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Expert advice for the oral hygiene of your 0-18 month old child

Expert advice for the oral hygiene of your 0-18 month old child

New parents are often confused about the best way to care for their children’s teeth, especially when they are infants. In fact, some parents don't even think about oral hygiene or their baby's teeth until the first tooth comes into the mouth. This may be too late as some problems can be prevented far before the first tooth sprouts into the mouth.

Dental caries is by definition a common chronic, transmissible infectious disease that is a result of many risk factors. It is a fast-growing problem in school aged children and an alarming rate of children in America have at least one cavity by the time they reach Kindergarten. The prevention of the problems associated with dental caries or Early Childhood Caries (ECC) can begin before your baby is even born. Furthermore, other oral issues specific to babies 0-18 months can be addressed and avoided as well. Learn about the things you can do during the prenatal stage, the perinatal stage and beyond in order to care for your baby's mouth and prevent future problems in his gums and future teeth.


Do

Do stay healthy and practice good oral hygiene during your pregnancy

Your baby's primary teeth, like other organs, are undergoing development while he is still in the womb. Because of this, it's not surprising that anything that happens to the mother at this time will affect baby as well. This is why it is important to optimize your own nutrition and take care of your health so that you can keep your baby healthy. In fact, studies have shown that children who display low birthweight, systemic illness or malnutrition during the perinatal period are more likely to have enamel defects in their primary teeth. Enamel defects make the tooth more prone to cavities and once a cavity starts, it spreads faster than in a tooth with healthy enamel. Additionally, while babies are born without the presence of the bacteria that primarily causes cavities, Streptococcus mutans (SM), they can be infected by their mothers in a process called vertical transmission. Thus, mothers who display high levels of SM and poor oral health are more likely to infect their children, thus increasing their risk for future caries.

Pregnant women can decrease their oral SM by improving their oral hygiene with twice daily brushing, regular flossing and the use of fluoride or chlorhexidine rinses. They should also visit their dentist regularly for preventive care and the treatment of any active caries or infections. The safest time for a pregnant mother to undergo dental procedure is during the second trimester, although necessary dental treatment is encouraged and safe at anytime during pregnancy with certain precautions.

Do bring your baby to the dentist before his first birthday

It is suggested that your baby see a dentist for his initial dental visit by the time he gets his first tooth but no later than his first birthday. Because baby teeth can typically appear around 6 months, problems can begin to occur within that first year. Your baby's first visit to the dentist is an important one. A comprehensive initial visit to the pediatric dentist will likely include a thorough medical history of your infant, a clinical exam of his mouth, and a prophylaxis and fluoride treatment if indicated.

The session will provide you with valuable information regarding oral health instruction (which should include an toothbrushing demo appropriate for your child at his age), information on his fluoride status and recommendations, dietary counseling and an assessment of his current state as well as future risk for cavities. Additionally, you should leave with and understanding of what to expect and problems to avoid as your baby grows, known as anticipatory guidance.

Most importantly, with this first visit you will have established an all-important "dental home" for your child, which is recommended over only a simple screening or a problem-focused, emergency visit. Thereafter, bring your child to the dentist regularly for check up and maintenance visits every 6 months.

Do perform proper oral health care for your baby

The American Academy of Pediatric Dentistry (AAPD) recommends that you should begin oral hygiene practices for your baby no later than the time his first tooth erupts. Twice daily cleanings by wiping or brushing your infant’s teeth with a soft cloth or brush is indicated. Some experts recommend wiping your baby’s gums with a wet cloth even before he gets his teeth as doing this after feedings will remove the residue from food, formula and milk that can get trapped in your baby's mouth. This can lower the amount of cavity-causing bacteria that populate in your baby’s mouth. Some evidence even suggests that regular wiping of your baby’s gums can make teething more comfortable because the teeth are erupting into healthy gums vs. inflamed gingival tissue.

