In a typical pediatric well visit, the time is often spent talking about such important issues as proper sleep habits, healthy eating and exercise habits, car seat and seat belt safety or the proper use of helmets. The time in the doctor’s office can go fast and, unfortunately, some topics may not always be adequately covered. One such topic that can get overlooked is a review of pediatric dental health. As the development of cavities is one of the most common chronic conditions of children, it is important that families understand and practice the recommendations for proper care of children’s teeth. The article below will review some of the more common questions regarding helping families care for their children’s teeth.

Why is this such an important issue?

Despite some decreases in the rates of caries (cavities) in school age children over the last three decades, cavities still remain one of the most common infections in children. Nearly 50% of children will have a cavity by the time they reach grade school ages.

Did you say that cavities are an infection?

Absolutely! Having bacteria in your mouth is normal. Despite this, there are types of bacteria that can attach themselves to the enamel that covers your teeth. If they are allowed to stay there, they grow until a colony forms. Your saliva has proteins that mix with the bacteria creating a film on the tooth. This film is called plaque and as it eats up sugar, it produces acid inside the plaque which can’t be easily washed away by your saliva. The acid dissolves the minerals that make your tooth enamel hard and tiny holes begin to appear in the teeth. After a while, these tiny holes in the enamel get bigger until one large hole appears. This is a cavity.

Are there ways to predict who is at risk of cavities?

We are all at risk of cavities if we practice poor dental health such as inadequate brushing and flossing and failing to get routine dental visits. Still, there are some risk factors that independently increase the risks of cavities that can be screen for at the pediatrician’s office. These include:

-mother/primary caregiver has active cavities

-parent is of low socioeconomic status

-child has at least three sugar-containing snacks or beverages/day

-child is put to bed with a bottle containing natural or added sugar (including milk)

-child has visible cavities or plaque on exam

What are the recommendations for tooth brushing for younger children?

At a minimum, parents should be encouraged to clean the child's teeth at least daily when the child is between 6 and 24 months of age, and twice a day thereafter. The teeth may be cleaned with a small soft toothbrush. In my practice, I encourage brushing at least twice a day starting at age one. I tell parents that I would have them focus on quantity (making sure that it is done twice a day) and not worry too much about quality (how well it’s done). As the child gets used to the routine, the quality will improve.

When should fluoride toothpaste be used?

We suggest that all children with teeth have their teeth brushed twice daily with small amounts of fluoride-containing toothpaste. The appropriate amount of toothpaste for infants and toddlers (younger than three years) is a “smear” – a very thin layer of toothpaste that covers less than half of the bristle surface of a child-size toothbrush. The amount of toothpaste can be increased to a “pea-sized” amount at age three years; older preschoolers can use slightly more than a “pea-sized” amount.

What do you do with a younger child who fights tooth brushing?

Give them as much choice as possible but do not give them the choice of brushing their teeth or not. Buy two toothbrushes and let them choose which one they want. That will be their choice, not whether or not they get the teeth brushed. Or let them choose whether they brush their teeth first or you brush first. Always make sure that a parent brushes the teeth until the child is old enough to do it well, which is typically around six years of age.


Any motivators for getting older kids to brush their teeth?

I have a favorite way that I use in my practice. Have the parents make a chart with 14 boxes for the mornings and 14 boxes for evenings for each child in the family. To get credit for brushing the teeth and get a check in the box, they should be witnessed brushing their teeth (a wet toothbrush or saying they did it is not enough). If they complete all boxes at the end of two weeks, the kids get to pick a movie from Redbox, parents are treating. If only one child in the family does not complete all boxes but other children did, the ones who completed all boxes get to pick the movie and the one who didn't is buying it for them. Finally, if no child completes all boxes, the parents are picking the movie and the kids are buying it for them. It can be a powerful motivator to brush your teeth if the cost is spending your money on your siblings.

By Dr. Matt Dougherty, Esse Health Pediatrician