Oral Care for Children and Teens
An ounce of prevention is worth a pound of cure.
—Benjamin Franklin
There are some dental truths that may be new to you, and some of these may sound shocking if you have always believed a different story. It’s important to know the facts, and so I will try to dispel the most frequent myths and explain the relevance of understanding the truth. The four questions we will explore are:
1.Does sugar attack teeth?
2.How do you “clean” teeth to be cavity-free?
3.Do baby teeth influence adult oral health?
4.Are cavities genetic, and are they preventable?
You could try to answer these questions now and then compare your thoughts after you have learned more about these topics. Hopefully this chapter will give you more confidence and knowledge to effectively care for your children’s teeth.
TRUTH 1: SUGAR DOES NOT ATTACK TEETH—BUT IT FEEDS TOOTH-DAMAGING BACTERIA.
You can soak a tooth in sugar, and nothing will happen. Sugar exerts its tooth-damaging effect by providing fuel and conditions that are ideal for harmful bacteria to grow and multiply on teeth. Cavity-forming bacteria produce acids, which soften teeth and create an entry place into the tooth, where they will continue to destroy the tooth’s structure and form cavities. Since xylitol behaves in the opposite way from sugar, it can be wiped on teeth or eaten frequently as mints or gum to help rid the mouth of cavity-forming plaque bacteria and to deprive the harmful bacteria of the energy they require to grow, multiply, or stick to teeth.
Because bacteria are fueled by even tiny amounts of sugar, as the consumption frequency of any sugar or carbohydrate increases, so does the risk for tooth damage. Conversely, as the frequency of xylitol exposure increases, the more beneficial are its effects to control harmful plaque bacteria and promote healthy ones. Toddlers often eat small amounts of fruit, bread, cookies, and snacks. All these foods—no matter how healthy and organic they are—digest to become sugary liquids in the mouth, and it is this sugary liquid that fuels harmful bacteria. These damage-promoting conditions continue for up to an hour after eating carbohydrates or sugars, but a clever strategy is to end snacks and meals with a tooth-protective food or xylitol. Tooth-protective foods help control mouth acidity but xylitol additionally works to promote good bacteria and rid the mouth of cavity-forming ones.
TAKEAWAY:
•It is more practical to control the bacterial composition of a child’s mouth than try to completely eradicate all forms of sugar and carbohydrates in a child’s diet, which is not a realistic option.
•Every exposure, even tiny amounts of sugar or carbohydrates in any form, fuels the growth of cavity-forming bacteria and increases the chance of tooth damage.
•Xylitol alkalizes the mouth and helps control cavity-forming plaque bacteria, which can dramatically lower a child’s risk for cavities.
•It is good to limit sugar and carbohydrates in our diet, but frequency of sugar exposure determines the severity of the tooth damage more than the total amount of sugar consumed.
•Frequent tiny amounts of xylitol will more effectively reduce harmful bacteria than a larger amount consumed at one time.
TRUTH 2: YOU CANNOT “CLEAN” TEETH TO BE BACTERIA-FREE, BUT YOU CAN PROMOTE A CAVITY-FREE MOUTH BY NURTURING HEALTHY BACTERIA.
Although we want to control harmful bacteria, we do not want to sterilize our mouth. A mouth devoid of bacteria is not healthy. A healthy mouth is naturally filled with a wide diversity of beneficial bacteria that work to protect it and keep it free from harmful kinds that cause disease and cavities. Destroying healthy bacteria in the mouth will limit this protection and damage the mouth’s ecosystem, which is the backbone of true mouth health. Exposure to a variety of bacteria will benefit infants and children and it means we should encourage kissing and contact with adults and other family members. The key is to exchange healthy bacteria with your infants and children and try to limit their exposure to harmful ones. Children whose mouths are populated by a healthy selection of oral bacteria will grow up to enjoy attractive natural teeth that gleam in sunshine and sparkle as they smile.
You should not aim to physically clean all bacteria from teeth, and adding probiotic supplements is not a solution either. The mission should be to use a progressive and effective strategy that nurtures a wide diversity of healthy bacteria in your child’s mouth, ideally starting at the moment a first tooth erupts. Try to replace the idea of cleaning teeth with a new idea of nurturing your child’s overall mouth health.
