Beyond the Tooth Fairy

Caring for your children's teeth isn't magic. Just follow some simple advice.

When April and Raphy Decipeda noticed a dark spot on their 2-year-old son’s front tooth, they suspected sinister bacterial forces were preying upon his young teeth. Wisely, they called a pediatric dentist.

After a general examination of Christian’s teeth, the dentist tallied about 10 cavities and recommended that the boy’s intensive work be done in a hospital under general anesthesia. Four pulp therapies (a euphemism for root canals) and 10 caps later, Christian emerged like a champ and has absolutely no fear of the dentist. Now at 4 1/2, he brushes his teeth up to three times a day and even occasionally attempts flossing.

“He doesn’t associate pain with the dentist,” April says. “And even though his situation was and continues to be more of a challenge than with our two other children, he takes pride in his teeth and loves to show them off, especially after he brushes.”

Most dentists advocate starting good dental care at an early age. And like many parents, the Decipedas face the often daunting costs and perceived pains that accompany trips to the dentist. Even without dental insurance, the Decipedas’ health-care policy covered most of the hospital and anesthesia charges, but not the nearly $2,000 in dental fees. But given Christian’s positive attitude toward his dental health, his parents are happy with the outcome.

Christian’s story is drastic. His parents still aren’t sure what exactly caused his problems, but look to a number of factors, including Christian’s genetics, his penchant for drinking orange juice and a stressful second trimester of his mom’s pregnancy, which is when babies’ soft tooth tissue forms.

“We can prevent cavities when we start early,” says Dr. Yasser Armanazi, assistant professor of pediatric dentistry at the Case Western Reserve University School of Dental Medicine. “So it’s important that parents establish good habits and avert bad ones.”

Infant care

Children should avoid sucking juice from a sippy cup for extended periods, pacifier use and thumb sucking, especially beyond age 4, Armanazi says. Also, babies and toddlers shouldn’t sleep with milk or juice bottles. The sugars in these drinks — even milk — fester in tiny nooks and crannies and often lead to tooth decay.

“I thought I was being a good mother by giving my children fruit juice,” April says. “But our dentist told us that we were in essence pouring sugar on our children’s teeth. Now, I’m conscious of juice drinking and encourage frequent brushing.”

Parents should examine their babies’ mouths before the first teeth begin to surface, which usually occurs between four and eight months of age, says pediatric dentist Dr. Lisa Richards. “Gently massage their gums and get them used to having things in their mouths,” she says. “This way, when it comes time to brush and floss, it’s not such a strange sensation.”

Painful teething can be assuaged with over-the-counter gels and drops. Ice rubs and chilled teething rings can also help relieve pain, but dentists say that minor discomfort is normal and will pass. Expect teething babies to want to chew on something to help relieve the pressure from incoming teeth.

Baby teeth

When a couple baby teeth are in place, parents can let their children pick out a favorite toothbrush and, together begin a morning and nighttime brushing routine. “It’s important that parents make the brushing experience fun as early as possible to establish a lifelong routine,” Armanazi says. “And then it’s time to start thinking about the first trip to the dentist.”

The American Academy of Pediatric Dentistry recommends that parents take their children to the dentist six months after the first tooth comes in, or at age 1, and continue visiting every six months.

Many dentists say there’s a big misconception about the care of baby teeth. Just because these teeth are temporary doesn’t mean that cavities won’t affect the still-developing permanent teeth. It’s common for an untreated baby-tooth cavity to sink into the nerve and infect the permanent tooth.

“We see this problem all too frequently,” Armanazi says. “People think that baby teeth are no big deal, but how these teeth are treated can directly affect permanent teeth. Even if the teeth don’t get abscesses, they will tend to crumble down and space can be lost between the teeth, which then can lead to a need for braces.”

The Tooth Fairy

Around age 6, a new set of permanent molars erupt, which is usually when children are ready to begin using a fluoride rinsing solution. Parents should instruct their children not to swallow the rinse, only swish and then spit it out.

And just as soon as all those sparkling white teeth are in place, along comes another set of changes. Anywhere from age 5 to 8, kids’ teeth start becoming loose, and along with visits to the dentist, kids now look forward to visits from the Tooth Fairy. Usually, but not always, the bottom middle teeth are the first ones to go, followed by the upper middle teeth. Loose teeth signal a new phase in the child’s oral maturity.

“One of the mistakes we see parents make is to not touch a loose tooth,” Richards says. “When a tooth is loose, it’s time for it to go. Let kids wiggle them and pull them out themselves. The underlying teeth are trying to get into position, so by freeing up space, these new teeth will have an easier time.”

A typical concern of parents is the color variation of emerging permanent teeth in contrast to the often ultra-white baby teeth. No need for worry. Adult teeth are simply a different color. “This is just part of the way we’re genetically programmed,” Richards says. “Most baby teeth line up perfectly and are a pleasing bright white color. And then the new ones come in yellow or gray and may be crooked. Color isn’t a big deal.”

Richards says many whitening systems are available in drug and grocery stores, and that dentists also offer professional-grade bleaching customized to patients’ desires. However, she doesn’t recommend using them until at least age 14.

Parents of school-age children could save much grief by packing lunches that include healthy, natural foods. “I know most kids don’t want celery sticks as their treat,” Richards says, “but don’t give them sugary, gummy, sticky snacks that adhere to teeth and won’t be brushed away until evening.” Apples, pretzels and low-sugar snacks are preferable alternatives to heavy-sugar ones.

Brace for orthodontics

As kids get older, crooked teeth may require orthodontic treatment. Luckily, the stigma of wearing “tinsel teeth” is over, and many kids today look forward to wearing braces and the straight teeth these orthodontics produce.

“The ugly and painful braces seen only a generation ago have been transformed into small, easily applied brackets,” says Dr. Dennis C. Beeson, assistant professor and clinic director, Department of Orthodontics, Case School of Dental Medicine. “Young patients appreciate an attractive smile and are willing to spend the two-year average treatment of having their teeth straightened.”

Many dentists recommend two phases of orthodontics, harnessing the natural growth of the jaw bones and teeth during the early phase between age 8 and 10, and then applying a second set of orthodontics at around age 12 to 13. “Some things will self-correct,” Beeson says, “and many people can skip the first phase of orthodontic treatment. But if the growth pattern looks as though teeth are getting worse, then it’s something to consider, especially if the upper archway is narrow or if there are airway problems.”

So, once a child is fitted with braces, some fun decisions involve choosing colors and spicing up the package with festive bands. “We see kids pick orange and black bands for Halloween or red and green ones for Christmas,” Armanazi says. “It’s a lot of fun these days. The problem isn’t braces; it’s caring for teeth with them.”

Teeth are more susceptible to cavities with braces because pieces of food tend to get stuck in the orthodontics and can lead to decay if not cleaned right away. “Parents and kids need to be religious about brushing, but at this age, the good news is that the kids are able to do it themselves,” Armanazi says.

As for Christian Decipeda, braces are too far into the future for him or his parents to worry about. But for now, he enjoys visiting the dentist and taking care of his teeth with help from mom and dad.

“Dental care may be difficult, but it’s worth it,” Raphy Decipeda says. “Pick a good dentist and start going. It may cost time and money now, but over time, I bet we’re saving money on repair work simply by brushing, flossing and visiting the dentist regularly.”

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