Part I: Dental Health from Toddlers to Teens
What you need to know from a local Tulsa dentist.
Caring for children’s teeth is critical to overall health, but often parents assume that regular brushing and flossing will take care of preventing tooth decay in young children, and other dental issues can be wait until they’re older. Wrong. Tooth decay, or dental caries, is actually a disease caused by certain germs and can spread within families. Did you know that if you feed your child from your spoon, you may be passing on cavity-causing bacteria from your mouth to your child’s? We asked Dr. Ryan Roberts, a board certified pediatric dentist in Tulsa, to talk about oral health and to answer some common questions that parents have regarding their children’s teeth and mouths.
TK: When should a child’s first dental visit be? And why is this the optimum age?
Dr. Ryan: According to the American Academy of Pediatric Dentistry, the first tooth or the first birthday is the best time to bring your child to the dentist for the first visit. Usually the first tooth will come before the first birthday but not all the time. Every child is different.
The purpose of the first visit is to establish what is called a dental home, and a dental home serves to educate parents on how to properly care for and maintain a healthy mouth. On the first visit we mainly discuss ways to prevent cavities and disease, and the exam itself is pretty short and simple. However it’s an important time to build a relationship and get your child comfortable going to the dentist.
I have seen cavities in children as young as one year old. And I have taken many children to the operating room for general anesthesia for the treatment of extensive cavities as young as one or two years old. By extensive cavities, I mean decay on every tooth that’s in the mouth that’s causing pain and discomfort and will ultimately result in infection for the child.
TK: How often should kids be taken to a dentist?
Dr. Ryan: It’s important at the first visit that we assess the child’s risk of decay or disease, and most often the most appropriate time is twice yearly at that point. If mom or dad has suffered from a lot of tooth problems or tooth decay, then the child is at a high risk for those same problems. So we may see those children back at the dentist every three months or up to four times a year, applying fluoride as needed to help reduce the risk of decay for these young children.
TK: Should children have sealants put on their teeth? Why?
Dr. Ryan: A sealant is a protective coating that is applied to the surface of the tooth, and the point is to literally seal out the cavity-causing bacteria found in plaque and also seal out food debris which leads to decay. The molars in the back have deep grooves and pits that trap food and bacteria. That’s the most common area for children to have decay. A sealant prevents that by preventing the bacteria from getting trapped in those deep grooves and also keeps the food and debris from the deep grooves, therefore, preventing the cavities.
The sealant material itself is a composite resin made of the same material that fillings are made of, and it’s very safe and non-toxic. The sealant is only a preventive barrier for the biting or chewing surface of the teeth, so the tooth can still get decay on the other sides of the tooth and in between the teeth where you’re supposed to be flossing. It’s only the biting surface of the tooth that is protected. The chewing area is the most common area for kids to have decay, so it prevents that from happening.
A sealant is usually applied to the permanent molars; however, we do offer sealants for baby teeth and I place them on a regular basis. The lifespan of the sealant is typically 3 to 5 years depending on how much ice and hard crunchy stuff your child chews.
The vast majority of children will benefit from sealants.
TK: What are the biggest causes of tooth decay (or tooth health risk) in young children and how can they be avoided?
Dr. Ryan: One question I get a lot is, “Is tooth decay genetic?” There’s a genetic component in almost everything from parents to their children, however, for cavities it’s mainly an environmental component – the environment that the teeth are in. In order to have a cavity, you have to have three things:
- You have to have a tooth
- You have to have cavity-causing bacteria
- And you have to have the food that the bacteria eat to cause decay
If you don’t have those three things, you can’t get a cavity.
The most common causes of cavities that I see are sugary drinks that are taken either at nighttime or throughout the day or frequent snacking in between meals. A sugary drink, for example, would be milk or chocolate milk or any type of juice – those are the most common types of sugary drinks that I see for kids.
It takes about 45 minutes for your mouth to balance out the acid after you eat something. So if your child is snacking every 30 to 45 minutes, even if it’s a healthy snack like fruit or cheese or crackers, it can still cause decay because there are natural sugars in all of those things.
Breast milk alone is not associated with early or severe decay; however, when your child starts eating from the table and continues to have breast milk whenever they like, then that is associated with severe decay. For example, if your child is eating from the table and is also nursing, the food is still a source of sugar or carbohydrates and can cause severe decay in young children.
