The general rule has been to introduce toothpaste with fluoride at three years old, but the American Academy of Pediatrics (AAP) has just released new guidelines to counter the risk of cavities and tooth decay, including using fluoridated toothpaste on all children starting as soon as the first tooth emerges. The AAP suggests a tiny smear (the size of a grain of rice) of toothpaste up to age three and then a pea-sized amount after age three, with parents dispensing, supervising and helping with brushing. What does this mean for Canadian kids? Both the Canadian Dental Association (CDA) and Health Canada share the position that fluoridated toothpaste should be used in children younger than three years of age when there’s a risk of tooth decay. However, the risks they outline are common scenarios in many families with small children, including consuming sugar—even natural sugars like fruit—between meals. Other risk factors include a low level of fluoridation in the drinking water, or failure to brush at least once a day (talk to your dentist to assess your specific child). Because not all parents remember to brush their baby’s brand-new teeth several times every day, and often serve fruit as a go-to snack, Euan Swan, the CDA’s manager of dental programs, admits that many dentists would likely recommend a fluoride toothpaste for a child of any age because “the amount of fluoride in a smear the size of a grain of rice is so little.” The AAP’s position, he explains, is that if you reduce the amount of toothpaste, chances of swallowing fluoride are low and you gain the benefits of preventing tooth decay. The bottom line for Canadian parents: If you’re concerned about tooth decay, use a very small amount and do your best to make sure kids don’t swallow.
Like many parents, Jeni Armstrong, a Toronto mom of two, assumed kids don’t need to see a dentist until they’re around three years old. It wasn’t until her son, Seve, had his first visit at two and a half that she discovered otherwise. Luckily, he didn’t have any cavities (one in five kids already do by age three), but the experience was rocky nonetheless. “There were a lot of tears,” recalls his mom, despite a great paediatric dental health team and tricks like letting Seve sit in her lap with Treehouse TV playing on a ceiling-mounted flatscreen. Hoping to avoid a repeat performance with Seve’s younger sister, Juno, Armstrong took the 14-month-old in a few weeks later, and she breezed through the visit. But what happens in the dentist’s office is just a small part of keeping kids’ teeth healthy.
Here’s what you can do at home, according to Toronto paediatric dentist Paul Andrews, to get little ones on board with looking after their pearly whites:
* Wipe out your infant’s mouth following each feed, before and after teeth start erupting—if you don’t get in the habit, teething discomfort may make him reluctant to co-operate. Once the first tooth pops through, use a damp washcloth to gently clean it.
* The first checkup should take place around age one, or when the first tooth erupts, so you are well-informed and your tot’s introduction to the dentist is fun and easy before lengthy exams or uncomfortable procedures are needed.
* Start with a baby toothbrush with just water as soon as there are four teeth sitting side by side. Regardless of your child’s age, brushes should be soft, with a small, flat head. Toss once the bristles start to splay—roughly every three months.
* Once kids can eat a whole meal with a knife and fork, their fingers are nimble enough to take over brushing duties, though you’ll still want to check to ensure they’re doing a thorough job.
* Flossing can wait until teeth are touching each other, or until adult teeth first start to appear (flossers make it easier for little hands).
* Avoid mouthwashes and rinses unless your dentist recommends otherwise. Alcohol-based varieties pose a danger of poisoning, and repeated use causes irritation that can actually contribute to bad breath.
* Dried fruit and fruit snacks can cause cavities even with good brushing technique, so save the treats for special occasions.
At the Armstrong home, oral care is now part of the kids’ routine. “It’s gratifying to see them start to own that responsibility for themselves,” says Armstrong.
You may be eligible for programs that will pay 100 percent of the cost of dental visits in most provinces and territories. Find info about your provincial dental association at cda-adc.ca.
A version of this article appeared in our September 2014 issue with the headline “Pearly whites,” p. 32.