Age One Dental Visit: Why It’s Important For Your Baby
When parents or caregivers mistakenly say, “They are only baby teeth, they are going to fall out anyway” they have the wrong impression. The Age One Dental Visit sets the tone for lifelong dental health. The fact is, primary teeth serve as the guides for the permanent teeth and are critically important to the health and function of their adult successors. What’s more, primary teeth are the child’s teeth for most of childhood — children don’t usually begin losing them until about age six, and the last primary teeth aren’t lost until around age twelve. It’s just as important to care for them as for the permanent teeth that come later.
An Ounce of Prevention
What really is prevention anyway? Prevention in the truest sense of the word means stopping an anticipated problem before it even starts. The importance of primary teeth and preparing for a lifetime of good oral health are the main reasons why parents should bring their children to see a dentist or pediatric dentist (children’s specialist), preferably before their first birthday. It’s more than just a casual visit: even a one-year old needs a comprehensive examination and even some preventive applications. Parents will benefit from the guidance of “Family Oral Health Education” including: risk assessment for decay; training (hands on) in teeth cleaning; nutritional counseling and use of cups for drinking; fluoride recommendations based on individual needs and important follow-up appointments for monitoring based on the level of risk determined by your dentist.
The Age One Visit may also reveal underlying conditions that may indicate future problems, and determine how often follow-up visits might be needed. Children with low risk for oral or dental disease might only be seen annually or semi-annually until the primary (baby) teeth are all fully erupted in the mouth and in occlusion (biting function). Children assessed at high risk might be seen as often as every two to three months.
Diagnosing and Treating Tooth Decay
One of the prime purposes for an Age One Visit is to examine the child for a number of forms of tooth decay that can affect babies and small children. For many years, health and childcare professionals have recognized a specific pattern of such decay, known as Baby Bottle Tooth Decay (BBTD). BBTD was believed to be primarily associated with the use of a sleep-time bottle that contains a liquid with natural or added sugars such as formula, juice or Kool-Aid. It generally occurs between the ages of twelve to eighteen months.
In recent years, similar cases of early and severe tooth decay have been found in children who do not fit the classic BBTD pattern of bottle use. The term Early Childhood Caries (ECC) is now being used to reflect a broader concept of the problem of tooth decay in infants and young children. ECC includes cavities associated with many causative factors, mostly sugars. These include continuous use of a “Sippy-cup,” at-will breast-feeding throughout the night, use of a sweetened pacifier or the regular use of sugar-based oral medicine to treat chronic illness.
ECC develops rapidly — the progression from the hard, outer enamel layer of the tooth into the softer, inner dentin can occur in six months or less. It first affects the upper front baby teeth, which usually erupt at around eight months of age, followed by the primary molars (back teeth), which begin to erupt at about twelve months of age. At its most severe stage, ECC may then affect the lower front teeth.
The extent and severity of ECC can vary depending on culture, the child’s genetic makeup and socio-economic factors. On the other hand, ECC is really much like any other type of tooth decay, dependent on the presence of three conditions: specific bacteria in dental plaque on the teeth, unprotected teeth and the right mix of carbohydrates from food and drinks, such as natural or refined sugars.
“Here We Go Round and Round” — Breaking the Cycle of Decay
These conditions form a cycle of events, even in babies, that slowly unravel oral health: decay causing bacteria interact with the carbohydrates (sugars) to produce acid; the acid in continual contact with the teeth slowly demineralizes (dissolves) the tooth enamel; as demineralization continues, cavities form.
Because all three of these conditions must be present for a cavity to form, there are at least three opportunities for intervention: (1) eliminate or reduce the bacteria through oral hygiene; (2) reduce the presence and frequency of carbohydrates by dietary changes; and/or (3) make the tooth more resistant through the use of fluoride.
Until a child is about seven years old, an adult needs to brush the child’s teeth for them.
Age One Visits provide insight into these three opportunities for both the child and parents. For example, Age One Visits can help parents or caregivers learn the proper techniques for cleaning their children’s teeth. Until a child is about seven years old, an adult needs to brush the child’s teeth for them. Parents can allow the child to brush his or her own teeth, but at least once a day, preferably at bedtime, an adult should carefully and thoroughly brush the child’s teeth.
The child’s dentist can demonstrate the proper way to clean a child’s teeth, a procedure that usually takes less than two minutes with a very small child’s toothbrush or by simply wiping the teeth off with a wet cloth.