In the 1970s, pure xylitol chewing gum was given to pregnant women who had bad teeth, and these women had cavities that were never treated, because they lacked access to dentistry. These women were able to improve the bacterial composition of their mouths and minimize their levels of cavity-forming bacteria by 98 percent, simply by eating a few grams of xylitol each day. These mothers kissed their babies after they were born and transferred healthier oral bacteria to their children. At six years old, these children had 85 percent less tooth decay than the children whose mothers did not chew xylitol gum. Traditional dental advice in the United States is for mothers to avoid sharing their mouth bacteria with their children by sterilizing toys and not kissing their babies on the lips. This cannot be recommended for the medical, emotional, or dental health of the child. The baby’s mouth will become infected with bacteria, arriving from someone or somewhere. So, if you are pregnant or a young mother, take action and consider improving your own mouth health so that you can share healthier bacteria with your baby. You can also wipe your baby’s teeth with a few grains of granular xylitol 3–5 times each day. Xylitol will nurture healthy mouth bacteria and loosen any plaque that may have infected your baby’s mouth.
TAKEAWAY:
•You do not need to fight a small child to floss or brush their teeth. Give them xylitol treats, or let them suck on a clean toothbrush dipped in a few xylitol crystals instead.
•Focus on ways to adjust eating and drinking habits to promote healthy bacteria and not harmful ones that feed on sugar and carbohydrates.
•Try to limit snacking and nibbling on sugary or acidic foods, and snack instead on the tooth-protective foods outlined in chapter 4 when possible.
•Don’t listen to out-of-date recommendations that tell you to avoid kissing your children. You intuitively know such ideas are wrong. Xylitol is your ally. Learn how to use it in your family. Healthy teeth at age four are a good indicator of a child’s future oral health.
TRUTH 3: BABY TEETH ARE VITAL AND INFLUENCE ADULT ORAL HEALTH.
Some people think baby teeth fall out and so these little teeth are of little or no importance, but this could not be further from the truth. Baby teeth play a vital role in the development of a child’s future mouth ecology, and this can determine his or her oral health as an adult. The bacteria that cover a first baby tooth as soon as it erupts will provide the foundation for the child’s future oral health. Bacterial sharing is continuous between adults and children throughout life, as we interact with, cuddle with, or kiss one another. Bacteria will easily transfer from an adult’s mouth to a baby’s mouth, and the first bacteria to cover a child’s tooth will easily transfer to consecutive teeth as others erupt alongside. An infant’s mouth ecology will continue to develop as the child matures, and many kinds of good and bad bacteria will reach a baby’s mouth in the first years.
The kind of bacteria that thrive in your baby’s mouth will be the ones that benefit by the foods and drinks that he or she is consuming. During the first years of life, it is relatively easy to control the kinds of bacteria that will flourish and become dominant in your baby’s mouth. This offers you an amazing opportunity to help a young child develop a wonderful and diverse bacterial ecology that can be the foundation for a lifetime of oral health.
As baby molars erupt, you have one of the most important opportunities of all to affect the future mouth health of your child. The bacteria that are the first to cover these new molars will gain a foothold in their grooved biting surfaces. The kind of bacteria that gain entry to these grooves will begin to dominate the mouth’s ecosystem. Preparing your child’s mouth to be as healthy as possible before these baby molars erupt is a simple way to promote the future mouth health of your child. These baby molars erupt soon after a baby’s first birthday, but there are some other opportunities that are almost as powerful for change: during kindergarten (as first permanent molars erupt), in the teen years from eleven to twenty-one years of age (when premolars and molars erupt), and finally in the college years (as wisdom teeth erupt).
TAKEAWAY:
•You cannot stop bacterial transfer, which is a totally desirable and normal part of healthy development. The sooner you guide your child’s mouth ecosystem, the easier it will be to establish healthy bacteria in the molar grooves, where they will become entrenched and offer protection from cavities, potentially for a lifetime.
