When should my child see a dentist? And other FAQs

[awesomejc]

@cat7 Sure.
This relationship exists due to a couple of factors:

When babies are born, the do not have the bacteria that cause cavities (mainly strep. mutans) in their mouths. We get those bacteria from our environment, and mostly from those who interact with us. Anyone who comes in very close contact or shares saliva is capable of passing these bacteria. This happens by kissing the baby on the mouth, talking really close to the baby's mouth, sharing utensils/cups, washing of the pacifier in your mouth, etc. When it comes from siblings it is called horizontal transmission, when it comes from parents it is called vertical transmission. Since mothers are the primary caregivers in our society, the vertical transmission is mostly associated with them. When a mother (or caregiver, sibling, etc) has untreated cavities/decay, they have higher numbers of bacteria in their mouth, and more bacteria colonize in the baby's mouth.

Another factor is based on home oral hygiene habits. The studies show that mothers with good oral hygiene are more attentive to the oral hygiene of their children, and these good habits get passed on. The opposite is also true, and mothers with poor oral health fail to address the oral health of the kids. So children whose mothers have cavities are at much higher risk for cavities themselves.

Here is one publication that supports these claims. There are more.
http://www.nypediatricdds.com/Porta...l health status and that of their mothers.pdf

 

[neveragain1]

@katrina2017 Commenting so I can come back for the response!

 

[awesomejc]

@neveragain1 Got it? Let me know if you have any other questions.

 

[neveragain1]

@awesomejc Thank you. I have one question. Are we wiping the tops or are we trying to get between cheek and gums and back of gums?

 

[awesomejc]

@neveragain1 All around. This may help: How to Clean a Baby's Gums:

 

[neveragain1]

@awesomejc Thank you!

 

[debranch]

@awesomejc Thank you, thank you, thank you for this post! I now know that my daughter (31 months) has cavities on her front teeth, and you have motivated me to finally set her appt. (I only just recently found her a dentist, I just hadn't called them yet).

Looking back, I feel so stupid. We didn't know that we needed to start brushing her teeth until her pediatrician asked us about it. And even after that I didn't know that you can/should book a dentist appointment for 1 and 2 year olds. I hope we haven't done any permanent damage by waiting so long. We started brushing her teeth every day once we found out we needed to (which wasn't too long after she got her teeth) but she still got these cavities (I'm guessing it's because of what @fallior said and it's because she was breast fed to sleep until she was 2 and I never knew to wipe her teeth off afterwards).

I won't make the same mistakes with my younger daughter, and I'll be telling all of my friends this information. I truly didn't know a lot of this stuff, and it sucks that my daughter will now have to suffer through dental work and possible sedation/restraint (she can't even handle a simple exam by the pediatrician without freaking out, so I'm guessing that's what going to have to happen, and now I'm freaking out).

Anyway, thank you again for taking the time to type out your very informative post. The pictures really helped and you have successfully made me a little less ignorant today.

 

[awesomejc]

@debranch I'm glad it helped. And that your little one will be receiving treatment. Don't feel bad. Oral health information gets overlooked and is usually hard to come by unless you specifically search it out. You're on the right track now, and your daughter will be fine. Cavities can be filled, so don't worry about that. Teeth are just teeth. The important thing is to treat the decay and establish good home care habits are good so you can prevent future problems.

If you ever have any questions or concerns, feel free to PM me.

 

[fatherhood]

@awesomejc I waited until my son was 30 months to take him to the dentist and he has several cavities already! I believe it was caused by nursing him to sleep every night for two years. Even though we would brush his teeth the breastmilk was just sitting on his teeth all night.I'm a huge advocate for breastfeeding but nursing mothers should know to wipe off their babies teeth after nursing. The pediatric dentist also said he seems to be predisposed to cavities because he has many grooves in his teeth. So now we're left with a $1600 dental bill and I'm concerned about them sedating and restraining my toddler while they do the fillings.

 

[awesomejc]

@fatherhood Sedation is safe when practiced appropriately. And a note about the restraint: In most cases I don't use it. Most kids can be tolerate quick procedures, even the really little ones. Many times I will only use the slowspeed drill to remove decay as it is easier to tolerate, and skip the anesthetic for small cavities. But when the restraint is used, it truly is for the child's safety. We have some sharp instruments, and it just isn't safe to have them moving around too much or grabbing at things.

Im glad you're getting it taken care of. The kids deserve it.

 

[fatherhood]

@awesomejc Thank you I appreciate your input. Hopefully my son does well with the hydroxyzine and laughing gas that they dont need restraints. But I will do what's in his best interests. When I tell family that he is getting several fillings they say "don't the baby teeth just fall out anyway?" I know that a cavity in a baby tooth can turn into something more serious if left untreated. I will also have the dentist apply a sealant to the other teeth to prevent future problems. I can't wait to get it over with so we can have a fresh start.