I hear a lot of parents tell me that they have “soft teeth” and now their children have “soft teeth.” In most cases that’s far from the truth simply because of those environmental factors that we talked about. Most often that child has cavity-causing bacteria that has been passed down from the parent. Those cavity-causing bacteria are most often passed from mom to baby during infancy and in some cases can also be passed from sibling to sibling. It’s the bacteria that we pass to our children that causes decay rather thangenetics.
That’s the reason that it’s important to avoid saliva-sharing activities. For example, when your child drops the pacifier and you clean it off by putting it in your mouth and then in your child’s mouth, you’re sharing bacteria with your child. Or tasting from the spoon and then allowing your child to use that same spoon, or sharing drinks, those are all activities that can pass bacteria [from you to your child].
This is especially true if parents have untreated decay or active cavities. That means you have that bad bacteria and you are thoroughly infecting your child with it.
TK: How often should a child get X-rays?
Dr. Ryan: Typically, the first dental X-rays are taken around age two to three, and most often that’s only for the front teeth, top and bottom. The reason for that is those top front teeth can be touching and we want to make sure that the roots are healthy, and that’s also a nice way to expose children to X-rays without it being traumatic. We call the X-ray sensor a “cookie,” so the child simply bites down on the “cookie” and we take the X-ray. The child can sit comfortably in a chair or in a parent’s lap. Those first X-rays assess the growth and development of the front teeth and check for any cavities or disease.
The next set is taken when the child’s molars are coming in. Those X-rays are called bitewings. We want to take those X-rays when the teeth in the back are touching because we can’t see in between those teeth and that’s where the cavities can be hiding.
Your child bites down on the X-ray, and those can be a bit more difficult for the child, so at On the Cusp we have the most advanced digital sensors that are extremely sensitive to the X-ray. The amount of radiation exposure is incredibly lower than it used to be and the time that it takes is much shorter. In most cases, the amount of radiation your child is exposed to is about the same as walking down the street.
The first thing that we’re looking for are areas of decay or cavities, and then we look for extra teeth that may be coming in. We also want to check the alignment of the teeth, which direction they are coming in, and whether there are impacted or extra teeth. We also check for disease or pathology in the X-ray or in the bones or the tissues that we can identify early that could be a problem. We are checking things that we can’t see with our eyes, which is the reason we typically take X-rays annually.
TK: Are there any new dental treatments for children that readers should know about?
Dr. Ryan: Really, the new dental treatment is to start early. And this is something that has come around in light of the epidemic that our children are faced with, as cavities are currently the number one disease of childhood. We want to get kids in early so we can prevent the disease, establish healthy habits and establish a dental home from an early age.
Today, the focus is on preventive care as opposed to treating problems with the disease. So a cavity is a disease, or an abscessed tooth is a disease, and we’ve been taught at the beginning of dental school that that’s what we do – we treat the disease. But in recent years, the focus has really changed, and now we’re focusing on preventing the disease before it happens. We’re best able to do that when we see the child at a young age, and we can educate the parents on how to prevent cavities before they happen.
We also use fluoride varnish, which is a new way to deliver fluoride. It’s actually made from tree sap resin, so it’s incredibly sticky and is delivered directly to the teeth. It doesn’t wash around, and it doesn’t get swallowed like the foams and gels and tray we used to use. Fluoride varnish helps harden or strengthen the enamel to resist and fight cavities. We also use it for young children where we are literally trying to stop the progression of decay.
We have found a dramatic reduction in decay and far fewer cavities in children who take advantage of fluoride varnish applications twice a year. On some children who are high risk, we might apply fluoride varnish up to four times a year.
There’s also been a shift in making the dental visit fun. That’s one of the main things that we focus on — setting up a fear-free environment. When I was a kid, I never had any of that. The dentist’s office was a very cold and sterile place, and I had a traumatic experience as a child. That’s one thing that led me to be a pediatric dentist. So, especially for us younger dentists, we are trying to reverse fear and anxiety in dentistry. There are so many people out there who are fearful or who have had a bad experience at the dentist, and [we try to] prevent that. All of that starts at an early age. A lot of times, a child has had a traumatic experience and is very, very scared. So if the child is managed appropriately, then we can have a lifetime free of anxiety, which leads to a lifetime of oral health.
In order to reduce fear and anxiety for young children who need treatment, often times we take advantage of sedation or even general anesthesia, which is more accessible than in years past.
Also the materials that we use now are stronger, they are more effective and more attractive.
Part II will focus on orthodontics and teen oral health.