Either way, make sure you are cleaning for your infant and doing so until he is old enough to do it properly himself. It is also important that you use an appropriate sized cleaning tool for your child. Finger brushes are OK when your baby only has his front teeth, but when he begins to get his molars you may want an infant sized child toothbrush that can reach further back. Flossing should begin when your baby’s teeth contact each other as doing so will clean the surfaces that cannot be cleaned with a toothbrush.

Do educate yourself on infant-specific problems

Know the age-specific problems associated with your baby’s oral health so that you can prevent them. You will receive most of this important information from the anticipatory guidance your dentist should give you which will include information on general dental growth and development, teething issues, poor oral habits, teething, oral injuries, dietary counseling and oral hygiene instructions. Key take home points at this age with regard to oral problems that you may not know about have to do with injuries. Babies are often curious and discover many things with their mouths which puts them at risk for injuring themselves with common objects like toys, pacifiers and even household objects such as electric cords (which can produce painful and serious burns with a risk for scarring). Being informed is the best way to prevent problems for your baby's teeth early on.

Do create a healthy bedtime routine

The bedtime practice of putting a child to sleep with a bottle containing milk or sugar-containing liquids is the most common cause of ECC. When babies fall asleep with the bottle nipple in their mouth, the liquid inside the bottle pools around his teeth (most commonly the front teeth) and gums and can cause cavities on those surfaces. The best way to prevent this is to avoid putting your child to sleep with a bottle altogether.

However, some children are soothed by this practice, especially when nursing ceases and they still crave that contact. Small changes can help to decrease your child's risk of getting cavities. Avoid putting any liquids containing sugar in the bottle at night. If your child is used to having milk or juice in his bottle, slowly begin diluting the liquid with water gradually until he is accepts the bottle with only water. Remember that after your baby falls asleep you should promptly remove the bottle and quickly clean his teeth. Discontinuing the bottle altogether will be the goal. However, know that when you make these changes, it makes a big difference in decreasing your baby's risk of getting ECC.


Don't

Do not allow your child to share utensils or cups with anyone, including yourself

Because most children are first introduced to cavity-causing bacteria by their mothers through vertical transmission, it's wise to avoid any saliva sharing practices. Common things such as "testing" milk from the nipple before giving the bottle to your baby, "cleaning" a pacifier that has dropped onto the floor, sharing a drink or kissing your baby on the lips should be avoided. In addition to vertical transmission, babies can also be infected with the harmful bacteria via horizontal transmission, by siblings or other children that come into contact with your baby. This was proven when studies on children with severe ECC confirmed the presence of foreign, non-maternal strains of SM in their mouths. You should always make sure your baby does not share any utensils or drinks with anyone and similarly avoid any behaviors which transfer saliva between people.

In addition to ECC, horizontal transmission can also spread other conditions which affect the mouth and oral cavity. One of the most common things is the Herpes Simplex Virus (HSV). In very young children and infants HSV can present as Primary Herpetic Gingivostomatitis, a self-resolving condition that can be quite painful and is often accompanied by fever, generalized sores/swollen gums, and the inability to eat or swallow comfortably. The take home message is to avoid all behaviors that would encourage the sharing of saliva between your baby and anyone else.

Do not delay brushing your baby's teeth until he gets his first tooth

It is beneficial to begin cleaning your child's mouth even before his teeth begin to come in. Begin by wiping his gums with a wet cloth frequently after feedings and before bed. Toothpaste is not necessary at this stage. The most common complaint that parents have is that it is a struggle to brush their child's teeth or that their baby hates brushing. Starting an early practice of cleaning your baby's mouth regularly establishes a daily routine that will pave the way for an easy transition to daily toothbrushing when he gets his teeth. Even more importantly, the frequent cleansing of your baby's mouth will decrease the load of cavity-causing bacteria in his mouth and thus decrease his risk for cavities and infection. Furthermore, the tongue harbors a great number of this bacteria, even in infants without teeth. Thus, it is important to begin to clean your infant's entire mouth and tongue long before the first tooth sprouts into his mouth.