•There are a few easy steps that can help pregnant mothers, grandparents, and parents to prepare their mouths for sharing healthy bacteria with children in the family. It is important to comprehend that, although fillings may be necessary to fix damage, fillings do not bacterially improve the health of your mouth.
•Xylitol should offer encouragement to every family with bad teeth, because it offers a way to change the mouth’s ecosystem from unhealthy to healthy over a six-month period. Regular use of xylitol has been shown to help prevent the transfer of harmful cavity bacteria to the next generation and to other children in a family, no matter the previous family history of cavities or bad teeth.
TRUTH 4: CAVITIES ARE NOT GENETIC AND ARE COMPLETELY PREVENTABLE.
Bad teeth are not a genetic trait, like a pointy nose or small ears, passed down the family tree. Genetics can affect oral health if a hereditary feature creates an increased risk for cavities. Like any other risk, this can be overcome with strategies designed to protect teeth and avoid dental problems. Remember, oral bacteria are transferable and literally pass from one generation to the next in droplets of saliva, moving from person to person as we kiss and interact with each other and even as we use toothbrushes. Children who develop healthy oral bacteria will have protection from cavities and gum disease and vice versa. The truth is that an inherited family feature may put you at increased risk for developing cavity-forming bacteria in your mouth or increase your susceptibility for bad teeth, which can make the dental problems appear to be genetic.
Hereditary features create risks for teeth, because they promote either acidic or dry mouth conditions, which are ideal for plaque-forming bacteria. Families may share a similar face, nose, or mouth structure that predisposes them to allergies, sinus problems, or mouth breathing, which all create drier mouth conditions. Certain jaw or lip shapes can make it difficult for people to seal or close their mouths and moisten their front teeth with saliva. Any of these features promote an environment preferred by cavity disease bacteria. This is why inherited features shared by family members can put an entire family at increased risk for cavities and dental disease.
TAKEAWAY:
•You or your children may be at a higher risk for cavities, because you are a mouth breather, have allergies, crowded teeth, or incomplete lip closure, but you can gain control over your mouth’s ecology and overcome these risks.
•Xylitol stimulates a flow of alkaline saliva into the mouth and can help control a dry mouth when used regularly. Xylitol will also help improve the ecology of your mouth and reduce the number of harmful bacteria to limit your risk for cavities. Xylitol works as the centerpiece of my Complete Mouth Care System, which offers cavity protection from the time adult teeth begin to erupt at around six years of age.
•If allergies, nasal drip, or sinus issues are compounding your dental problems, consider the additional use of a xylitol nasal spray, since it works to clear the nasal passages as effectively as xylitol clears and promotes health in the mouth.
PREVENTIVE CARE DURING PREGNANCY AND AFTER DELIVERY
The womb was believed to be a sterile environment, but now we know this is not accurate. Bacteria have been discovered in the placenta and also in the amniotic fluids around the baby. We also know that a mother’s mouth health can directly influence the health of her unborn baby’s initial gut bacteria. As a result, pregnant women should work to establish their own mouth health even before their babies are born.
Also, just before birth, hormonal changes alter the mother’s body pH and create an alkaline medium, friendly to healthy bacteria, in the mother’s vagina. This coats the baby as he or she passes headfirst through the birth canal. Dentists have often observed that children born by cesarean section appear more likely to have cavities. A cesarean-delivered baby may be more easily infected by harmful bacteria after birth and may also be more likely to experience colic, acid reflux, and stomach acidity than vaginally delivered children. Xylitol can easily be used to reverse any negative oral health consequences from cesarean-section birthing.
Breast Milk
Breast milk is a very misunderstood topic, and it frustrates me that breastfeeding has so often been thought a cause of early childhood caries. Media headlines have distorted the truth with false emphasis, and often the studies do not reflect the meaning of the headline. This was the case in a newspaper headline that falsely claimed that breastfeeding causes cavities.
In 2005, a study at the University of Rochester was published in the local paper with the headline: “Breast Milk Causes Cavities.” I immediately read the study, which was done on rats and did not deliver this result at all. I complained to the newspaper editor and the lead researcher, asking them to correct this error, which they eventually did, but the damage had been done.
