Information about oral health—especially oral health in children—continues to evolve. New research is constantly improving our understanding of oral health and its effects on overall health.
For example, a common misconception is that baby teeth were eventually going to fall out; so there is no reason to visit a dentist until the permanent teeth are in. In response to this myth and to promote the importance of oral health in children, the American Academy of Pediatrics (AAP) recommends that all children receive an oral health risk assessment by 6 months of age from a qualified pediatric health care professional; and that they have their first dental visit by 1 year of age.
By providing children with adequate fruits and vegetables and limit the amount of sugar in their diet, you are helping to protect their teeth. However, new research demonstrates this may not be completely true.
Highly acidic foods, including some fruits and juices, can destroy the outer surface of the teeth (also known as the enamel) when consumed frequently. Other offenders include sour candies, carbonated beverages, and sports drinks. To prevent enamel erosion in children’s teeth, the AAP suggests giving children only one cup of juice per day once their baby teeth have started to erupt and recommends that children avoid drinking carbonated drinks during the first 30 months of life.
Research also has shown that tooth enamel can be further damaged by brushing right after eating or drinking something highly acidic. The Mayo Clinic recommends waiting at least 30 minutes after eating or drinking something acidic to brush your teeth. It also suggests brushing teeth beforehand, if possible.
In addition to limiting highly acidic foods, the British Dental Association recommends that children avoid “grazing” during the day. If the child does snack, select cheese, nuts, or raw vegetables instead of sugary foods. These food choices will help remove the plaque that forms on teeth and gums after eating or drinking.
According to the American Dental Association (ADA), plaque constantly forms on the teeth and gums; and every time bacteria comes into contact with sugar or starch in the mouth, an acid is produced that attacks the teeth. Each attack can last for at least 20 minutes, and enough attacks will eventually result in tooth decay. For this reason, the AAP recommends that caregivers clean an infant’s mouth with a damp cloth after every feeding.
In childcare, infants should always be held when given a bottle; laying an infant with a bottle can lead to choking or increase risk of ear infections. If a parent indicates they give a bottle at naptime or bedtime, then the bottle should contain only water.
Pacifier use or thumb-sucking is a young child’s response to the natural need to suck. This behavior, referred to as non-nutritive sucking, does not generally present a problem unless it is prolonged, which can impact a child’s bite.
Thumb-sucking, in particular, can cause an over bite, which occurs when the jaw becomes improperly aligned and the top teeth stick out farther than the bottom teeth. Some dentists may take a wait-and-see approach where thumb-sucking and pacifier use is concerned, but most will recommend curbing these habits as soon as possible.
Whether a child develops an over bite should not be the only concern with non nutritive sucking. Streptococcus mutans is the primary bacterium involved in tooth decay and can be passed from caregiver to child through shared eating utensils.
Caregivers may inform parents that this bacteria can also be transmitted when the adult cleans a pacifier with saliva or tastes food to test its temperature before giving it to a child. To help prevent this transfer of bacteria from caregiver to child, the AAP recommends adults avoid sharing utensils and always clean pacifiers with water instead of saliva.
The type of water that caregivers give children also can impact their oral health. The ADA recommends limited use of bottled water, which often does not contain fluoride. Even some at-home filters or water treatment systems can significantly reduce fluoride levels, so unfiltered tap water is recommended.
For children who exclusively drink formula that is mixed with water, there is a possibility of fluorosis, a purely cosmetic condition in which white spots appear on the surface of the teeth. Formula tends to be low in fluoride; however, when combined with fluoridated water, the risk for fluorosis increases.
For children who are fed formula exclusively, the Centers for Disease Control and Prevention (CDC) recommends using bottled water that is considered low-fluoride (such as purified or distilled water) some of the time to prevent the possibility of fluorosis. Because fluoride is present in other sources besides water, such as toothpaste and mouth rinses, the Department of Health and Human Services modified its recommended level of fluoride in drinking water in January 2011 to prevent excess exposure.
Promoting Oral Health in Your Childcare Program
As a childcare provider, you spend plenty of time with children every day—time that can be used to share important health messages. Allowing older children to brush their teeth after non-acidic snacks is one way to protect their teeth. Another way is to promote healthy snack choices, limit bottled water use, and ensure that pacifiers are properly cleaned.
Inform and encourage parents and families to promote oral health through take-home activities. Newsletters, such as HIP On Health provide current information in an interesting and fun format.
Examples of parent information include the AAP recommendation that every child visit a dentist by 1 year of age; limiting the use of bottled water at home; and the risks in giving a bottle at bedtime or naptime. Such steps can go a long way toward brightening and protecting the smiles of those in your care.
Diona L. Reeves
Owner, Content Visionary
American Academy of Pediatrics Oral Health, www2.aap.org/oralhealth
Centers for Disease Control & Prevention, www.cdc.gov/oralhealth/topics/child.htm
National Children’s Oral Health Foundation, www.ncohf.org
National Maternal & Child Oral Health Resource Center, www.mchoralhealth.org