Children Need Good Dental Hygiene Starting as Infants
Baby teeth may not be permanent, but dentists say they require just as much cleaning and care as adult teeth.
The reason: Neglecting them can cause your child pain and create lifetime consequences for his/her dental health.
And with October designated as National Dental Hygiene Month, dentists are reminding parents they need to pay close attention to their children's oral health.
About 20 percent of children already have tooth decay by age three, according to the American Dental Association.
Not only do these kids experience pain from cavities, they run the risk of having their permanent teeth come in incorrectly, said Katie L. Dawson, president of the American Dental Hygienists' Association, and a dental hygienist in Oakland, Calif.
"Baby teeth direct the permanent teeth that are developing underneath," Dawson says. Failure to keep them healthy can lead to expensive orthodontia work later in childhood.
"The child also suffers because of the pain in the tooth," she notes.
Even before the first tooth appears, parents should get their babies used to having their gums cleaned by running a wet washcloth around in their mouths. Or you can use a finger brush made of terry cloth or soft rubber, Dawson says.
"Bacteria sets up a haven in the mouth, and once those teeth start coming in it's hard to introduce cleaning to a baby," she explains. "It's almost like preparing the baby for cleaning."
Once a baby's first tooth erupts, parents need to pay even closer attention - a fact that comes as a surprise to some parents.
"A number of parents aren't aware that they need to take care of baby teeth," Dawson says.
One reason those baby teeth need lots of TLC is because they are more prone to cavities than adult teeth, says Dr. Jonathan D. Shenkin, a pediatric dentist in Bangor, Maine, and an assistant professor of pediatric dentistry at Boston University.
"When teeth erupt into a child's mouth, they're not completely hardened or mineralized," Dr. Shenkin says. "They can be more susceptible to decay."
Neglecting their care can leave your child vulnerable to cavities and fillings that last through much of childhood, he explains.
"A lot of these teeth need to stay in their child's mouth up until the age of 12," Dr. Shenkin says.
Parents should clean their infant's teeth with a child-sized toothbrush and a little water, according to the American Dental Association. A pea-sized amount of toothpaste can be used once the child is two years old and is able to spit out the paste and not swallow it.
Flossing should begin as soon as two of the child's teeth begin to touch.
Diet also can help preserve an infant's dental health, Dawson says.
"Don't allow your children to go to bed with a bottle containing any beverage other than water," she says. "Even milk, which has sugars. With those sugars, you've got this constant attack on the teeth."
Parents should also encourage their children to drink from a cup by their first birthday, as research has shown extended use of a baby bottle can increase a child's risk of tooth decay.
Children should be allowed to start using a toothbrush as soon as they have the manual dexterity to handle the job.
"As soon as they can hold a toothbrush in their hand, it's important to show them how to manipulate it in their mouth," Dr. Shenkin says.
However, parents should not confuse the ability to work the toothbrush with an ability to brush teeth properly, he adds. Parents should go in and brush after the child is done up to age six, and continue monitoring until age 10.
"It's important that the parent goes in after the child is finished and do a more thorough job," Dr. Shenkin advises.
Again, diet also plays a role in protecting the teeth of children as they grow older and begin getting their permanent teeth.
In a study published last year in the Journal of the American Dental Association, Dr. Shenkin reported that children who do not eat breakfast every day have higher levels of tooth decay, mainly because they tend to snack more. The same held true for children who do not eat five servings of fruits and vegetables a day.
Dentists say parents should limit the breads, pastas, and sugary snacks or drinks their children eat.
Dr. Shenkin recommends restricting children to 4 ounces to 6 ounces of juice a day.
"I'd prefer to have that consumed at a meal where water is also consumed," he says.
Finally, parents should take their children for their first trip to the dentist about six months after their first tooth erupts, Dr. Shenkin notes.
But even dentists have trouble following that guideline, adds Dr. Shenkin. "Most dentists want children to sit in their chairs as soon as they can be quiet," he says. "That's around four."
