Pediatric Healthy Teeth

Allisun Jensen, PA-C
Ravalli Family Medicine
411 West Main Street
Hamilton, MT 59840
(406) 363-5104

We worry about lots of things after we have children. Are they hungry, cold, happy, getting enough sleep? Do they have a common cold or is there something more long standing like asthma? There are so many things to worry about as our children grow and one very important aspect of a child's health often gets overlooked. Dental caries (cavities) remain the most common childhood illness, five times more common than asthma and seven times more common than hay fever. For the period 1999-2004, 28% of 2-5 year-olds had experienced tooth decay.

The problem known in the medical community as early childhood caries (ECC) can cause pain, tooth loss, infection, impaired eating, and speech delay. A child's first set of 20 teeth called primary or baby teeth usually erupt from six months to three years of age. These primary teeth are gradually replaced with 32 adult or permanent teeth that commonly erupt between 6 and 21 years of age.

Primary teeth are as important as permanent teeth because:
  • Allow children to bite and chew food
  • Are critical for proper speech development
  • Aid in the development of the facial bones and muscles
  • Hold space for the permanent teeth and help guide them into position.
With the importance of these teeth, we need to focus on both prevention and when necessary treatment. Decay is caused by bacteria with the addition of sugar that attach to the tooth within plaque that then erode that tooth enamel. This is easily preventable with the use of fluoride. Fluoride works by promoting enamel remineralization, reduces enamel demineralization and inhibits bacterial metabolism and acid production. In certain cities fluoride is found in the water and therefore no supplementation is necessary. However in Montana there is no fluorinated water. Most commonly fluoride is taken systemically with drops, tablets or lozenges or it can be applied topically.

Systemic formulations should be used after the age of 6 months and most commonly through 3-6 years of age depending on risk. Topical fluoride varnish is recommended every 3-6 months. Also a topical form of fluoride is toothpaste and mouth rinses. Under two years of age, fluorinated toothpaste should not be used. After age 2 a smear (rice sized) of toothpaste on a toothbrush is appropriate and after the age of 3 a pea sized amount is recommended. In all cases parents should supervise and help. Over the counter mouth washes should be held until around 6 years of age when children are able to swish and spit appropriately.

Other important prevention strategies are not allowing a child to have a bottle continuously throughout the day or sleeping with a bottle. Other risk factors are excessive sugar intake, not only from foods/candy but from sugary drinks (INCLUDING JUICE).

Dental exams also play a big role in the prevention and treatment of ECC. The recommended age of first dental exam is 12 months old. This visit mainly focuses on prevention and evaluation of risk for the child. However, this also allows for early recognition of decay and earlier treatment. This can decrease problems significantly in the long run.

In a perfect world all of these strategies seem easily accomplished but there are many barriers. Often young children do not have dental coverage and if they do have coverage, access to a dentist is difficult. Rural areas such as ours are often affected by this lack of access. Many kids have dental coverage under state run plans like Medicaid but there isn't dental practices in their local area that accept it. In certain situations a pediatric dentist may be warranted and again there isn't a provider in close proximity. Also fear over the safety of fluoride decreases the use of this effective treatment to prevent ECC. Parents are often concerned about too much fluoride. Most cases of this occur in areas where there is fluoride in the water in addition to supplementation. In Montana we do not have fluoride in the water so our risk of too much fluoride is very low. Too much fluoride can cause white spots or flecks on teeth to more severe cases that will actually pit the tooth. It takes a fairly large dose of fluoride for extended periods of time to cause problems such as this. A three year old would need to ingest 3 pea sized dollops of adult toothpaste daily over an extended period of time. Child toothpaste has lower fluoride amount so if the suggested amounts for age are followed, there is essentially no risk of too much fluoride.

There is no doubt that this is a large problem for our children. With the help of your family practitioner and dentist, make sure to develop a plan for your children to protect their teeth. The health of their teeth now will have major impacts on their health for the rest of their life.

This week's health column is collaboration between Ravalli Family Medicine and Marcus Daly Memorial Hospital. Questions and or comments regarding this week's health column please contact Allisun Jensen, PA-C at Ravalli Family Medicine, 411 West Main Street, Hamilton, MT 59840. Working together to build a healthier community!


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