What you need to know about cavities

Do our kids get more cavities than we did? You betcha. Find out why and learn what you can do about it.

April is Oral Health Month, dedicated to educating Canadians about the importance of good oral hygiene and its connection to overall wellness. Instilling healthy oral hygiene habits for kids of every age is harder than you think. To mark Oral Health Month, we surveyed the most vital information.

More kids are getting cavities
Michelle Gritter’s third visit to the dentist with her daughter Avery, then four, was a horrible experience for the mom of three. Gritter was no stranger to cavities – her son had needed some fillings at age seven or eight. But she was still floored when the hygienist stormed into the full waiting room and demanded to know what she’d been doing – or not doing – to her youngest daughter’s teeth.

The dentist filled Avery’s cavities and sealed her molars, and, after sitting through an oral health lesson, Gritter redoubled her efforts to brush all of her kids’ teeth more thoroughly.

“It’s not like I was a moron,” says Gritter, still irked by the ordeal two years later.  “Everything they told me was consistent with what I knew and what I was already doing.” She’d been brushing her daughter’s teeth twice a day and encouraging her to eat apples and carrots. Avery got her share of junk food, too, but still – how did she end up with a mouth full of fillings in preschool?

Read on to find out why Early Childhood Cavities are on the rise and why baby teeth matter >
Early Childhood Caries (ECC) on the rise
The reality is that more young children are getting cavities in their baby teeth, and stories like Gritter’s are becoming common. Data from the US Centers for Disease Control and Prevention from 2004 reveals Early Childhood Caries (ECC) – the process by which enamel gets broken down, leading to cavities – affects a quarter of all kids in North America between ages two and five. Even worse, the incidence of ECC (also referred to as early childhood tooth decay) in this age group had increased by four percent from the previous assessment period. A July 2008 report by the College of Registered Dental Hygienists of Alberta went so far as to call ECC a “public health epidemic” that afflicts children from every income level.

Baby teeth matter
Early Childhood Caries is a disease that’s not on the radar for many parents, who may think cavities in baby teeth aren’t a big deal since they’re going to fall out anyway. But primary teeth matter – they aid in speech development, play a role in digestion and are placeholders for permanent teeth. And the earlier a child starts to get tooth decay, the greater the risk of future decay, says Rosamund Harrison, a paediatric dentist in Vancouver. Harrison, who is also chair of the Division of Paediatric Dentistry at the University of British Columbia, says the risk increases for both baby and adult teeth.

Society’s focus on permanent teeth has certainly paid off: The percentage of children aged six to 11 with at least one cavity has dropped dramatically, from 74 percent in 1972 to less than 25 percent in 2009, according to the Oral Health Component of the Canadian Health Measures Survey 2007-2009. Factors credited with the reversal among older children include better access to professional oral health care, the widespread use of fluoridated toothpaste, and the availability of fluoridated water (45 percent of Canadians receive fluoridated drinking water, according to Health Canada).

What isn’t as clear is why some young kids are experiencing the opposite phenomenon: accelerated decay. The issue is complex and, ultimately, it’s about more than just brushing, flossing and visiting the dentist every six months.

“Dental caries is a process – you don’t just wake up one day with a cavity,” says Harrison. “The issue with ECC is it’s not just about the teeth; it’s about the child, the family and the community. It’s a multifactorial disease.”

Read on to find out factors that influence ECC and what habits to cut out right now >
Factors influencing ECC
Genetics play a role in ECC – if both parents have a lot of fillings, chances are their kids will inherit cavity-prone teeth. What’s more, the enamel on primary teeth is more porous and thus more susceptible to erosion by the acid created when bacteria metabolizes sugar inside the mouth. In addition to genetics, Harrison says a family’s diet, oral health behaviours and exposure to fluoride influence whether or not ECC develops.

Our Run-at-Home Mom blogger, Jennifer Pinarski, believes she passed on her weak teeth to her kids. She also wonders if moving from Winnipeg to Bobcaygeon, Ont. – where she, her husband and their two children drink non-fluoridated well water – had anything to do with their cavities. Shortly after the move, “the cavities started taking off,” she says. She was shocked when the local public health unit sent her a letter informing her that a dental screening revealed that Isaac, then five, had cavities. Now Pinarski’s two-year-old daughter, Gillian, has one, too.

Whether or not water is fluoridated varies by municipality across Canada. If water is non-fluoridated it’s important to brush with toothpaste containing fluoride – a natural compound that remineralizes tooth enamel and helps it resist decay. “It strengthens the tooth from the outside in,” says Harrison.
Fluoride toothpastes can be safely used only after a child reaches age three. However, the Canadian Dental Association (CDA) does recommend fluoride toothpaste for those children under three who have been deemed at risk for ECC. Your dentist will determine your child’s ECC risk at the first visit, usually around age one. According to Harrison, low-fluoride toothpastes have not been shown to be effective. Fluoride supplements (like lozenges, drops and chewable tablets) are not needed in the majority of Canadian communities, says the CDA, unless specifically prescribed by a dentist. Fluoride mouth rinses are only suitable for children who are over age six and at high risk for tooth decay.

Simply brushing kids’ teeth twice a day may no longer be enough, say dental health experts. Parents must look at their children’s behaviours, including how often they eat and the kinds of food and beverages they consume.

The parenting connection: Milk or juice and constant snacking
“Parenting patterns have changed over the past generation,” says Calgary paediatric dentist Sarah Hulland. “Kids are eating and drinking frequently and it’s not generally water – it’s milk or juice.” She says this “constant snacking” is having disastrous effects.

After watching her kids sit through numerous cavity fillings and two root canals over the past decade, Jeni Marinucci added midday brushing and a fluoride rinse to her two kids’ oral health regimen. She also mandated a snack overhaul. Sofia, 13, and Nicolas, seven, now snack on veggies between meals instead of chewy dried fruit bars and trail mix with chocolate pieces, and sip on water instead of juice.

Though Marinucci jokes that the $3,000 she’s spent on dental care has paid for her dentist to put in a new pool, the reality is that her kids’ dental woes – especially the cavities when they were little – rattled her confidence. “It’s funny how closely we attach our feelings of success in parenting to our kids’ physicality, especially their teeth,” she says.

Our culture places a lot of value on straight white teeth and a perfect smile, so if a child has fillings at age four it can make mom and dad feel like failures. While parents shouldn’t blame themselves, they need to understand the connection between all oral habits – sipping, snacking and brushing – and dental health.

“The parameters of behaviour you instil early on make a huge difference for children,” says Hulland.

A version of this article appeared in our April 2012 issue, with the headline Million-Dollar Smile (p. 101). To see more from this issue, including an age-by-age breakdown of proper oral hygiene, visit our oral hygiene section.

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