Don't Neglect Your Kids' Baby Teeth

Last Editorial Review: 1/31/2005

Though they only last a few years, baby teeth need just as much care and maintenance as adult teeth.

By Martin Downs
WebMD Feature

Reviewed By Brunilda Nazario

Even though baby teeth are temporary, dentists stress that they need to be taken care of as diligently as permanent teeth.

Cavities are still woefully common in today's children. According to a 2003 U.S. Surgeon General's report, tooth decay is the most common chronic childhood disease. It's five times more common than asthma and seven times more common than hay fever. The CDC reports that 17% of children aged 2-4 already have some tooth decay.

Losing a baby tooth or two prematurely, due to decay, may not seem like a big deal, but it is. "The baby teeth are meant to stay in for actually quite some time," says Kimberly A. Harms, DDS, a dentist in Farmington, Minn., and spokeswoman for the American Dental Association (ADA).

Baby teeth in the front of the mouth are the first to grow in and the first to come loose, around 6 or 7 years of age. "They're doing a lot of work for those years," Harms says.

What's more, she says, the back molars, which come in later, may not be replaced with adult teeth until age 12.

Baby teeth serve many critical functions. First and foremost, kids need them to chew. But many parents don't realize that the positions of baby teeth are also the blueprint for adult teeth.

"When the permanent teeth start to erupt, they are guided by the roots of the baby teeth," Harms says. If baby teeth are missing, the permanent teeth are likely to come in askew.

Tooth loss can be the ultimate consequence of tooth decay, but it's not necessarily the worst. Failing to take good care of your child's first teeth can lead to considerable expense for you and pain and anxiety for your child, if repeated drilling becomes necessary.

Fluoride, Yes

Fluoride is the keystone of dental care. This naturally occurring mineral was first added to the public water supply in the United States in 1945. Since then, the CDC reports, water fluoridation has led to an estimated 18%-40% decline in tooth decay overall.

According to the ADA, water fluoridation reduces decay of baby teeth by up to 60%. The American Dental Association recommends that children (over 2 years of age) and adults use a fluoride toothpaste displaying the ADA Seal of Acceptance, or talk with a child's dentist if considering the use of toothpaste before age 2. The ADA also recommends the use of fluoride mouth rinses, but not for children under 6 years because they may swallow the rinse.

The benefit is so great for children because when fluoride is taken internally, it is incorporated into teeth as they grow. Fluoride makes the enamel coating of teeth stronger and more resistant to decay.

Nevertheless, about one-third of the U.S. water supply still isn't fluoridated. If your community doesn't have fluoridated water -- for example, if you live on well water -- you should give your child fluoride supplements as directed by your dentist.

But there can be too much of a good thing. Exposure to excess amounts of fluoride from several sources can cause what's called fluorosis -- a discoloration of the teeth or mottled tooth enamel. Sometimes it manifests as brown spotting, and other times white capping on teeth, like snowcaps on mountains. Other than the cosmetic concern, there are no health effects from fluorosis.

After teeth have grown in, fluoride applied topically, as in toothpaste or fluoride treatments, does more good than fluoride in the water.

"Fluoride in the toothpaste can also help re-mineralize a damaged part of your tooth," says Michael J. Hanna, DDS, a spokesman for the American Academy of Pediatric Dentistry (AAPD).

Not all dentists agree, however, on whether fluoride toothpaste should be used on very young children.

Mary J. Hayes, DDS, a pediatric dentist in Chicago, who also spoke to WebMD on behalf of the ADA, says that fluoride toothpaste shouldn't be used on kids until they learn to spit. "A child will eat toothpaste," she says. "The child who is not spitting, you want them to get the infant dose, which is nothing."

Harms and Hanna say they think that a small amount of fluoride toothpaste is fine for young children. "If you use a little bit of toothpaste, it's not going to hurt," Hanna says. But use no more than a pea-sized dollop.

Brushing & Flossing

Before any teeth come in, a baby's mouth still needs to be cleaned regularly. "After every feeding, before the teeth come in, we suggest that you wipe the gum pads of any food debris," Hanna says.

To do this, use a wet piece of gauze or a clean, wet washcloth, he says. This gets the child accustomed to having a clean mouth, and it feels good, especially when the child is teething.

You should brush children's teeth for them until around age 6 or 7. "When the child is able to tie their shoe, then they're getting more into the age range of being able to manage their brush," Hayes says. Younger kids don't have the manual dexterity it takes to brush properly.

But once you start letting children handle the brush on their own, you still need to monitor their brushing, to make sure they're doing it, and doing it correctly. "When you can trust a child to really clean every surface of the teeth on their own, that's when you stop supervising," Harms says.

Flavor is important for encouraging a child to brush, she says. Choose any toothpaste that the child likes, as long as it has the seal indicating that it's approved by the ADA. That means it has been proved to do what it says it does -- namely, to prevent tooth decay.

Don't forget to floss the teeth, either. "If they're in contact with each other, you need to floss them," Hanna says.

The First Dental Visit

The AAPD tells parents to bring a child in for the first checkup six months after the first baby tooth comes in. That first tooth usually erupts around 6 months of age. But in case the first tooth comes in later, a visit is recommended no later than the first birthday.

The time it takes for baby teeth to come in can vary for each child by several months. "Don't panic if you don't see your first tooth by 6 months of age," Hanna says.

Hayes agrees. "There's a lot of inconsistency that still is within normal," she says.

Sometimes problems beneath the gums can cause a delay in the eruption of baby teeth. If the dentist suspects something is wrong, X-rays may be necessary.

Many people are wary of having X-rays shot into their own heads, let alone young children's, but the ADA and the AAPD insist that dental X-rays are safe, and the benefits of having them done, when necessary, far outweigh any risks.

"If you take away the dental X-ray, you're taking away one of our most important diagnostic tools," Harms says, adding, "The level of radiation is very, very minimal."

According to the ADA, the level of radiation received during a full-mouth series of dental X-rays (about 19 films) is 20 times less than the background radiation people are exposed to from natural sources every year, but slightly more than a chest X-ray.

Drinks & Diet

All the dentists WebMD spoke to agreed that one of the worst things you can do is to let your baby go to sleep with a bottle containing anything but plain water.

Allowing a baby to sleep with a bottle of juice, milk, or infant formula bathes the teeth for hours in carbohydrates and sugars, which bacteria in the mouth feed on. The bacteria break down carbs and sugars into an acid that eats away at the enamel, causing tooth decay.

Hanna says the same can be true of "sippy" cups, because children will slowly sip from them for hours at a time. He says you should only put water in sippy cups -- no juice or soda.

As for diet, Hayes says, "You want to make sure that they have good calcium intake." Calcium is essential for the development of strong teeth and bone.

Finally, Hanna says that when you give a child candy for a snack, avoid things like caramel, which don't rinse away from the teeth easily. "What you want to stay away from are sticky, gooey foods," he says.

Published Sept. 8, 2003.

SOURCES: Kimberly A. Harms, DDS, spokeswoman, American Dental Association (ADA). Mary J. Hayes, DDS, spokeswoman, ADA. Michael J. Hanna, DDS, spokesman, American Academy of Pediatric Dentistry. ADA. AAPD. CDC. Office of the Surgeon General, National Call to Action to Promote Oral Health, 2003.

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