Early dental care: From brushing to fluoride

Finding your child a dentist by their first birthday and brushing teeth as soon as they erupt are important practices, said Steven Chapman, pediatrician at Dartmouth-Hitchcock in Lebanon and New Hampshire oral health advocate for the American Academy of Pediatrics.

First teeth come in at about six months and parents may be surprised to find they should start brushing right away.

Some pediatric offices, like Chapman’s also offer topical fluoride treatments. Chapman says 18 months is about the age when he begins using a fluoride varnish and the practice is starting to catch on with pediatricians throughout the state.

But even if a child receives fluoride varnish in a pediatrician's office, they still need to see a dentist.

Andrew Cheifetz, pediatric dentist at Children's Dental Center of New Hampshire in Amherst, said the first visit with a dentist is primarily about meeting the family, discussing best practices like putting your child to bed without a bottle, brushing and fluoride, as well as answering questions the parents have.

Unless the child has dental issues, Cheifetz said he may not even see the child back until a year or more after that first visit.

“As soon as your teeth come in, you can get cavities,” Cheifetz said which is why it is important to establish good dental habits very early.

Dentists tell parents to use toothpaste containing fluoride on children starting at about 1 year, Cheifitz added, although some dentists hold off on that recommendation until the child is 2.

A smear of toothpaste or an amount about the size of a piece of rice is what most doctors suggest using on younger children.

“A little bit goes a long way,” Cheifitz said, he tells patients to start with about half the size of a pea.

Fluoride: How much is too much?

Guidelines regarding fluoride supplements have changed in the past several years, Cheifitz said.

Pediatricians routinely prescribed fluoride supplements to patients 6 months to 16 years who do not have fluoride in their well or town supplied water. New pediatric dental recommendations suggest supplementing with fluoride pills only if a child is at higher risk of tooth decay.

This helps with what Cheifitz calls the “halo effect.” Although there might not be fluoridated water at home, the children may spend a lot of time at their grandparents or another place where there is fluoride in the water. If they are on supplements and drinking it in the water on a regular basis, they may be getting too much.

Fluoride comes from many different sources and too much can cause fluorosis of the teeth, which can result in a brownish staining.

In New Hampshire fluoride naturally occurs in some areas; people with well water should test to see how much fluoride they have. Cheifitz has some patients whose fluoride level in their well water is way too high for children to drink.

The recommendation for fluoride in water for children is 1 part fluoride to 1 million parts water (parts per million or ppm). Some areas near where Cheifitz practices have fluoride that measures up to 9 parts per million. He sometimes has to caution parents to not let children drink the water at home and in extreme cases, the family is not even able to cook with water from their wells.

Although there are concerns about some children consuming too much fluoride, there are also concerns about children who need it the most.

The American Academy of Pediatric Dentistry guidelines for supplemental fluoride outline that the primary caregivers dental health should be considered. If they have cavities, fluoride might be suggested for their children.

Low socioeconomic status, children who have several sugary drinks or snacks a day or are put to bed with a bottle that contains sugary liquids, are among some of the other risk factors professionals consider.

Parents should speak with their child’s doctor and dentist about what kind of dental care is best.        

Andrea Bushee Belanger is a PMA award-winning freelance writer and mom living in Pembroke.

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