Do not give your child too many sugary liquids and snacks

Cavity-causing diet behavior and food preference is often adopted long before your baby's first birthday and can continue into the rest of childhood. Avoid feeding practices that increase the risk for cavities. This includes continuous, at-will nighttime breastfeeding which should be discontinued by the time the first tooth erupts and other dietary carbohydrates are introduced. Breast milk itself has not been proven to cause cavities directly, but the practice of ad libitum nursing, combined with other dietary carbohydrates and sugars, has been associated with ECC.

Frequent daily and night-time bottle feeding or the use of no-spill training cups containing sweetened liquids, milk or juice is particularly damaging to your baby's growing teeth. This goes the same for snacks containing carbohydrates or sugar. The AAPD recommends that children above 6 months of age consume no more than 4-6 ounces of fruit juice per day and it is best given in a cup with a meal or snack. Keep in mind that even drinks that claim to be 100% juice or all-natural with no added sugars cause tooth decay. Water is generally the best liquid to give your child. If you are having trouble cutting down on juice and sweetened liquids, try to slowly dilute the drinks with water each day until the drinks are comprised of more water than juice or all water completely.

Do not give your baby a bottle past his first birthday

Encourage your baby to begin drinking from a cup as he approaches his first birthday. Your child should be completely weaned from the bottle well before he is 18 months old. The practice of drinking from a bottle causes the liquid inside the bottle to have lingering or prolonged contact with your baby's mouth. With the presence of teeth, the prolonged bathing of the teeth with sugar-containing drinks can cause generalized tooth decay.

For some children, discontinuing the bottle can be easy. However, if he persistently cries in protest, you can begin the process gradually by initially changing the liquid inside the bottle to water, or nothing at all. Sometimes children lose interest in the bottle at this point and can stop the bottle completely. If unsuccessful, you can continue to gradually decrease the frequency of the bottle and then replace it with a pacifier as a transition step. Keep in mind that the use of a pacifier should be a only a temporary stage and should eventually be stopped before the habit can harmfully affect your baby's dentoalveolar structures and growth.

Do not let bad habits begin

You should be aware of the habits children typically acquire during this period of infancy that can be particularly damaging to his oral structures and growth, especially if the habit continues past 3 or 4 years of age. These habits are generally comprised of non-nutritive sucking, which comes about as a way to satisfy the baby's initial need or desire to feed. Non-nutritive sucking habits can include sucking a finger or digit, a pacifier, or a play object such as a blanket or stuffed animal. Prolonged continuation of the habit will result in a reshaping of the teeth and oral structures and the severity of the damage is correlated to the intensity and duration of the habit. This can result in an open bite in your baby's front teeth, a crossbite, misalignment of the teeth and even can interfere with the growth of the bone resulting in a constricted palate and other growth disruptions. Once this happens, the change can be permanent. While you can treat a malocclusion with orthodontic treatment, it is still best to prevent it. So take away that pacifier early or encourage your child not to suck his thumb so that it doesn't develop into a poor habit.


Summary
Jumping cartoon

Your baby's teeth and dental health are very important in order for him to thrive and grow. There are many ways that you can start your baby on the right path to having a healthy mouth. Prevention is the most effective method which can begin very early in your baby's life, including the prenatal stage. Otherwise most of the practices can be implemented before your infant turns 18 months. Stay informed and proactive when it comes to caring for your baby's mouth and you can eliminate most problems for the future.


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Photo Credits: Happy Baby Wearing Big Sunglasses free creative commons by Flickr: Pink Sherbet Photography; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Megan Chin, DDSPediatric Dentist

Dr. Megan Chin completed her dental degree from New York University College of Dentistry where she received the American Academy of Orofacial Pain award as well as being inducted into the OKU National Dental Honors Society. She then moved to Cal...

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