Breast milk will only cause cavities if the baby’s mouth has been infected and allowed to develop very harmful plaque, an anaerobic kind that can ferment milk. Mothers should avoid passing harmful cavity bacteria to their babies, and they should also wipe erupting baby teeth with xylitol to clean them daily and ensure that they are not coated with unhealthy, stagnant plaque. Provided the baby’s mouth is protected in this way, breast milk will not cause cavities.
A baby with healthy mouth bacteria can safely drink breast milk from a bottle or be breastfed even during the night, and you will not need to immediately wipe or clean the baby’s teeth after this night feeding. A healthy mouth, with balanced and healthy bacteria is not at risk. The only risk is when aggressive anaerobic plaque bacteria are present, since they can ferment the milk and create strong lactic acids, which damage the baby’s teeth. These bacteria take days and even weeks to grow, and they are easily and quickly removed with some xylitol on a soft cloth or brush. Your baby will not need surgery for a lip tie, and do not allow yourself to be blamed for giving the baby a bottle or breastfeeding as a cause of dental problems. It is not pooling milk that is the concern but, rather, the pooling of cavity bacteria. Remember to wipe the hidden areas of your baby’s teeth that are close to the gumline every day with some xylitol; then, you can nurse your child with confidence, even when he or she has multiple teeth during the second year of life.
Remember, acidic or sweetened juices do cause problems to teeth directly by their acidity. Baby formula and skim milk are also not as safe as breast milk, although cleaning teeth with xylitol reduces cavity risks. Feed any acidic tooth-damaging drinks at mealtimes, and try to wipe the teeth afterward with xylitol, or as your child grows, consider giving him or her a xylitol mint or xylitol gum after meals. For mothers who have problems weaning children from juice in a sippy cup, try to interrupt the duration of sipping with tooth-safe snacks of very tiny cheese cubes to help break the damaging cycle of juice drinks.
SEALANTS
Sealants may give temporary protection to the most vulnerable biting surfaces in molar teeth, but there are alternative strategies that are equally effective and can help you avoid the potential hazards of placing sealants in your child’s teeth. Parents looking for protection for their children’s teeth have a choice: seal up the grooves of molar teeth and try to block out all bacteria, or adopt a long-term approach that works to nurture healthy bacteria and encourage them to colonize the molar grooves and dominate your child’s mouth. It takes about six months of adequate amounts of xylitol to adjust a mouth’s ecology—to promote good bacteria and eliminate unhealthy ones. Xylitol offers a natural defense system and one that will continue to offer long-term and more sustainable benefits than sealants, especially when xylitol is consumed regularly before and during times of tooth eruption.
Remember that sealants are a type of plastic, and even those sealants said to be free of BPA are also plastic and will require constant maintenance to prevent the problems that occur if they chip or break and allow liquids to seep under the sealant surface. Most important of all, sealants make it impossible to visually check the mouth and determine any change in health, taking away the ability for advance warning that can alert you to potential decay in these grooves. Losing sight of the molar grooves obliterates these bellwethers of mouth health, and now you only have one option: depend on regular X-rays for the rest of your child’s life to determine if cavities have formed.
One day, a friend told me that his dentist wanted to put sealants on his son’s teeth, and he had insisted that, without sealants, these teeth would become severely decayed by the boy’s next six-month checkup. I explained to the family how to improve the mouth’s ecology, using xylitol to promote healthy bacteria, and a dilute 0.05 percent sodium fluoride rinse to hasten mineralization and maturation of the new six-year-old molars. We discussed diet and healthy snacking and how a cavity usually takes over a year to form, but often can be reversed in a matter of months. With this approach, the motivation for a sealant was removed. The dentist checked the child’s teeth six months later, and found healthy molar grooves. The boy’s mouth health had improved, and his risk for decay had disappeared without the need for any dental treatments.
