What is the most common chronic disease among children? If you guessed tooth decay (cavities), you are right. More than a quarter of children 2 to 5 years old and half of all teenagers have had tooth decay.
Children from lower-income families are twice as likely to have decay than are children from higher-income families, and they are half as likely to receive effective preventive care or treatment. No wonder one-fourth of all adults 65 and older in the United States have lost all their teeth.
A mouthful of sparkling, white teeth highlight a person's physical beauty. Decayed teeth look bad — they often are yellow or brown, get chalky spots and become misshapen. And the cosmetic harm caused by poor dental hygiene pales in comparison with some of its other effects on children. Teeth that are injured, diseased or poorly developed can interfere with a child's nutrition, can lead to painful and dangerous infections, cause problems with normal speech development and diminish a child's self-image. The pain and embarrassment of cavities and other dental problems limit a child's ability to pay attention and learn in school or participate in social and recreational activities.
Think of the costs to children's health, growth, development and learning: Almost 2 million school days are missed every year due to dental problems.
What's more, problems that appear in the mouth sometimes indicate the presence of serious disease or illness elsewhere in the body — for example, diabetes and chronic inflammatory disease.
The good news is that most dental disease is preventable. Simple attention to healthy nutrition and daily cleaning beginning as soon as baby is born, together with some inexpensive and painless professional preventive dental care services during early childhood can help ensure a child's healthy, happy and successful future.
Let's look at what to expect, and how to protect healthy teeth and prevent oral disease.
Primary teeth, also called baby teeth, usually begin to erupt any time after four months of age and almost always before 15 months. Starting at 7 months, every four months children grow another four teeth until they have a full set of 20 baby teeth shortly after their second birthday. Premature infants can be on a somewhat later schedule.
Permanent teeth start erupting between 5 and 7 years of age, finishing by 13 to 14 years.
If you want to help your child have healthy, strong teeth and gums, here are a few easy, sensible and necessary things to do:
1Start cleaning your baby's gums with a soft, clean, damp washcloth from the first days of life on, even if you are breast-feeding.
2Stop night feedings after teeth erupt. Most infants can tolerate fasting overnight beginning at 6 months.
3No milk, juice, teas or formula in bottles at nap or bedtime — only water if necessary.
4Sippy cups can be introduced around 6 months. All bottles can usually be eliminated by 1 year of age. Sugar-containing drinks should be avoided.
5Encourage children to discontinue nonnutritive sucking habits (thumb, fingers or pacifier) by around 4 years of age in order to promote proper alignment of teeth, jaw and palate.
6Fluoride in community water is among the most important public health advances in history. If you live in an area without fluoride in the water supply, supplements can be used beginning at 6 months of age. You don't want to overexpose children to fluoride, so use only a pea-sized amount of fluoridated toothpaste for children younger than 6 years.
7Use a soft toothbrush twice daily, teaching children to spit out extra toothpaste.
8Dental flossing should begin when two teeth touch, usually between 2 and 2 ½ years of age. Children usually need assistance flossing until they are 8 to 10 years old.
9Take your child to a dentist starting anytime after the first tooth appears and return every six months. Many dentists encourage you to bring your young child in for a trial visit the first time just to become familiar without getting an actual examination. Have the dental professional apply a fluoride varnish at each regular checkup.
Seeing your child smile is one of the greatest rewards of parenting. You'll enjoy it all the more by helping your child grow ready, willing and healthy enough to use that smile to his advantage.
Peter A. Gorski, M.D., M.P.A., is a child development expert at the Children's Board of Hillsborough County, a pediatrician, and a professor of pediatrics, public health and psychiatry at the University of South Florida.