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.