Dental professionals can also provide important information on the types of food and their frequency that promote a child’s oral health. At first glance, many foods like cereals, granola bars, and similar snacks may seem healthy and good for a child to have throughout the day. They aren’t — and neither are foods like raisins or fruit juices, even though they contain natural sugars and are full of vitamins and minerals. Carbohydrates in cereals, crackers, and granola bars will stick to the teeth where bacteria can easily interact with them over extended periods of time. And, regardless of whether the food contains processed or naturally-occurring sugars, bacteria metabolize both and form acid. Parents are advised to avoid giving their children sugary foods, especially in high frequency, that have any form of sugar listed as the first or second ingredient.
It’s not just baby drool; frequent snacking also inhibits one of the mouth’s most important cavity-fighters — saliva. Saliva neutralizes acid and supplies calcium and fluoride to protect and even reverse early decay. But it takes time — about two hours to neutralize the effects of acid. So, a snack every hour — which promotes the continual presence of acid in the mouth — won’t give saliva the opportunity to work effectively.
Breast Feeding, Baby Bottles and Other Practices
Generally, breast-feeding is highly recommended for babies and doesn’t necessarily inhibit good oral health in young children. Breast milk by itself does not promote tooth decay any more than other forms of fermentable carbohydrates. On the other hand, once a child begins to consume foods or liquids in addition to breast milk, the combination of breast milk and other sugar-rich foods may potentially put the child at risk of developing ECC. Babies should be removed from the breast when they are finished feeding and children should not be allowed to nurse at will throughout the night.
Baby bottles are frequently used by parents or caregivers to modify the child’s behavior by giving it during sleep time to stop fussing or crying. Other methods of improper bottle-feeding include propping the bottle or round-the-clock feeding. All these practices promote the constant production of acid in the mouth, so the use of baby bottles should be limited to meal-times.
Pacifiers dipped throughout the day in a variety of different sweeteners, including jam, corn syrup or sugar, results in frequent exposure of the teeth to fermentable carbohydrates and promote higher acid levels in the mouth.
Children with chronic illnesses or special health care needs may also be at increased risk of ECC if their medication contains sugar. Also, certain medications such as antihistamines may cause decreased saliva production causing mouth dryness and diminishing the protective effects of saliva. Daily oral hygiene care for these children is critically important.
Every time bacteria are exposed to sugars, either refined or “natural,” they produce acid — so the more frequently a child eats sugar, the more frequently the teeth are exposed to acid. Frequent sugar exposures equals frequent acid exposures. Parents can therefore reduce the chances of their child developing cavities by limiting the frequency and amount of sugar their child consumes and not snacking on sugary products especially between meals.
What About Fluoride?
Finally, while oral hygiene and dietary changes require behavioral change on the part of the child’s family, fluoride does not. Optimal water fluoridation requires no effort at all on the part of the family. Fluoride supplements might aid in the process of enamel formation, however, because fluoride works best when the teeth have fully formed and have erupted in the mouth. Treatments can be applied to the child’s teeth at your dentist’s or pediatric dentist’s office and are important and quite routine.
The benefits of prenatal fluoride supplements remain poorly studied. There are many unanswered questions and it is somewhat controversial. Therefore, indications for prenatal fluoride supplementation have not been established. More research is needed to determine the advantages, if any, and the dosage levels for prenatal fluoride supplements.
Opportunity for Promoting the Entire Family’s Health
A child’s oral health is closely related to the family’s overall dental health and hygiene practices. The Age One Visit can educate parents or caregivers on the importance of their own good oral hygiene.
Children are not born with high levels of cavity-causing bacteria in their mouths. They acquire the bacteria from their caregiver, usually their mother, through close contact. These bacteria are transmitted through kissing, sharing eating utensils like a spoon or a glass, sharing food, or cleaning off a pacifier by mouth. The period when a child is most susceptible to acquiring the decay-causing bacteria is quite short, beginning as early as six months of age and continuing through approximately thirty-one months.
There is mounting evidence that a child’s oral health is closely tied to his or her mother’s. This is why it is important that caregivers of young children promote their own oral health through regular dental visits and proper hygiene habits. The Age One Visit is a good reminder — and a learning opportunity — for proper hygiene and care.
Diagnosis, prevention, education and treatment — the Age One Visit can cover a lot of ground for your baby’s first visit to the dentist. Most importantly, the immediate diagnosis and treatment of emerging dental problems, as well as the long-term attention to good oral hygiene, can help build a foundation of good dental health for your child — and your entire family — that will last a lifetime.
Review Date: 2/1/2009
Authored By: Dr. Joel H. Berg
Reviewed By: Dr. Garry A. Rayant, Editor-in-Chief, Dear Doctor, Inc.
This content provided is for general informational purposes only. No action should be taken by you based on this content. We urge you to consult with your dental health professional on all matters relating to you and your family’s dental health. Copyright ® 2011 Dear Doctor, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.