through saliva — by sharing cups or cutlery, for example — and weak tooth enamel sometimes runs in families). If you opt for the later start, take your toddler to a few of your own checkups, or those of an older sibling, beforehand: It won’t seem so scary when her turn rolls around. My own three kids watched Dr. Marnie examine Mom’s teeth and even got to choose a toy from the treat stash!

Q: What happens during a first dental appointment?
A: A child’s first visit to a general dentist’s office is usually a low-key affair, says Ursula Gazalka, a dental hygienist in London, Ont. “We’ll take them for a ride in the chair, count their teeth and teach them to brush. And we’ll probably polish the teeth to introduce them to the instruments.” The dentist or hygienist often provides parents with information on choosing tooth-friendly snacks and evaluates the child’s fluoride intake. If you live in a community with a non-fluoridated water supply, or rely on bottled or purified water, your dentist may prescribe this cavity preventer.

In contrast, since an initial visit to a paediatric specialist often occurs before most of a baby’s teeth come in, the dentist spends most of the time talking, asking parents questions to determine whether a child runs a higher-than-average risk of developing decay, and advising them on issues such as preventing trauma to teeth.

Q: What are the treatment options if my child develops a cavity?
A: Cavities invisible to the naked eye (but detectable under a special light) may be treated using fluoride and an antibacterial solution; otherwise, the tooth will need to be filled (tiny cavities may not need freezing). Many dentists have switched to using white filling materials, which, unlike amalgam, chemically bond with enamel (reducing the amount of healthy tooth that must be drilled away). Some fillings even slowly release fluoride. Molars (back teeth) with deep cavities may need to be capped with stainless steel crowns. If your child requires extensive treatment, or is very frightened, a dentist can use different types of sedation.

Q: Apart from regular dental visits and daily care, what can I do to protect my child’s teeth?
A: What your child eats and drinks, and how frequently, plays a key role in dodging decay. Avoid bedtime bottles filled with anything but water — juice and even milk contain natural sugars, so a constant trickle allows acids produced by sugar-guzzling bacteria to gnaw at teeth all night. Try to limit starchy or sugary foods (including potato chips and even dried fruit) and drinks to mealtimes to reduce exposure to enamel-eating acids.

Be sure your junior athlete wears appropriate protective equipment, including a mouthguard, for higher-risk activities such as hockey and basketball (ask your dentist for recommendations specific to your child’s sport). If your child sips sports drinks during practice, have her brush or sip water afterward since they can contribute to cavities.

Q: Some of my son’s permanent teeth are coming in behind his baby teeth. Will he need to have the baby teeth pulled?
A: This is more common than you might think, affecting about 15 percent of kids, Hatibovic-Kofman says. Extraction often isn’t necessary — your child’s dentist can assess whether the lingerers are likely to fall out unassisted. Baby teeth generally start falling out between six and eight years of age. Resist the urge to pull out loose teeth — pain and bleeding are lessened if they fall out naturally.

Q: My child’s permanent front teeth look yellow. Should I be concerned?
A: “Compared to baby teeth, which are paper-white, permanent teeth are darker,” reassures Dean. However, anytime you have a concern, talk to your dentist.

Q: Can certain medications damage my child’s teeth?
A: There are liquid and chewable medications that are sweetened with sugar; follow a dose with a rinse of water. (If your child takes medicine frequently, your pharmacist may be able to suggest a sugar-free alternative.) However, some medications, like certain cough remedies, need to stay in the mouth for a while to do their job, so rinsing would counteract the drug’s effect; again, speak to your pharmacist if your child uses these medications frequently.

Certain drugs can cause dry mouth; since saliva rinses away food and fights bacteria, kids who take them need to be extra-vigilant about preventative care. Mark Kearney, a pharmacist at The Prescription Shop at Carleton University in Ottawa, adds that kids who use corticosteroid puffers should ensure traces of these medicines don’t stay in the mouth, since they can suppress immune cells locally that prevent infections like thrush. “We suggest rinsing with water, gargling and then spitting,” Kearney says.

Some antibiotics, such as tetracycline and ciprofloxacin, can discolour teeth permanently and interfere with bone development in young children, but doctors no longer prescribe these medicines to kids unless there’s no alternative.

When should I...
Begin brushing my baby’s teeth? No need to wait until teeth make their debut. Soon after birth, you can use small gauze pads to wipe and massage gums once a day. “The idea is to keep the mouth clean and get the child used to oral care,” explains Kelly Wright, president of the Canadian Academy of Pediatric Dentistry. After that first tooth arrives, use a soft baby toothbrush and plain water to clean it daily. You may also want to try a baby teeth-cleansing gel that doesn’t contain fluoride.

Time tooth-brushing bouts? Ideally, it’s best to brush two or three times a day — at least after breakfast and before bed.

Start using toothpaste? Don’t use fluoridated paste until your child learns to spit it out, and then use only a pea-sized blob under adult supervision, advises Ursula Gazalka, a dental hygienist in London, Ont. Why? Ingesting too much fluoride can cause enamel to develop discolorations; extremely large amounts can be toxic.

Start flossing? Ask your dentist. Some recommend starting as soon as two teeth are touching; others say you can hold off until age two or three. Either way, floss holders (either the disposable type or a reusable handle) make the job much easier. You might also give flavoured flosses a try.

Replace toothbrushes? Manual toothbrushes and electric brush heads should be replaced every few months, or sooner if the bristles become bent or worn. You may also want to chuck your child’s brush when she’s getting over an illness — viruses can lurk on brushes for weeks.

Let my child take over brushing duty? Kids lack the dexterity to do a good job until they master cursive writing — around age eight or nine.

No brush?
Try one of these stopgap solutions: • a few bites of hard cheese, which helps neutralize enamel-eating acids; • a stick of sugarless gum, which steps up saliva production.

Resources
utoronto.ca/dentistry University of Toronto, Baby Oral Health online video cda-adc.ca Canadian Dental Association capd-acdp.org Canadian Academy of Pediatric Dentistry