start right PARENTS MAKE THE DIFFERENCE A practical guide to your baby’s dental health A PROJECT OF THE MISSOURI DENTAL FOUNDATION A CHARITABLE SUBSIDIARY OF MISSOURI DENTAL ASSOCIATION PROJECT FUNDED BY THE MISSOURI FOUNDATION FOR HEALTH

Presented by members of the Missouri Academy of Pediatric Dentistry & Missouri Dental Association

Importance of Baby Teeth Help a child to chew and speak Hold space for the adult teeth & guide teeth during eruption Aid in jaw and face formation Influence the child’s overall health The early childhood dental visit can help educate the parent as well as categorize the potential dental disease risk of the child.

When Teething Starts Baby teeth usually start to come in at 6 months 20 primary teeth usually present in our jaw bone at birth The front four teeth erupt first, followed by the first molars and then the cuspids The second molars are the last to erupt, usually by age 2 ½ to 3 years of age

Primary Teeth Eruption Chart

Comforting Your Teething Baby Comforting babies who are irritable because of teething Chew on a cool washcloth or spoon Chew on a teething ring Massage gums with a clean finger Give children’s Tylenol or ibuprophen an hour before bedtime so sleep isn’t interrupted

Avoid Numbing Medications High levels can be toxic Babies can injure their numb lips or tongue if rubbed against their teeth

Tips for Preventing Decay What parents can do Proper Baby Bottle Usage Good Oral Home Care Good Nutrition Habits (Eating & Drinking) Checking teeth regularly Scheduling child’s first dental visit

Tips for Preventing Decay It’s not the bottle, it’s the beverage H2O X X

Proper Baby Bottle Usage

Tips for Preventing Decay Proper Bottle & Sip Cup Usage Don’t allow your baby to fall asleep with a bottle or “sip cup” filled with anything other than water

Tips for Preventing Decay Proper Bottle & Sip Cup Usage Milk and other sugary liquids can pool against the back of the top front teeth for the several hours the baby is sleeping Because of this, cavities can occur on the backs of the top front teeth, undetectable to parents Note: Going to bed with bottle can also cause liquid to pool in ear tubes, causing ear infections

Decay on Teeth from Bottle Decay on the back side of top front teeth, caused from improper bottle usage, is not always visible on the front of teeth This is a mirror shot shows which shows the front of the upper front teeth at the bottom of the slide. Dental caries due to prolonged bottle feeding usually begins on the backside of the upper front teeth. It is not visible from the front and therefore difficult to detect without a dental mirror. This child is less than two years of age because the right second molar has not even erupted yet.

Tips for Preventing Decay Good Oral Home Care Have parents get into the habit of wiping the baby’s gums after feedings, even before teeth have erupted As teeth come in, brush them with a finger or child’s toothbrush with water or child-safe (non-fluoride) toothpaste Don’t use fluoride toothpaste until child can spit (can be toxic if swallowed) Parents need to be the ones in charge of oral hygiene. Kids who are independent can brush first, but the care giver should still give a once over afterwards.

Gauze or a burp rag can wipe an infant's mouth before there are teeth Gauze or a burp rag can wipe an infant's mouth before there are teeth. The Finger toothbrush finger cot is good to gently wipe the anterior teeth and massage the gums. Children under the age of three can't spit sufficiently and should use only water or a non-fluoride tooth cleanser on the toothbrush.

Tips for Preventing Decay Good Oral Home Care Parents need to be the ones in charge of oral hygiene. Kids who are independent can brush first, but the care giver should still give a once over afterwards.

Tips for Preventing Decay Creating Good Hygiene Habits Kids under age 6 need help brushing Some kids over age 6 may still need supervision Bedtime is the most important time to make sure the teeth are free of plaque Flossing should be initiated as soon as teeth begin to touch Any plaque left on the teeth at night has several hours to become cariogenic since there is decreased saliva flow during sleep. The plaque can also mineralize into calculus and be more difficult to brush away in the morning.

Tips for Preventing Decay Toothpaste & Fluoride Fluoride is important for fighting cavities However, if children younger than 6 years old swallow too much, their permanent teeth may have white spots Use only a small amount of toothpaste (about the size of a pea) At about age 3, you can teach child to spit out the toothpaste and to rinse well after brushing

Once children reach age 3, a pea-size amount of toothpaste can be used A pea-size amount of toothpaste is recommended to decrease the amount that can be potentially swallowed. The blue bristles can show the parent where to place the toothpaste.

Tips for Preventing Decay Toothpaste & Fluoride Replace worn toothbrushes Brushes may have bent bristles, even though “blue” indicator color isn’t gone Infants/Toddlers may wear out toothbrushes sooner because of chewing on bristles The middle blue bristles on these Oral-B toothbrushes are supposed to fade away after 4-6 months indicating time to get a new toothbrush. Toothbrushes have very soft bristles and may need to be replaced before the indicator dye disappears.

Tips for Preventing Decay Good Nutrition Habits Food doesn’t cause decay, but rather “eating” food in general Children’s dental health depends less on what they eat and more on how often they eat it Sugary snacks should be consumed within a short period of time as opposed to "grazing" throughout the day. This will give the mouth a chance to clear away the sugary foods from the teeth.

