National Children’s Dental Health Month: Q&A with Dr. Julia Dobson

February is National Children’s Dental Health Month! In honor of the occasion, we sat down with Dr. Julia Dobson from our Breckenridge Lane practice to answer some questions around oral health in children.

At what age should children begin seeing a dentist?  

We want a dental home for your child by age 12 months. So an easy way to remember: on the first birthday make the first dentist visit. If mom or dad are worried about teeth coming in, trauma, issues with eating or nursing, it’s always fine to make the child’s first visit earlier. 

Does it really matter how children treat their baby teeth since they will eventually lose them anyway?

I get this a lot, and I totally understand why this question surfaces, but baby teeth are so important. First, primary (baby) teeth have nerves. So if a cavity or trauma is affecting the pulp or nerve of the tooth, the child could be experiencing pain. This pain will then affect the child’s food intake and growth, it can affect sleep and cognition. Therefore, dental pain has a direct affect on the child’s behavior and performance in school.

These teeth are place holders for our permanent teeth. If the young child starts to have teeth pulled early, other teeth like to move into this new extra space. I always say, teeth are like dancing partners, they want to be touching each other. This dental drifting can then cause the permanent teeth developing down in the bone to be blocked when it’s their time to erupt.  

Finally, baby teeth serve the functions of esthetics, speaking and eating. If baby teeth have large enough cavities that warrant extractions, it can affect the child’s self esteem as their smile is altered. We always try to restore the cavities in a timely manner to avoid extractions. The child’s speech is changed if anterior teeth are missing, and teeth are super helpful with chewing food. 

What is the best way to keep my child’s mouth clean before teeth come in?

One of the best ways to set up a baby for a lifetime of good oral hygiene is for the parent to address any of their own dental needs. On our first appointment together, I always tell parents why it is so important to get any of their own cavities fixed. Cavities are driven by a bacteria called Streptococcus Mutans (S. Mutans). If the parent has a large amount of S. Mutans in their own mouth, and the family is sharing food, drinks, and eating utensils, then the parent is directly passing on the bacteria to the baby. The baby will then have the right bacteria to start making cavities once their teeth erupt. 

It is so important to create healthy nighttime habits before teeth come in. I try to encourage eliminating bedtime milk bottles and limiting nighttime breastfeeding. If a child is going to bed with a milk bottle, the milk — which has sugar in it — will rest on the child’s teeth all night, increasing the risk for decay. So before the teeth even erupt, try to limit the bedtime milk habit. If a bedtime bottle or breastfeeding is necessary (I get it, I’m a mom too), then I encourage the parent to wipe off the mouth with a wet wash rag or even brush the teeth after the feeding. 

Are thumb-sucking and pacifier habits harmful to teeth? 

Pacifier and thumb or digit habits are called non-nutritive sucking habits. These habits are very common and a good way for the infant to self soothe. Beyond infancy, these habits can alter the way the child’s teeth are supposed to naturally grow, creating what is called a malocclusion. A child with a non-nutritive sucking habit can have an excess amount of anterior flaring, so the front teeth buck outward. It is common to see an anterior open bite where the front teeth do not close down together. It’s also common to see a posterior crossbite, where the back teeth do not overlap correctly, and this can lead to the abnormal eruption of permanent teeth. I like to see pacifiers eliminated around age 2. Generally, pacifiers are easier to eliminate than a digit habit. I am a mom to a thumb sucker and we are still trying to stop this habit. It is important for the parent or caregiver to offer gentle guidance when the child is trying to stop their thumb or finger- sucking habit rather than become frustrated or shame the child. It’s likely the child developed  this habit in utero, so it will take time for him or her to figure it out. You can always ask your pediatric dentist for advice. Each child is different, but eventually most everyone stops using a pacifier and sucking their thumb. 

What is the biggest cause of cavities in children? 

The ingredients for a cavity: the right bacteria (S. Mutans), less-than-optimal hygiene, the right child (for example, genetic predispositions like enamel quality and saliva composition), and diet. I see a lot of kids and usually pinpoint an issue with diet and hygiene. 

• Diet: I tell parents to be aware of anything sticky, including gummy vitamins. Gummy vitamins are sticky, have sugar and get wedged in between teeth. Other foods include granola bars, raisins, dried fruit, fruit snacks and sticky candy. We are all human and love treats, so stick with things that melt. A piece of plain chocolate does not get stuck between teeth like a piece of Laffy Taffy. 
• Hygiene: So often parents allow the child to brush their own teeth, and often flossing is not part of the routine at all. Parents should brush and floss their child’s teeth until the child can fully tie his shoelaces and write his name in cursive. Even then, I still want the parent to spotcheck the teeth for any missed areas. Night time is the most important time to have the best hygiene. Flossing is also key. Even on a baby, if teeth are touching, the toothbrush bristles can not get in between the teeth. I like the Crayola brand of flosser picks. They come in fun flavors and are easy for the parent to use on their child. 

How can I help my child avoid cavities?

If the parent values their own teeth, generally the child will see the importance of dental health. To stay on top of everything, I encourage the parent to brush and floss for the child, help the child make good food choices (avoid buying sticky snacks and sugary drinks), and get the child into the dental office every six months for preventive care. 

How do I know which kind of toothpaste to give my child? Is it safe to use one that has fluoride?

After 12 months, I want the child to be using an anti-cavity toothpaste with fluoride. I always say, if there is a Cars or Frozen character on the tube, then you know it’s for kids. Smear a small amount of toothpaste for children who do not spit. If the child is able to spit on command, use a pea-sized amount. Never let the child have free access to the tube of toothpaste. 

When should children begin brushing their own teeth?

I like for the parents to be a part of the brushing and flossing routine for as long as possible, and especially at night. Once the kid can tie his shoelaces independently and write his name in cursive, he has the hand skills to brush and floss his own teeth. 

What should I do if my child has a toothache?

Make a dental appointment with a pediatric dentist. The dentist will likely order a radiograph to see what is causing the toothache. If the toothache is from a cavity, and it is causing pain, it means the bacteria is affecting the nerve of the tooth. It is important to not ignore the child’s complaint, because dental infections can progress into dental abscesses, cause facial swelling and fever, and can become serious rather quickly. 

If you could only provide one piece of advice for parents when it comes to their children’s teeth, what would it be?

It’s always easier to prevent dental disease than to deal with dental disease once decay has developed. A lot of parents are scared of the dentist and this anxiety rubs off on the child. It is my job as a pediatric dentist to stop that. I want my patients to love coming to the dentist, so they grow into adults with total body health, which includes good oral health. I also want to say, cavities sometimes happen and that is okay. I would love to have a T-shirt made that reads “Cavities Happen”. Even my daughter (yes, the thumb sucker) has gotten two fillings. She had a ton of fun getting them fixed. 

Learn more about Dr. Julia Dobson by clicking here.