When should I schedule my child's first trip to the dentist? Should my 3-year-old be flossing? How do I know if my child needs braces?

Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don't always know the best way to do so.

When Should Dental Care Start?

Proper dental care begins before a baby's first tooth appears. Just because you can't see the teeth doesn't mean they aren't there. Teeth actually begin to form in the second trimester of pregnancy. At birth, your baby has 20 primary teeth, some of which are fully developed in the jaw.

Running a damp washcloth over a baby's gums daily will help clear away harmful bacteria. Parents can brush kids' teeth as they come in with an infant toothbrush, using water with just a smear of toothpaste until about age 2.

Around age 2, most kids can spit while brushing. Use a pea-sized amount of toothpaste, with supervision, until around age 5.

Even babies can develop tooth decay if good feeding habits aren't practiced. Putting a baby to sleep with a bottle might be convenient, but can harm the baby's teeth. When the sugars from juice or milk remain on a baby's teeth for hours, they can eat away at the enamel, creating a condition known as bottle mouth. Pocked, pitted, or discolored front teeth are signs of bottle mouth. Severe cases result in cavities and the need to pull all of the front teeth until the permanent ones grow in.

Parents and childcare providers should help young kids set specific times for drinking each day because sucking on a bottle throughout the day can be equally damaging to young teeth.

Pediatric Dentists

Consider taking your child to a dentist who specializes in treating kids. Pediatric dentists are trained to handle the wide range of issues associated with kids' dental health. They also know when to refer you to a different type of specialist, such as an orthodontist to correct an overbite or an oral surgeon for jaw realignment.

A pediatric dentist's primary goals are prevention (heading off potential problems before they occur) and maintenance (using routine checkups and proper daily care to keep teeth and gums healthy).

Preventing Cavities

The American Dental Association (ADA) recommends that a child's first visit to the dentist take place by the first birthday. At this visit, the dentist will explain proper brushing and flossing techniques (you need to floss once your baby has two teeth that touch) and conduct a modified exam while your baby sits on your lap.

Such visits can help in the early detection of potential problems, and help kids become used to visiting the dentist so they'll have less fear about going as they grow older.

If a child seems to be at risk for cavities or other problems, the dentist may start applying topical fluoride even before all teeth come in (this also can be done in the pediatrician's office). Fluoride hardens the tooth enamel, helping to ward off the most common childhood oral disease — dental cavities (also called dental caries).

Cavities occur when bacteria and food left on the teeth after eating are not brushed away. Acid collects on a tooth, softening its enamel until a hole — or cavity — forms. Regular use of fluoride toughens the enamel, making it more difficult for acid to penetrate.

Although many towns require tap water to be fluoridated, others don't. If your water supply is not fluoridated or if your family uses purified water, ask your dentist for fluoride supplements. Most toothpastes contain fluoride but toothpaste alone will not fully protect a child's teeth. Be careful, however, since too much fluoride can cause tooth discoloration. Check with your dentist before supplementing.

Discoloration also can occur from prolonged use of antibiotics, and some children's medications that contain a large amount of sugar. Parents should encourage kids to brush after they take their medicine, particularly if the prescription will be used for a long time.

Brushing at least twice a day and routine flossing will help maintain a healthy mouth. Kids as young as age 2 or 3 can begin to use toothpaste when brushing, under supervision. Kids should not use a lot of toothpaste — a pea-sized amount for toddlers is just right. Parents should always make sure that kids spit out the toothpaste instead of swallowing.

As your child's permanent teeth grow in, the dentist can help seal out decay by applying a thin wash of resin to the back teeth, where most chewing occurs. Known as a sealant, this protective coating keeps bacteria from settling in the hard-to-reach crevices of the molars.

Dental research has resulted in better preventive techniques, including fillings and sealants that seep fluoride, but seeing a dentist is only part of good tooth care. Home care is equally important. For example, sealants on the teeth do not mean that a child can eat lots of sweets or skip daily brushing and flossing — parents must work with kids to teach good oral health habits.

If Your Child Has a Problem

If you are prone to tooth decay or gum disease, your kids may be at higher risk as well. Therefore, sometimes even the most diligent brushing and flossing will not prevent a cavity. Be sure to call your dentist if your child complains of tooth pain, which could be a sign of a cavity that needs treatment.

New materials mean pediatric dentists have more filling and repair options than ever. Silver remains the substance of choice for the majority of fillings in permanent teeth, though other materials, such as composite resins, are gaining popularity. These resins bond to the teeth so the filling won't pop out and can be used to rebuild teeth damaged through injury or conditions such as cleft palate. Tooth-colored resins are also more attractive.

But in cases of fracture, extensive decay, or malformation of baby teeth, dentists often opt for stainless steel crowns. Crowns maintain the tooth while preventing the decay from spreading.

Orthodontia

As kids grow older, their bite and the straightness of their teeth can become an issue. Orthodontic treatment begins earlier now than it used to, but what once was a symbol of preteen embarrassment — a mouth filled with metal wires and braces — is a relic of the past. Kids as young as age 7 now sport corrective appliances, and efficient, plastic-based materials have replaced old-fashioned metal.

Dentists know that manipulation of teeth at a younger age can be easier and more effective in the long run. Younger children's teeth can be positioned with relatively minor orthodontia, thus preventing major orthodontia later on.

In some rare instances, usually when a more complicated dental procedure is to be performed, a dentist will recommend general anesthesia be used. Parents should make sure that the professional who administers the medicine is a trained anesthesiologist or oral surgeon before agreeing to the procedure.

Don't be afraid to question the dentist. Giving your child an early start on checkups and good dental hygiene is an effective way to help prevent this kind of extensive dental work. Encouraging kids to use a mouthguard during sports also can prevent serious dental injuries.

As kids grow, plan on routine dental checkups anywhere from once every 3 months to once a year, depending on the dentist's recommendations. Limiting intake of sugary foods and regular brushing and flossing all contribute to a child's dental health. Your partnership with the dentist will help ensure healthy teeth and a beautiful smile.

Reviewed by: Steven Dowshen, MD
Date reviewed: October 2012