Tips for Preventing Decay Good Nutrition Habits Anything that breaks down into sugars/carbohydrates can cause cavities Candy and cookies are NOT the only bad things for teeth! This includes starchy foods like potato chips and crackers

Tips for Preventing Decay Good Nutrition Habits Sticky foods, like gummy fruit snacks and raisins can be worse for the teeth Get stuck in chewing surfaces and in between teeth Don’t wash off the teeth as quickly

Tips for Preventing Decay Good Nutrition Habits Fruit roll-ups, gummy fruit snacks and raisins BAD FOR THE TEETH! Everyone knows that candy is bad for you. Sticky snacks like fruit rollups, fruit snacks and raisins, once touted as "nature's candy" can be just as destructive to teeth.

These snacks look nutritious, but are they?

3 of the Top Ingredients are Sugars!

Tips for Preventing Decay Good Nutrition Habits Don’t allow children to "graze" throughout the day on snacks/drinks (except water) Encourage balanced meals at “mealtimes” Sugary snacks/drinks should be consumed within a short period of time This will give the mouth a chance to clear away the sugary foods from the teeth Have kids brush after meals Sugary snacks should be consumed within a short period of time as opposed to "grazing" throughout the day. This will give the mouth a chance to clear away the sugary foods from the teeth.

Tips for Preventing Decay Good Nutrition Habits Provide better choices Healthy snacks like fresh fruit and cheese are better not only for the teeth, but for the overall health of the baby

Tips for Preventing Decay Good Nutrition Habits Stop the Pop! Soda should never be encouraged Diet soda can also cause cavities due to the acid in the carbonation

Tips for Preventing Decay The First Dental Visit It is recommended the first dental visit be within 6 months of the first tooth eruption This is usually around the child’s first birthday

Tips for Preventing Decay The First Dental Visit Pediatric dentists are specially trained and may feel more comfortable examining young children than general dentists A child’s pediatrician should be able to assess if a child is at high risk for dental decay

Tips for Preventing Decay The First Dental Visit This 3-year-old is at the dentist for the first time Unfortunately, one of his teeth is already infected and an abscess is present

About Dental Decay Did you know? Dental caries is the most common chronic disease in children, 5 times more common than asthma More than 40% of children have tooth decay by the time they reach kindergarten More than 51 million school hours (85,000 school days) are lost each year due to dental related illness

About Dental Decay Did you know? 80% of dental cavities are found in 20% to 25% of children 18% of children between the ages of 2 to 4 have visible cavities Infants of low socioeconomic status, whose mothers have a low education level, and who consume sugary foods are 32 times more likely to have caries at age 3 than children in whom those risk factors are not present

About Dental Decay Did you know? Tooth decay is a disease that is, by and large, preventable The ultimate goal of early assessment is the timely delivery of educational information to prevent decay

Screening for Dental Decay Getting Started Following are guidelines only Goal is to help parent educators feel comfortable educating parents Empower parents to do screenings on their child and know what to look for

Screening for Dental Decay Getting Started What you need Dialogue with parent/consent to do screening Good light source to see teeth

Screening for Dental Decay Getting Started The knee-to-knee lap exam allows the parent to help hold child’s hands while the examiner is able to look at the teeth

Screening for Dental Decay What do cavities need to start TEETH No Caries No Caries PLAQUE (BACTERIA) REFINED CARBOHYDRATES (FOOD) DECAY Dental caries cannot exist without the Strep Mutans flora, plaque (carbohydrates) on teeth, and enough time for the plaque to create changes in the enamel structure. No Caries No Caries TIME PLAQUE IS ON TEETH

Screening for Dental Decay What do cavities need to start What to look for: Plaque along the gumlines White chalky lines along the gumlines Brown spots or discolorations on the fronts of teeth Holes in the chewing surfaces of the teeth

Plaque is an invisible film that is noticeable when scraped off the teeth

White or chalky areas can turn into brown spots (cavities) Once the decalcifications are present, continued exposure to plaque can break them down into full-fledged cavities.

Lift the lip to see gumlines better This dental decay is due to plaque that has rested up against the gum lines for a long period of time. These cavities began as white lines on the enamel which, if detected early could have been reversed with fluoride applications.

Large cavities can damage the nerves of the teeth, leading to abscesses Early childhood caries can get larger if not treated. They can grow to the other tooth surfaces, and even damage the nerve of the tooth, causing abscesses to occur.

Primary molars do not fall out until age 10-12 Primary molars do not fall out until age 10-12. Cavities in these teeth need to be treated right away.

Screening for Dental Decay Large cavities can be repaired, but it’s expensive and the child is always more cavity prone…

As a Parent Educator What’s your role? Educate parents about good early childhood oral hygiene Provide parents with tips to make healthy choice and prevent decay in primary teeth

As a Parent Educator What’s your role? Conduct screenings to identify children at risk for dental disease Help parents learn to know what to look for when checking their child’s teeth for decay Direct parents with any concerns to dental health professionals

Thanks you for your interest The Dental Community Thanks you for your interest in helping the children of Missouri obtain good oral hygiene and healthy brushing and eating habits to prevent early childhood decay

Starting Right Means a Lifetime of Smiles

Contact Information Missouri Dental Association www.modental.org 573-634-3436 Program Coordinator Melissa Albertson melissa@modental.org

Start Right: Parents Make the Difference A project of the Missouri Dental Foundation The charitable subsidiary of the Missouri Dental Association The Start Right project is funded through a grant provided by the Missouri Foundation for Health. The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves. All “Start Right” materials and presentation © Missouri Dental Foundation & Missouri Dental Association