The Fight Against Cavities: How to Care for Toddlers' Teeth

When Lisa Kiell of New York City took her 5-year- old son, Jake, to the dentist for a checkup, she was shocked. X-rays revealed that he had five cavities, including three in his molars that were so severe they couldn't simply be filled. The kindergartner would need considerable work, including treatments sometimes referred to as "baby root canals."

To avoid this extensive dental work -- requiring three appointments -- Kiell had asked about having the three molars pulled, since they'd be falling out anyway when his permanent teeth came in. But since primary molars last until a child is 12 or older, and losing baby teeth early can cause the permanent teeth to come in crooked, the dentist felt it was better to save all the baby teeth.

Although Jake received laughing gas and a shot of Novocain, the little guy was so freaked out that he cried almost the entire time he was in the dentist's chair. The next appointment was even harder for Jake and the third one, when he needed a restraining jacket, was the worst.

This story may sound like an extreme example, but dentists are seeing more and more children like Jake. The Centers for Disease Control and Prevention reports that cavities in young children have been on the rise, and that one in seven 3- to 5-year-olds have untreated tooth decay. Early tooth decay is now the most common childhood disease -- five times more common than asthma. (It's considered a disease because cavities are caused by bacteria that use sugar in a child's diet to produce acids that destroy the teeth.) Even if a cavity isn't painful, decay in baby teeth greatly increases the risk of cavities in permanent teeth. "When permanent teeth come into an environment where the baby teeth have already decayed, the same bacteria will attack the new teeth," says Parents advisor Burton Edelstein, D.D.S., M.P.H., professor of dentistry and health policy at Columbia University and founding director of the Children's Dental Health Project.

Causes of Cavities
Rates are rising in part because of what, and how often, kids are eating, say experts. They're consuming more processed carbohydrates like pretzels and crackers, as well as more sweets, juice, and soda, than in the past. (Kiell was told that Jake's fondness for gummy candies had contributed to his severe cavities.) The bacteria that feed on sugar erode the structure of teeth by depleting calcium. Once an area without calcium becomes big enough, the surface of the tooth collapses and your child has a cavity.

Many parents are surprised to learn that kids need help brushing their teeth until at least age 6. Young children simply don't have the manual dexterity to do the job well. "They tend to brush the same teeth in the front over and over again, but don't get to the back teeth or the inside surfaces," says Paul Casamassimo, D.D.S., chief of dentistry at Nationwide Children's Hospital, in Columbus, Ohio. That was the case with Jake. He'd insisted on brushing his own teeth at age 4, says his mom, who's now taken over the task.

Another reason for the cavity surge may be a lack of fluoride, as more families rely on non-fluoridated bottled water, and fluoridation of public drinking water has been discontinued in some communities. Fluoride strengthens tooth enamel, making it resistant to the acid produced by bacteria. In the last four years, at least 15 municipalities across the country have halted the practice due to tight budgets and skepticism about its benefits.

With cavities on the rise and healthy baby teeth so important, it's up to you to be proactive about checkups and early oral care. We've gone straight to the experts to get the latest advice and smart strategies for preventing baby dental problems.

How to Care for Toddlers' Teeth

According to the Centers for Disease Control and Prevention, cavities affect 11 percent of 2-year-olds, 21 percent of 3-year-olds, and 44 percent of 5-year- olds. Taking steps to prevent cavities while your child is a toddler could make a big difference. Start by limiting how often you serve high-carbohydrate snacks such as crackers, pretzels, and cereal, which break down into sugars.

Juice is another culprit. "Every time a child drinks juice, it makes his mouth more susceptible to cavities," says Lezli Levene Harvell, D.M.D., a board- certified pediatric dentist in Newark, New Jersey. "Many parents who don't allow candy are shocked that their child has cavities -- but it turns out he drinks juice all day long."

And often that juice is in a sippy cup. "Some kids have almost 24/7 access to juice because they're walking around with a sippy or sitting in a stroller with one right in front of them," Dr. Harvell notes. While juice is certainly healthier than soda, it still bathes your little one's teeth in sugar. The AAPD recommends no more than 6 ounces of juice daily, and Dr. Harvell recommends giving up the sippy cup by 12 months.

Be sure to brush your toddler's teeth at least twice a day. Instead of doing it at the sink, it's more effective to lean his head on your lap and place the brush at a 45-degree angle to the gum line. Pay attention to the inside surfaces. Try to make it fun; for her own daughters, ages 2 and 4, Dr. Harvell sings "Brush, brush, brush your teeth; brush them every day" to the tune of "Row, Row, Row Your Boat." Or create a song about something your child loves, such as his teddy bear, and only use that special song at tooth- brushing time. You can also tell him to roar like a dinosaur, which will make him open his mouth wide.

If your toddler has reached the "I want to do it myself " stage, let him watch you brush and mimic you. Finish the job after he takes his turn. By the time he's 2 or 3, all 20 baby teeth should be in place. At this point, you can increase the thin smear of fluoride toothpaste to a pea-size amount.

To avoid preventable orthodontic bills down the road, think about pitching the pacifier. If your child sucks too strongly or frequently, over time the pressure can cause his front teeth to point outward. Dr. Shenkin suggests giving the Binky the boot by age 2. If that's not happening, at least have your child use one that's labeled orthodontically correct. This type may not harm the teeth as much.

Is Your Child Scared of the Dentist?

As many as 20 percent of children have some fear about going to the dentist, says John E. Nathan, D.D.S., adjunct professor of pediatric dentistry at the University of Alabama, Birmingham, and an expert on dental anxiety in kids. Help things go smoothly with his tips:

Figure out the problem. Understanding the origins of your child's dental fears will give you a way to find effective strategies for helping him develop coping skills.

Choose the right dentist. Ask your child's doc for a referral or find one at aapd.org. You're looking for someone who can recognize and allay dental fears, a person you find easy to communicate with and who has a gentle manner with kids.

Talk to the dentist before the appointment. Prep him about your child's temperament, and find out what you can expect. Ask things like, "How do you work?", "Will I be allowed in the exam room?", "How do you handle uncooperative behavior?"

Control yourself. Kids can quickly pick up on a parent's anxiety, so if you're nervous about how your child will react, do your best to conceal it. And avoid statements like "it won't hurt too much" and bringing up shots or the idea of pain.

Use a step-by-step approach. If your dentist is willing, make the first visit a "look-see," the second for the exam, and then a third for any procedure. It requires more time and money, but this approach can help.

Don't give up. Toddlers and preschoolers tend to outgrow their apprehensions by school age. And research shows that kids who go to the dentist for regular checkups (even those who have meltdowns at first) are less likely to have anxiety than kids who don't go as often.

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