BLEACHING CHILDREN’S TEETH
A relatively new craze is causing damage that may not be fully recognized for decades. Sadly, it almost seems normal today to artificially whiten teeth. However, many studies indicate that this may not be safe, especially for the newly erupted teeth of seven- or eight-year-old children. These newly erupted teeth are delicate and start their life in the mouth lacking minerals, which is why they usually look darker at first. Artificially whitening young teeth may make them look whiter but minerals are lost in the process. Bleaching can also damage the internal proteins, damage the surrounding gums, and weaken a tooth’s outer enamel.
New adult teeth erupt into the mouth only partially mineralized, which means their enamel is soft and very porous. Light does not reflect properly on their surface until they have fully mineralized and hardened, which may take from six to twelve months through a natural process called maturation, which allows the new teeth to absorb minerals into their outer layer. Until this mineralization process has been completed, these teeth will always appear dull or yellowish in color, especially in stark contrast to the extreme white color of most baby teeth.
These new adult teeth are soft and easily stained and can be at risk for tooth decay. As a pediatric dentist, I believe the last thing these new teeth need is to be whitened with commercial whitening toothpastes that are abrasive or with whitening rinses or treatments that may make the new teeth look white but actually damage these teeth, roughen their surfaces, and pull out minerals that can cause enamel erosion, sensitivity, and a higher risk for cavities. Many studies have warned of the dangers to the protein structure of teeth following whitening, and this is an even bigger concern for thin, young enamel, which is very vulnerable. Nerve and pulp damage can sometimes lead to the death of the tooth—not immediately, but possibly in the future—and there is legitimate concern that changes to the stem cells inside a tooth could trigger blood problems many years ahead.
The most logical approach to help new teeth appear whiter is to be sure they are given every chance to mineralize. This would include careful habits, a good diet that includes healthy fats, adequate protein and possibly bone broth, plus a regimen of daily xylitol. You may want to consider vitamin supplements and digestive probiotics for a limited time as part of your child’s daily routine. Keep acidic drinks, particularly carbonated drinks and juices, to mealtimes. A dilute 0.05 percent sodium fluoride rinse will hasten the mineralization process, and the Complete Mouth Care System that I recommend in chapter 9 will quickly help to improve the color of these teeth.
Please ensure that your child rinses and spits effectively. At first, your child may need guidance to ensure he or she uses each rinse in the correct order and does not rinse with water between the steps. You may want to take photos and monitor the progress as these teeth gradually whiten over a period of about two years. The system I suggest will stimulate natural mineralization, as it encourages minerals from saliva to enter the teeth. Xylitol promotes a healthy mouth ecology and also helps control mineral loss from teeth. My mouth rinse system promotes conditions that stimulate mineralization, and the less teeth demineralize and the more teeth mineralize, the whiter they will look.
FLUORIDE: PROS AND CONS
Fluoride is not a vitamin, and parents need to know that I do not recommend fluoride as a supplement or as an additive to drinking water, because dental prevention does not depend on fluoride being absorbed into the body. Ameloblasts are cells found in the jaws of infants and babies, and these cells produce the material that forms a tooth’s outer enamel shell. Ironically, it is these enamel-forming ameloblasts that are most sensitive to, and most easily damaged by, ingested fluoride. If these cells are harmed by fluoride, the teeth will continue to grow, but gaps occur where enamel does not form properly. These enamel defects are seen as white spots or, in more severe cases, brown spots.
This condition is known as fluorosis, and this damage is only possible during the development stage as teeth are forming in a baby’s jawbone. Fluorosis is only possible if a child ingests too much fluoride between birth and three years of age. This is why children under the age of six should avoid any consumption of fluoride in their water or diet. I feel strongly about artificially fluoridated water, and I believe that other less visible health issues may occur alongside the fluorosis of teeth. I also believe that girls are more adversely affected than boys by the consumption of fluoride. On the other hand, I view the appropriate use of topical fluoride (in pea-size amounts of toothpaste or a 0.05 percent dilute fluoride rinse) as helpful for mineralizing newly erupted adult teeth or teeth that, in certain circumstances, have decay and are at risk for needing fillings. Children younger than six should not need to use any fluoride products.