 

[awesomejc]

@fatherhood Be brave
I've noticed that most kids do better than the parents expect.

 

[iamjezreel]

@awesomejc Thanks for posting. Very informative. A couple of questions:

1. We brush our 10 month-old's teeth every night. But after that, she breastfeeds and has a small bottle before going to sleep. She also wakes at night to breastfeed at least once. Should we start curtailing this habit now? Should we start wiping down her teeth after that bottle? She was slow to gain weight and we want to continue Breastfeeding for the foreseeable future. I've heard mixed things about whether Breastfeeding affects the teeth. She currently has about 6 (almost 7!) teeth in various stages of eruption.
2. Any opinions regarding the best baby toothpaste to use? We are using an oral b brand. She seems to like it and is pretty good (not great, but good) about brushing her teeth and letting us brush them.
3. If a child does need dental work, what are your opinions re: sedation? I had a bad experience having my wisdom teeth removed years ago (had a seizure while sedated and stopped breathing. The cause was never determined although at the ER, where I was taken via ambulance, the doc suspected I was given too high of a dose of something) so I'm pretty cautious about the use of any anesthesia without an anesthesiologist present. Is there certification or certain things parents should look for if sedation is suggested?

Thanks!

 

[kellyomara]

@iamjezreel Not OP but re: 1 - I think a quick wipedown of her teeth after the breastfeeding/bottles at night would be best. Breastmilk is quite sweet/sugary (moreso than cow's milk), and it can definitely affect the teeth. Just wiping her teeth down certainly won't cause any damage, and it will allow you to continue breastfeeding without disruption.

 

[awesomejc]

@iamjezreel

1. If you are concerned about weight gain and want to continue the night time feeding, at least wipe out the mouth after feedings. Spiffies may be a great option for you. They are sweetened with xylitol, which can not be metabolized by s. mutans and actually shows reduction of bacteria with consistent use. Breastmilk itself is not necessarily bad for teeth. With proper oral hygiene you should be able to continue to feed and keep the cavities at bay. This article is very good.
2. Start brushing 2x daily with a regular kids fluoride toothpaste. Really any of them will be fine. Just use a scrape of the toothpaste on the brush. This will give him the topical fluoride without allowing him to ingest it.
3. Personally, I'm not very comfortable with moderate sedation in the office without an anesthesiologist. In residency we do rotations in anesthesia and learn to intubate and start IVs, but it is hardly a habit that we practice. It seems to be more risk than it is worth. The clinic I am in does oral sedation with a drug called Midazolam (Versed). It is a mild sedation, and has been fairly effective while still being very safe.

But that is just me. Other providers may have much more experience with it, and may be much more comfortable with it. Just don't agree to anything YOU are not comfortable with. Make sure all your questions are answered and all your concerns are addressed before allowing any type of sedation or other treatment. Most kids can be treated without sedatives or GA.

As far as certification goes, sedation is still a bit of a mess. Up until THIS YEAR you didn't need any type of training or certification to use sedatives in Hawaii. Some states still don't. Each state has its own rules and regulations regarding sedation. THIS WEBSITE will let you know what the certification requirements are for your state.

 

[iamjezreel]

@awesomejc Thank you!! Seriously. This is really helpful. I will start wiping down her mouth tonight. Seriously, thank you for taking the time to post and respond.

 

[awesomejc]

@swilson1 You should start brushing at least once a day. You could use a tiny scrape of toothpaste, or even just wet the brush with water. Continue to wipe out the mouth after feedings.

 

[troubledneighbor]

@awesomejc My son is 16 months and our pediatrician said not to worry about going to the dentist yet. I brush his teeth twice a day but it's a massive struggle because he hates anyone coming near his mouth. If I took him to the dentist right now he would have to be sedated because there's no way the dentist could be in his mouth for more than a minute without his head and arms being strapped down. I don't know what to do.

 

[awesomejc]

@troubledneighbor At 16 mo I would do a knee lap exam. You would hold your son in your lap, and lay him down into mine. He will probably scream, but his mouth would be open and allow for the exam. Really a few minutes is all that would be needed to make an assessment.
This is the basic idea

We are trained to do this, and do it frequently. We won't be upset if your child is loud and crying. Don't let it keep you from at least having him checked out. Kids enamel is thinner, and cavities grow faster than in adult teeth. Your son is probably fine, but consider just having an exam anyway.

 

[troubledneighbor]

@awesomejc Thank you. Would it be an exam only or a cleaning type thing?