Health NW: Old and new recommendations for children's dental health

<center>Kathryn B. Brown, FNP</center>

I was about 7 years old when something happened that convinced me my parents were right about taking good care of my teeth. One rainy day in Astoria, my great-uncle Bud was in a playful mood. To amuse me, my sister and our cousins, he popped out his partial dentures and chased us around the house. His teeth had to be pulled because he didn't brush them enough when he was a kid, he said. That was enough to make me a poster child for dental health.

I was fortunate that our dentist specialized in children and did his best to make his office kid-friendly. I have fond memories of the cool aquarium and Highlights magazines in his waiting room. At the end of each appointment, we got to choose a gift from a treasure chest full of a dazzling array of small toys and costume jewelry.

Children need a lot of help and encouragement to take care of their teeth. It's hard to convince them that brushing their teeth and visiting the dentist are important. Parents can set a good example by brushing and flossing daily and going to the dentist twice a year.

The American Dental Association (ADA) recommends that parents start brushing their baby's teeth as soon as the first tooth appears. Before teeth erupt, the gums should be cleaned with a cloth or gauze pad after each feeding. Schedule a dental visit by the child's first birthday.

Tooth decay can start as soon as teeth erupt. If sugars and starches from food and drinks are left on the teeth, bacteria in the mouth thrive. Plaque is formed, which produces acids, which destroy the tooth enamel. When the enamel surface of the tooth is destroyed, a cavity is created.

Most of the ADA's recommendations for children's dental health haven't changed since I was a kid.

• Brush twice a day with a soft, child-sized toothbrush.

• Brush with fluoride toothpaste starting at age 2; before age 2, just use water unless your dentist recommends toothpaste.

• Children 6 and under should use just a pea-sized amount of toothpaste, and should be taught to spit it out, not swallow it.

• Floss between teeth daily, wherever two teeth touch.

• Don't give infants and children sugar water or soft drinks.

• Don't let children fall asleep with a bottle of milk, formula or juice.

The ADA also offers some tips on making dental visits more enjoyable for you and your child:

• Schedule appointments for a time when your child is rested; avoid nap and meal times.

• Don't let others tell your child scary stories about dental visits.

• Don't let your child know if you feel anxious about going to the dentist.

• Never use a dental appointment as a punishment or threat.

• Don't bribe your child to go to the appointment.

• Try to make dental visits a pleasant outing.

Something new is the recognition that cavities in children can be considered an infectious disease - that is, a disease caused by bacteria in the mouth that can be transmitted from adult caregivers to children.

Adults should avoid sharing utensils with children and should not put pacifiers in their mouths to clean them off before giving them to a child. Besides transmitting dental bacteria that can cause cavities, these practices can transmit other infections such as colds, the flu and strep throat.

Next week's column will be about fluoride and the debate over the safety of adding fluoride to our water.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to

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