Fluoride—My Personal Story
My five children were born between 1977 and 1990. I had been trained to believe in fluoride, so I gave my first child fluoride drops in the recommended concentration, because I lived in an area without fluoride in the water. At that time, dentists believed that giving fluoride to infants would allow their teeth to grow more perfectly, with smoother surfaces and more resistance to decay. My first daughter’s two permanent front teeth erupted, and they had large brown marks in the center enamel of each. Her ameloblast cells had been poisoned by the fluoride drops I added to her water each day when she was a baby. The damage was not visible until these adult teeth erupted at age eight. To correct their appearance, she later required cosmetic dental repair with veneers to mask the damage.
I gave slightly less fluoride to my second daughter, who was born in 1979, because I was a busy mother. This daughter has less damage, but all her teeth are covered in cloud-like spots on the front and side teeth, the result of similar (but slightly less) poisoning of her enamel-producing cells. Both of these daughters have evidence of thyroid damage, but not my other children, who never received fluoride supplements. My family filters fluoride out of our drinking water, and my grandchildren are never given any fluoride to drink. On the other hand, since the age of about six (when they could rinse and spit), my children have used a dilute sodium fluoride rinse twice per day, as part of the Complete Mouth Care System, which has protected their teeth and kept them healthy and cavity-free.
The use of topical fluoride cannot cause fluorosis, since fluorosis only occurs when fluoride is ingested during the period when teeth are developing—before the age of three.
Fluoride Varnish
As a child’s first permanent molars erupt during kindergarten or first grade, there will be no sign of a loose or missing tooth as they erupt behind the row of baby teeth at the back of the mouth. These molars are vulnerable to decay in an infected mouth and often have cavities within a year of eruption. Up to 93 percent of these first permanent molars have decay within two years of erupting, and pediatric dentists are accustomed to treating children who need crowns, root canals, or even extraction of these new adult teeth, even before they have had time to fully mineralize and harden. This is why the preschool and kindergarten years are the perfect time to start using xylitol to improve a child’s mouth health. To speed mineralization of any new adult teeth, a tiny amount of sodium fluoride toothpaste can be brushed on the outside of these emerging teeth to encourage maturation and to strengthen the enamel to offer maximum protection from decay. If one of these new molars has poorly formed enamel or a soft spot, your dentist may suggest a fluoride varnish as a way to help protect this tooth. A fluoride varnish is a resin that is painted onto teeth, and it will stick to teeth for a month or two. Don’t confuse a fluoride varnish with a plastic sealant or with the goopy fluoride gels or foams that are sometimes applied to teeth but which have little or no benefits. A fluoride varnish applied to newly erupted teeth, combined with the daily use of xylitol, is a good suggestion, since it offers some direct help to prevent cavities and may speed up tooth maturation, allowing these new teeth to gain their natural and unique protective covering more quickly. When the fluoride varnish wears off, the tooth remains pristine and unharmed, and there is no blocking of the grooves or damage to the tooth surface.
Basically, this approach is just another way to combine xylitol with sodium fluoride, as I suggest in my home care regimen. Fluoride rinsing definitely helps hasten tooth mineralization and maturation, which will increase the odds that your child’s new tooth will remain cavity-free for life. It is difficult to say if varnish offers any more benefit than a 0.05 percent sodium fluoride home rinse. I think the choice depends on each family situation.
If you have difficulty monitoring your child’s regular routines, a dentist-applied fluoride varnish may be an advantage and a convenient option to help speed up the absorption of minerals by the young enamel of this newly erupted tooth. To ensure good daily use of my Complete Mouth Care System, you will need to oversee your child’s bedtime routine, and if these events are not well orchestrated, it may be prudent to have some extra help from a fluoride varnish rather than end up needing a filling in the future.
Fluoride Rinsing
Only children who can safely spit should use a fluoride rinse. If your young child needs the healing help of fluoride because they have damaged teeth, I recommend either brushing your child’s teeth with a good fluoride toothpaste or asking your dentist about coating on a fluoride varnish. Before you allow a child to use a fluoride rinse, have them practice using plain water to determine if they can rinse and spit safely.