Always consult your child's physician for more information.
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American Academy of Family Physicians
American Academy of Pediatrics
American Dental Association
American Dental Hygienists' Association
CDC on Adolescent Health
Centers for Disease Control and Prevention (CDC)
Journal of the American Dental Association
National Children's Study
National Institute of Child Health and Human Development
National Institutes of Health (NIH)
New England Journal of Medicine
Nutrition.Gov
US Health and Human Services (HHS)
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Putting off surgery to have ear tubes inserted in children who have persistent fluid build-up in their ears will not slow their development, according to a study reported in the New England Journal of Medicine.
For years, there has been concern that children with fluid in their ears might show delays in speech or language development, or could be perceived as having behavior problems because the fluid in their ears causes slight hearing loss.
Because of this concern, past guidelines recommended the insertion of ear tubes sooner rather than later.
However, the study found that delaying the insertion of tubes did not affect youngsters' developmental outcomes.
"If I had any words of advice for parents with children with this condition, it would be, 'Don't just do something, sit there,'" says Dr. Jack Paradise, a professor of pediatrics and otolaryngology at the Pittsburgh School of Medicine and Children's Hospital of Pittsburgh.
"If all your child has wrong is middle ear fluid, and they have no discomfort and aren't ill, and they're acting perfectly normal, it's OK to have a watch-and-wait attitude," he says, adding that parents should still "have their [child's] ears checked every few months, and have their hearing checked, too."
About 16 million children visit their physicians annually for fluid in their ears, according to the American Academy of Pediatrics. Besides causing some hearing loss, the fluid can also act as a breeding ground for bacteria, and can cause repeated ear infections.
The surgical insertion of ear tubes helps fluid drain from the ear, reducing the amount of fluid and the incidence of infection.
According to Dr. Paradise, because the fluid can reduce the transmission of sound from the ear to the brain, and because that disruption occurs at such a formative time in a child's life, it was previously believed that children would be left with a "developmental scar" or some type of irreversible loss in development if the condition was left untreated.
But, he says, while there were many studies that showed an association between fluid in the ear and developmental problems, no study was able to prove a cause-and-effect relationship.
Hoping to clarify this relationship, Dr. Paradise and his colleagues recruited more than 6,000 infants during their first two months of life. The children were from eight different locations in Pittsburgh and surrounding suburban and rural communities.
By the age of three, 429 otherwise healthy children had persistent fluid in their ears for at least three or four months.
These children were randomized into two treatment groups - one early and one delayed. The early treatment group included 216 children who received ear tubes as soon as possible when indicated, while the remaining 213 were assigned to the delayed treatment group.
If fluid persisted in the delayed treatment group for more than six months in both ears, children were given ear tubes. If fluid was only in one ear, youngsters in the delayed group received ear tubes after nine months.
By the age of six, 85 percent in the early-treatment group had received ear tubes vs. 41 percent for the delayed-treatment group.
The researchers also compared the treated children to children with no ear problems.
At three, four, and six years old, all of the children were given a battery of developmental tests to measure their speech, language, and reading skills, as well as tests to measure their behavior and emotions.
The researchers found no statistically significant differences in development between the groups.
"We concluded that it's highly unlikely that middle ear disease had any impact on children's later development," says Dr. Paradise. "Children are pretty resilient, and it's not as though there's no hearing. They might be turning up the TV or parents might have to speak louder, but these children aren't deaf. When their hearing gets better, they make up for the temporary loss."
"Even if there's a temporary delay because of effusion [fluid in the ear], at that age, the developing brain is so attuned to speech and language development that most kids catch up," says Dr. John Maddalozzo, an attending physician at Children's Memorial Hospital and an associate professor of otolaryngology and head and neck surgery at the Feinberg School of Medicine in Chicago.
Always consult your child's physician for more information.
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