A. The health of your child's teeth is largely dependent on four things: diet, oral hygiene, tooth makeup, and the amount and quality of her saliva (which helps rinse away food and bacteria). Since saliva and the strength of her teeth are based mainly on genes-and out of your control -- focus on what you can influence: eating and cleaning.
The kind of food in your child's diet -- and how frequently she eats it -- matters. When sugar and starch meet up with normal bacteria in the mouth, they can create acids that dissolve the tooth's structure and cause cavities. The more a child eats sugar and starches (processed snacks are the worst offenders), the more often her teeth are exposed to the acids. Eating regular healthy meals, rather than lots of small portions throughout the day, and drinking water (the fluoridated kind, for kids older than 1), will help prevent acids from settling on the teeth and stave off tooth decay. While a no-snack rule is unrealistic, offer more fruits and vegetables, as opposed to processed treats.
Just as crucial: Kids should brush at least twice a day and, ideally, after snacking, too. Keep in mind that the most important time to brush is before a nap or bedtime because saliva production slows during sleep (it's linked to blood pressure and heart rate), giving acids far more opportunity to damage teeth.
Q. At what age should I start taking my child to the dentist -- and how often should he go?
A. Babies should see the dentist within six months of their first tooth's appearance (usually around 6 months of age), and no later than 1. Stick to that time frame and your child may need fewer fillings than kids who wait until age 2 or 3, says a recent study. At the visit, as long as there are no major problems, the dentist will typically count and inspect your child's teeth (or tooth!), start to get him used to the office and staff, and talk with you about preventive care. The main goal is that a child have a happy and comfortable experience, says Beverly Mittelman, coauthor, along with dentist Jerome Mittelman, of Healthy Teeth for Kids. The rule of thumb is to bring your child back every six months or so for a routine cleaning and checkup.
Q. Are electric toothbrushes a good idea for kids?
A. They can be helpful for children who aren't yet coordinated enough to brush thoroughly with a manual toothbrush (kids under 4 sometimes aren't). They also often come with a two-minute timer that lets your child know when she can stop brushing. If you choose an electric model, make sure your child doesn't apply too much pressure when she's using it. If she does, the head of the toothbrush may not rotate and won't be as effective. No matter which kind of brush you pick, be sure that she's getting to those hard-to-reach places in the back of her mouth; this might require a little extra help from you until she's 5 or 6 years old.
Q. Should my child get dental sealants to prevent cavities?
A. They're no substitute for good oral hygiene. But sealants -- thin plastic barriers that are painted onto the chewing surface of the back teeth -- can help fend off decay if your child has deep grooves in his molars. Bacteria, plaque, and food particles can get into those grooves and are difficult to remove with a toothbrush. Though some research supports using sealants as a routine part of dental care for babies, baby teeth are less likely to be heavily grooved, and many insurance companies will only pay for sealants on adult teeth. If some (or all) of your child's permanent teeth are in, talk to your dentist about whether he recommends sealants. There's no drilling or anesthetic required, they won't show when your child talks or smiles, and they aren't painful -- though he may be able to feel them with his tongue at first. Prices vary; if you have dental insurance, check to see if sealants are covered.
Q. I see a lot of natural toothpastes in the store these days that don't contain fluoride. Are they okay for kids to use?
A. While fluoride protects enamel, non-fluoridated toothpastes are best for kids who can't yet spit. Why? Swallowing fluoride and getting too much of it can lead to fluorosis, which causes stains on the enamel of permanent teeth. (What's most important, whichever toothpaste you choose, is the action of brushing teeth, which does most of the cleaning.) When your child's old enough to spit, talk to your dentist; she may be getting plenty of fluoride through tap water, fluoride treatments, and food. Also note: Infants under 1 do not need fluoride and are particularly vulnerable to fluorosis. The American Dental Association (ADA) recommends that you use water that has no fluoride, or only a low level of it, for formula that needs to be reconstituted. Best bets are purified, deionized, demineralized, distilled, or reverse osmosis filtered water.
More dental Q&A
Q. Is it true that chewing xylitol gum can help reduce the risk of tooth decay?
A. Yes. The physical motion of chewing produces more saliva, which helps neutralize pH balance to prevent cavities. And studies have shown that xylitol, a natural sweetener that tastes like sugar, may suppress the growth of bacteria in the mouth.
For kids under 4, any type of gum is a choking hazard. But babies and toddlers can still reap the benefits of xylitol: If Mom chews it during her pregnancy and up to two years postpartum, her child's less likely to develop tooth decay down the road (the bacteria that cause it are often passed from mother to baby through kissing or sharing food).
Q. My toddler grinds his teeth. Should I be concerned?
A. Tooth grinding (bruxism) happens occasionally in young kids. As your child's mouth grows and changes, he may grind his teeth in order to comfortably align them with his jaw. While it can damage the enamel on baby teeth, they usually fall out before it becomes a problem. And experts say it's uncommon for grinding to do serious harm to permanent teeth because the habit usually goes away on its own by age 6. If you're still worried, or your child hasn't outgrown it by then, talk to your dentist. She may suggest a mouth guard to wear at night, or she may refer you to a myofunctional therapist, who can work with him to balance the muscles in the mouth and get at the cause of the grinding.
Q. Do I really need to wipe my baby's gums with gauze before his teeth come in?
A. It's a good idea. It will help your baby get used to the feeling of brushing, and sometimes there's a small opening in the gum before the tooth erupts -- a perfect hiding place for bacteria, which the gauze will wipe away. Payman Pirnazar, a pediatric dentist in Los Angeles and the founder of BabyTeeth.com, recommends that you start wiping your baby's gums after each feeding at around 6 months (it takes just a few seconds). Dentists say it may even have the added benefit of making teething more comfortable for your baby, since as you're cleaning you're also massaging the gums.
Q. What are the best kinds of fillings for children -- and are there any new, less painful ways to drill for them?
A. Often it comes down to aesthetics. "If you have a child walking around with metal crowns, it's not uncommon for other kids to start teasing him," says Dr. Pirnazar.
And then there are practical issues: Filling a cavity with composite (a tooth-colored material made of quartz and resin) may take up to 40 minutes -- as opposed to about ten minutes for an amalgam (metal) filling -- which is a challenge when the patient is a wiggly kid. On the other hand, composite restorations don't require the dentist to drill as much. And while the ADA maintains that the mercury content in metal fillings is safe, this has been debated, and some parents prefer to skip them.
Laser surgery is the newest way to drill and is said to be less painful, though it's not yet widely available. Because the equipment is expensive, if your dentist offers laser drilling, ask whether there's an extra fee for it.
Q. How is a pediatric dentist different from a family-practice dentist?
A. Pediatric dentists receive additional training in caring for children's oral health. And they tend to make their offices child-friendly by offering videos, special chairs, or music. The caveat: Since pediatric dentistry is a specialty, there may be fewer practitioners to pick from in your area. Ultimately, though, sizing up any prospective dentist comes down to this: How does she relate to your children? Is she competent? Does she listen to your concerns? The answers to these questions are more important than her title.
Meagan Francis is the author of The Everything Health Guide to Postpartum Care and the mom of four boys, ages 9, 7, 3, and 1, who work hard to give the tooth fairy shiny teeth.