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 hygienist told me it was one of the worst mouths she’d seen, and that Avery might have to have oral surgery,” Gritter recalls. “I got red in the face and I started to cry. I felt terrible. Like any parent, I want to do a good job.”
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?
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 ChildhoodCaries(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 tooth- paste, 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 more: Early pearly whites>
Factors influence 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.
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 screen- ing 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 deter- mine 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.
Read more: What you need to know about cavities>
The parenting connection
“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 them- selves, 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.
April is Oral Health Month, dedicated to educating Canadians about the importance of good oral hygiene and its connection to overall wellness. With that in mind, here’s a breakdown of oral care for every stage in childhood.
“At this young age it’s about forming habits,” says Mary Bertone, a board member for the Canadian Dental Hygienists Association. Bertone also educates parenting groups through her work with the Centre for Community Oral Health at the University of Manitoba in Winnipeg. Wipe down your baby’s mouth with a soft cloth several times a day after feeding, she says. Once the first tooth erupts, clean it twice a day with a finger brush. There’s no need for toothpaste, just gently rub the bristles around any teeth.
The CDA encourages parents to book a baby’s first dental visit within six months of the first tooth appearing, or by the first birthday. And never, ever send your baby to bed with a soother dipped in honey or with a bottle of milk – breastmilk, cow’s milk and formula all contain sugars that will linger in the child’s mouth. A bottle or sippy cup of water is OK.
All primary teeth come in during this stage so it’s important parents brush them twice daily using an age- appropriate soft-bristle toothbrush. Brush in small circles on the tops of the teeth, in the molar grooves and along the gum line, including where the tongue rests. Use a rice-grain- sized amount of children’s fluoride toothpaste only if your child has been deemed at risk for ECC. (Factors include genetic predisposition for tooth decay, still feeding on demand or consuming sugary snacks between meals.) This tiny amount of fluoride is too small to swallow, but it’s enough to stay on the teeth, says Bertone; if you’re unsure, ask your dentist.
If your tot resists brushing, persevere. You can try listening to music or watching TV during brush time. Make a game of it by letting your child brush your teeth if she lets you brush hers. If that fails, it’s OK to force her. “It won’t cause them a lifetime of trauma,” says Hulland. She compares it to changing a diaper. You wouldn’t put your toddler to bed with a dirty diaper; not brush- ing is putting your child to bed with dirty teeth, she says.
At this age children can start brushing their teeth on their own, but they still need help. Use “checking for sugar bugs” as an excuse to assist with brushing thoroughly in the morning and before bed, says Bertone. If you haven’t already started, start using fluoride toothpaste and up the amount to pea-sized if your child can spit well. Remember to regularly check the teeth along the gum line for white, chalky lines or discoloured areas that could indicate tooth decay.
“When all their teeth are in – and if their teeth are touching – introduce flossing,” says Bertone. Parents will need to do the flossing; try a floss pick (also called flossers).
Finally, be mindful of kids’ snacking: avoid sugary treats and sticky fruit skins and stick to water between meals.
School age (6+)
Permanent teeth, including the six-year molars, begin coming through at this age and kids will expect visits from the Tooth Fairy. “It’s important to brush permanent teeth well when they start coming through,” says Bertone. Parents still need to help kids brush and floss twice a day until they’re about seven or eight and can manage the task themselves.
Tweens usually consume more sweets and may not be as motivated to brush. Bertone suggests keeping them on track by appealing to their vanity. Explain that people don’t like to look at fuzzy teeth or red gums, and that no one likes bad breath. An electric toothbrush or a timer can also help extend the amount of time kids spend brushing — the goal is two minutes, but most do it for less than 40 seconds, she says.
A version of this article appeared in our April 2012 issue with the headline “Million Dollar Smile,” p. 101-4.