Month 14 Worry: When and How Do I Take Care of My Child's Teeth?

My son had miraculously survived my novice parenting (thanks mainly to my wife) and made it to 14 months of age. I was chasing him around, keeping him up to date with immunizations, trying to expand his diet, and it dawned on me: I should be taking better care of his teeth, too!

What's the Issue?

Toddler cavities, or "caries," are a preventable and all-too-common health issue for kids before age 3. A toddler with caries typically requires multiple dental procedures to restore his teeth to normal health. These procedures often involve general anesthesia in a controlled surgical setting for maximal safety—not a desirable venue for your active and otherwise healthy little one! The good news is that most cavities for children in this age group are preventable.

Consider the Numbers

While family dentists treat 80 percent of all children, only 25 percent of 2-year-olds have had preventative dental care in the past year. (The probable culprit? Lack of health insurance coverage. More than nine million American children are currently without health insurance, and the number without dental insurance is significantly higher.)

The Surgeon General has identified tooth decay as the most common childhood disease. And while 90 percent of all tooth decay is preventable, tooth troubles in young children are common:

• 10 percent of all children below the age of 2 have at least one cavity.
• 25 percent of all children have had at least one cavity by their third birthday.
• 40 percent of all children have had at least one cavity by the time they reach kindergarten.

What Parents Can Do

When cavities start out, they look like a white chalky line. This white line is an early cavity: It is a luscious mixture of plaque, bacteria, and sugars which are planning an assault on the surface of the tooth. If left unhindered, this plaque starts to turn brown and then black. That is the point of no return—then you are looking at some major dental work. (I frequently see the chalky white line when I examine the mouths of children in their second year of life.) Being informed and taking preventative measures can kick-start your child's oral health:

• Understand that cavities are bacterial infections of the surface of the tooth. I ask my school-aged patients, "What would happen if you had a dirty cut on your leg and you never cleaned it out? What if you never took a bath and never washed off the germs?" "Eeew! It would get infected!" they answer. "Well, you can get infections of your teeth in the same way. What do you call an infection of your tooth?" After some thought they almost always come up with, "A cavity!" I explain that as important as it is to clean your skin regularly, it is also crucial to clean your teeth. And that's the basic concept behind brushing and flossing.
• Know what a cavity looks like. Most cavities in toddlers occur in one of three places:
  • in between teeth
  • on the chewing surface of the molars
  • at the gum-tooth border of the back of the front teeth (incisors)