Oral Health Problems in Children

Baby bottle tooth decay (also called early childhood caries, nursing caries, and nursing bottle syndrome) occurs when a baby's teeth are in frequent contact with sugars from liquid carbohydrates, such as fruit juices, milk, formula, fruit juice diluted with water, sugar water or any other sweet drink. Human breast milk can cause tooth decay as well. As these liquids break down in the mouth into simple sugars and are allowed to sit in the mouth, bacteria start feeding on the sugars, causing tooth decay.

If left untreated, decayed teeth can cause pain and make it difficult to chew and eat. Also, baby teeth serve as "space savers" for adult teeth. If baby teeth are damaged or destroyed, they can't help guide permanent teeth into their proper position, possibly resulting in crowded or crooked permanent teeth. Badly decayed baby teeth could lead to an abscessed tooth, with the possibility of infection spreading elsewhere.

Some tips to prevent baby bottle tooth decay include:

1. During the day, to calm or comfort your baby, don't give a bottle filled with sugary liquids or milk; instead, give plain water or substitute a pacifier.
2. At anytime, don't dip your baby's pacifier in sugar, honey, or any sugary liquid.
3. At bedtime, don't put your baby to bed with a bottle filled with sugary liquids (watered-down fruit juice or milk still increases the risk of decay). Give plain water.
4. Don't allow your baby to nurse continuously throughout the night while sleeping, since human breast milk can cause decay. Use a pacifier or give a bottle filled with plain water instead.
5. Don't add sugar to your child's food
6. Use a wet cloth or gauze to wipe your child's teeth and gums after each feeding. This helps remove any bacteria-forming plaque and excess sugar that have built up on the teeth and gums.
7. Ask your dentist about your baby's fluoride needs. If your drinking water is not fluoridated, fluoride supplements or fluoride treatments may be needed.
8. Teach your baby to drink from a cup by his or her first birthday. Moving to a "sippy cup" reduces the teeth's exposure to sugars; however, constant sipping from the cup can still result in decay unless it is filled with water.

Generally, it's normal and healthy for infants to suck their thumbs, fingers, pacifiers or toys. Object sucking gives children a sense of emotional security and comfort. However, if thumb sucking continues beyond the age of 5 -- when the permanent teeth begin to come in -- dental problems may occur. Depending on the frequency, intensity, and duration of the sucking, the teeth can be pushed out of alignment, causing them to protrude and create an overbite. The child may also have difficulty with the correct pronunciation of words. In addition, the upper and lower jaws can become misaligned and the roof of the mouth might become malformed.

First, remember that thumb sucking is normal and should not be a concern of parents unless the habit continues as the permanent teeth begin to emerge.

The child must make the decision on their own to stop sucking their thumb or fingers before the habit will cease. To help toward this goal, parents and family members can offer encouragement and positive reinforcement. Because thumb sucking is a security mechanism, negative reinforcement (such as scolding, nagging, or punishments) are generally ineffective -- making children defensive and driving them back to the habit. Instead, give praise or rewards for time successfully avoiding the habit. Gradually increase the time needed without sucking to achieve the reward. The younger the child, the more frequent the rewards will need to be given. For children who want to stop, cover the finger or thumb with a band-aid as a reminder. Take the thumb or finger out of the mouth after the child falls asleep.

To help older children break the habit, parents should try to determine why their child is doing it -- find out what stresses your child faces and try to correct the situation. Once the problem is gone, the child often finds it is easier to give up sucking. If this doesn't work, there are dental appliances a child can wear in the mouth to prevent sucking. These appliances are cemented to the upper teeth, sit on the roof of the mouth and make thumb sucking harder and therefore less pleasurable.

Tongue thrusting is the habit of sealing the mouth for swallowing by thrusting the top of the tongue forward against the lips.

Just like thumb sucking, tongue thrusting exerts pressure against the front teeth, pushing them out of alignment -- which causes them to protrude, creating an overbite and possibly interfering with proper speech development.

If you notice symptoms of tongue thrusting, consult a speech pathologist. This person can develop a treatment plan that helps your child to increase the strength of the chewing muscles and to develop a new swallowing pattern.

Lip sucking involves repeatedly holding the lower lip beneath the upper front teeth. Sucking of the lower lip may occur by itself or in combination with thumb sucking. This practice results in an overbite and the same kinds of problems as discussed with thumb sucking and tongue thrusting. Stopping the habit involves the same steps as described for stopping thumb sucking.

Premature loss of a child's primary teeth typically occurs due to tooth decay, injury, or lack of jaw space.

If teeth are lost before the permanent teeth emerge, the nearby teeth can tip or shift into the space now unoccupied. When a permanent tooth tries to emerge into its space, there may not be enough room. The new tooth may emerge tilted. Crooked or misaligned teeth can cause a range of problems from interfering with proper chewing to causing temporomandibular joint problems.

If your child loses a tooth prematurely, your dentist may recommend a space maintainer. A space maintainer is a plastic or metal device that holds open the space left by the missing tooth. Your dentist will remove the device once the permanent teeth begin to erupt.

Reviewed by the doctors at the Cleveland Clinic Department of Dentistry.

Reviewed by Jay H. Rosoff, DDS, on March 1, 2007.

Edited by Charlotte E. Grayson Mathis, MD, on May 1, 2005.

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