I suggest parents slowly add a drop or two of the fluoride rinse to a small cup of water, adding more as the child’s ability to rinse and spit improves. Eventually, you will build to a full-strength and undiluted rinse. Most of us need to spit at least twice (one spit followed immediately by another spit) to effectively remove the fluoride rinse from our mouths. Encourage your young child to spit several times, because extra spitting is fun and also ensures they do not hold rinse in their mouths and swallow it. Do not use any other rinse, and try not to let the child eat or drink after the fluoride rinse for about an hour or longer. This is why the perfect moment to use this rinse is just before bedtime.
Fluoride Toothpaste
For children who are at risk for cavities or who have cavities, I recommend a pea-size amount of a plain fluoride toothpaste, a paste that contains some sodium fluoride and silica and does not contain any glycerin or glycerol, an ingredient which could hinder the mineralization process. Some toothpaste is too abrasive, and I never recommend any paste with whitening agents, baking soda, or tartar-control chemicals, or any paste designed for sensitivity.
Twelve-year molars and wisdom teeth are as vulnerable as any new teeth when they erupt into a teenager’s mouth. These later-erupting molars frequently cause problems, because they are at the back of the mouth and difficult to clean. With my own children, I discovered that xylitol and the Complete Mouth Care System was able to help them successfully erupt these teeth and keep them clean and healthy. Again, parents may need to look for new teeth as they erupt and help their children learn how to brush around them effectively, as techniques for gum massage need to adapt and will not only help promote tooth health but will also maintain gum health.
Professional Recommendations
Many physicians and dentists still prescribe fluoride tablets to children and continue to believe that fluoride’s protection occurs from ingesting fluoride. There are also dentists who have been misinformed and remain fearful that breastfeeding causes cavities. Many parents are told that mechanical tooth cleaning is vital, and some parents struggle to comply, believing that brushing and flossing is the way to their children’s oral health. Parents can be calmed and become more effective dental health caretakers by understanding the bacterial nature of dental disease and how to employ the incredible benefits of pure xylitol to promote a healthy mouth ecosystem.
The American Academy of Pediatric Dentistry has a mission to seal every fissure in every tooth in the United States, which seems to me to be a catastrophic idea. Be aware that the kinds of mouth bacteria that are naturally resident in the healthy fissures of molar teeth are usually bacteria that aid in the digestion of carbohydrates and gluten. To block these grooves without adequate reason is to expose a child to the plastic BPA, and, more importantly, potentially eradicate the natural habitat suited for these important bacteria. Our concern should be that sealants can leave children at risk for gluten intolerance or for digestive problems at some point in their lives.
BRACES FOR ADULTS AND TEENS
Braces and orthodontic appliances make tooth cleaning complicated, they can prevent your lips from closing over your front teeth, and they can cause mouth breathing, which dries your mouth and leaves it at increased risk for gum disease and cavities. Many orthodontists worry about demineralization of teeth, because they have seen how often this damage occurs.
Braces should never be placed in an unhealthy or infected mouth, but this seems to happen all the time. Sometimes parents imagine that the orthodontist will monitor their child’s teeth during treatment, but this may not occur regularly, or at all. Anyone considering braces for their child should ensure that their child’s mouth health is virtually perfect before the first appointment for braces. Braces can usually wait, and if you don’t prepare the child’s mouth, braces can quickly turn poor dental health into a dental nightmare. Many teeth are scarred by braces, and this scarring forms white spots, which can easily become cavities. Brackets and other equipment often trap bacteria, and in an infected mouth, hidden in difficult places, these aggressive acid-producing bacteria may demineralize teeth and ruin your child’s gum health.
A mother recently told me how her thirteen-year-old has been seeing a dentist regularly since she was small. The girl needed a few fillings each year, despite efforts to limit sugar and brush and floss in the way she had been instructed. The dentist put braces on her teeth to straighten them. When the braces were removed two years later, this young girl needed fifteen fillings in her permanent teeth. The mother feels sad and guilty, and with correct care before and during the time in braces, all this could have been completely prevented.
Of course, everyone should limit sugar and carbohydrates, but it is generally more realistic to insist that sweets and damaging drinks are consumed at mealtimes. Then, your child can learn to end every meal, snack, and drink with xylitol to protect their tooth enamel. Twice per day my Complete Mouth Care System can be used, but children will need adult supervision to ensure they spit out the rinses and use them in the correct order. Sometimes interdental brushes may be useful to clean where food is trapped, and these few strategies during orthodontic treatment can help your child avoid dental drama and instead receive praise for great oral care with no signs of bleeding gums, bad breath, scarred enamel, or cavities.
A NEW APPROACH
Statistics in the United States indicate a pandemic of early childhood caries, teens with fillings in over 75 percent of their teeth, and an estimated 50 percent of thirty-year-olds with gum disease who do not even know about it. The statistics show that, by the end of life, our current generation of seniors have few pristine teeth, and 98 percent have had lost teeth, fillings, crowns, implants, bridges, or dentures. Public health efforts have spent money to try to curb dental disease by teaching the public to brush and floss. Cities all over the United States have built state-of-the-art clinics and school-centered mobile units, and many have developed an army of professionals to treat adults and children, yet the problems escalate.
Today, dental disease is the most prevalent of all childhood diseases, and the 2006 MetLife Oral Health Insights Study for Americans shows that our young people are not doing well either. Twenty-four percent of responders ages 18–34 said their gums bled when they brushed; a third said their teeth were loose or discolored; one out of five young adults described their oral health as fair to poor; 15 percent said they had consistently bad breath; and 27 percent of young people between 18 and 34 said they had sensitive teeth that hurt when they drank hot or cold beverages.If we want to step outside these awful statistics, we must develop a new approach.
The strategies I use for adults can be modified for each stage of a child’s development, for patients with or without cavities or gum disease. My focus is always to:
•Develop and nurture healthy mouth bacteria with good eating habits and frequent use of xylitol
•Help teeth become strong and shiny by giving them time to interact with saliva and by choosing oral care products that enhance oral health
•Protect teeth as much as possible from acidic damage
Cavities in children’s teeth cannot be regarded simply as a statistic. The painful truth is that one or two cavities can easily crescendo into a lifetime of escalating dental problems. Once a filling has been placed in a tooth, the filling will likely need repair or replacement every 5–10 years. Cavities and gum disease are not inevitable. Xylitol can change the ecosystem of a mouth, weeding out unhealthy bacteria while promoting probiotic and protective ones.
Finland changed its public health policy in 1972 to focus its dental health policies on preventive care and away from drilling and filling. Ninety percent of Finnish kindergartens and preschools now offer xylitol gum to children during the school day in a program to adjust the oral microbiome in advance of the eruption of permanent adult molars. The effectiveness of this program has been monitored, and in 2013, the Finnish National Institute of Health and Welfare recommended that all one- to six-year-olds should be given xylitol confectionery after meals and that publicly funded xylitol products should be provided to children to improve their dental health and decrease the cost of public dental care. My belief is that teaching families about the benefits of xylitol for young children could be an effective and very low-tech method that could help us control dental disease in a fun and delicious way in every community.
As we have discussed, a pregnant mother with bad teeth can use xylitol and change the kind of bacteria that she passes to her baby. She can reduce the chance of decay in her child’s teeth simply by reducing the number of harmful bacteria in her own mouth by using xylitol. With a transformed mouth, she will transfer healthy, not bad, bacteria to her baby.
Parents-to-be, even those with cavities, should consider using small but frequent exposures to xylitol during pregnancy and throughout the first years of their baby’s life (as baby teeth erupt) to interrupt the transmission of cavity bacteria and improve the long-term dental health outcome for their child.This process can be called share-care, which indicates an understanding that health benefits are passed along by sharing healthy bacteria between family members. Understanding how share-care works should encourage families to enjoy their loving interactions and kissing one another, especially with a new baby.
Children’s mouth health is important. By developing healthier mouths, I am hopeful that the next generation may avoid many of the fearful health conditions exacerbated by poor teeth and gums. With continued efforts to inform and educate, I hope people will navigate the confusion of our current oral health approach. It is my hope that you will be able to take this new information to your extended families and friends and, with these effective home strategies, change the outcome and give your kids and grandkids the gift of healthy teeth—for life!