Fluoride? Yes Please!

At the time of my son’s birth, my wife in all her new motherly excitement joined many of our local mom groups on Facebook. These groups have been an encouraging community to turn to for truly anything.

It wasn’t long until she noticed a common question popping up, “when is the right time to start using fluoride toothpaste for my little one?”She turned to me and said, “What should I write?” I think she was looking for a simple cut and dry answer; my actual response was “well it depends!” 

Below I have broken it down into an easy fluoride cheat sheet. What is it, why do we need it, and when and how to use it?

What is Fluoride?

Fluoride is a naturally occurring mineral, easily dissolved in water and found in varying amounts in rivers, lakes and oceans.

Why do we need Fluoride?

When it comes to teeth, fluoride is absorbed into microscopic areas that recently lost mineral (from the cavity process) and rebuilds a stronger, more resistant outer layer of tooth. Halton and Hamilton community water is fluoridated to an optimal amount.Drinking fluoridated water and brushing with fluoridated toothpaste at least daily are perhaps the most effective methods in reducing dental cavities in children.

When to start using Fluoride for Little Ones?

The decision when to use fluoride and how much to use is based on a risk assessment and is unique for each young patient.When determining the risk-benefit of fluoride, the assessment is mild discoloration of adult teeth versus preventing devastating dental disease. Professional fluoride treatments at the dentist are recommended for all children at risk of cavities. Your pediatric dentist will do this risk assessment at each visit and will determine when it is time to start using fluoride toothpaste and when fluoride treatment at the dental office is a necessity. So you see why my answer was it depends!

How to use Fluoride?

Use no more than a ‘rice-size’ amount of fluoridated toothpaste for children less than three years of age and no more than a ‘pea-size’ amount for children aged three to six, twice daily for all children.Most toothpastes sold in Canada have a standard concentration of fluoride, irrespective of flavor, or whether marketed for children, adults or sensitive teeth. Frankly, it doesn’t matter which brand toothpaste you and your children use, just use one!

Quick Facts on Dental Decay:

·         Tooth decay is the single most common chronic disease in children and adolescents, 5 times more common than asthma, and 7 times more common than hay fever.

·         Research has shown that fluoridated drinking water greatly reduces the number of cavities in children.

The clearest answer on when to start using fluoridated toothpaste is tohave your child’s pediatric dentist assess their cavity risk. It is this assessment that will determine the earliest or latest timelines to introduce fluoridated toothpaste into your child’s daily dental care routine. 

Look ‘ma I got a new tooth: A short guide on the eruption of permanent teeth

For some teething is eons past, unlikely remembered by children, but the days of dental eruption is far from over! Those 32 permanent teeth erupt on average over the ages of 5.5 to 30 years old. With all these changes taking place, parents of Burlington Pediatric Dentistry frequently ask common questions regarding dental growth and development. I’d like to take this opportunity to highlight some of those questions and how I would speak to them as if we were sitting on the bright green benches of the clinic.

Q: When do the first permanent teeth erupt and in what order?

A: The first permanent teeth to erupt are typically the lower front incisor or the first molar (6-year molar), on average between 5.5-7 years old.  These are followed by the upper central incisors, then upper and lower lateral incisors, around 8 years old. Most children take a break in this “mixed dentition” stage until 10 years old.

Q: My child’s baby tooth is gone, when will the permanent tooth take its place?

A: Although we often expect when a baby tooth is lost it will get replaced immediately, the upper incisors are notoriously late arrivers, erupting as late as 12 months after the baby teeth are shed. While these maybe average times and patterns, some children deviate without concern, however it is best to make sure with your Pediatric Dentist.

Q: How are permanent teeth different from baby teeth?

A: Have a great look at that exciting new tooth, and recognize it is much different from the one it replaced in size, shape, and colour.

Size - It is bigger in every dimension, and so is each composing layer.  The larger shape of the permanent incisors starts to make the mouth look pretty full and may close spaces or cause crowding. Your Pediatric Dentist will be able to give you a good idea as to how it will all fit together, but the real space experts in dentistry are Orthodontists.  The current recommendation for a first Orthodontist consultation is age 7, but don’t worry, this doesn’t mean treatment will start then for most children!

Shape – You may wonder, what are those ridges on the top of my child’s teeth? These bumps or ridges known as mamelonsmay look funny, but they will wear down naturally on their own. Don’t let anyone grind them down; they sometimes have tiny pulp (nerve) horns the inside.

Colour - Permanent teeth are darker than baby teeth, this is because they are bigger in every dimension.  Even the inner layers are thicker, so less light passes, resulting in a darker tooth that is less translucent.  The colour of new teeth may be affected by a history of childhood trauma, disease, certain antibiotic or drug exposures, or other infections including infections of the baby teeth. Your Pediatric Dentist will be able to help determine any specific dental anomalies.

Q: My child’s permanent tooth has grown in but the baby tooth is still there, is that okay?

A: Ideally, as new teeth emerge they will replace the position of the corresponding baby teeth. This does not always occur, so watch for teeth that erupt inside or outside the arch form, especially if the corresponding baby tooth is not lost. The newly erupted tooth no longer forces the loss of the baby tooth and it may need a little encouragement from your Pediatric Dentist.

Remember, permanent teeth are supposed to last the rest of your child’s life, help them brush and floss daily for a lifetime of excellent oral health.

Tooth Friendly Nutrition for the Active (and Scheduled) Child

For the busy child, risk of dental caries (cavities) is high. Being out of the house for long periods of time means eating on the go. I find myself face to face with an important question when supporting the dental health of busy families in our communities: How can I provide easy to use information so parents feel empowered to feed their kids tooth friendly snacks on the road between school, dance, swim, hockey, piano, etc.? 

The landscape of articles on healthy and time convenient snacks for kids on the go is vast. Detailed lists of ingenious recipes are an easy Google search away. The parental toolbox is full, and back pockets of tricks are brimming at the seams, but with that, I would like to squeeze another conversation into the mix – one that focuses on food choices for nutrition breaks supporting dental health.

For busy families the equation can be quite simple by choosing tooth healthy foods and limiting the frequency (not amount) of carbohydrates. This means enjoying a nutrition period of 10-15 minutes, followed by a couple of hours of no food (water only). Carving out time for our teeth to have a break allows acids in the mouth to neutralize and teeth to re-mineralize rather than decay.

The goal of a nutrition period is to nourish the child with plentiful energy.This can be done by enjoying snacks full of proteins and fats while limiting the carbohydrates to crisp veggies and fruits, which won’t stick easily to our teeth.  Proteins and fats are ideal sources of energy– you get more calories per gram of food and it won’t get metabolized by cavity causing bacteria, meaning only your child gets fed, not their sugar bugs.

Here is a list of some great on the go tooth healthy foods to include in your child’s nutrition break:

Veggies such as carrots, celery, cherry tomatoes, peppers, snap peas

Hummus

Kale chips or dried seaweed

Dairy choices such as plain yogurt and cheese cubs

Pepperoni sticks

Nuts and sugar free nut butters or soy butter alternatives

Tofu sticks

As the title of this article suggest these ideas are for active and scheduled children, meaning busy parents too. If buying packaged foods is your time saving go to, be sure to read the Nutrition Facts box, selecting products with higher fats and proteins and lower carbohydrates and sugars.

It is what we eat and when we eat that make a significant impact on dental health for kids and for the whole family. Adding these tips to your child’s daily routine will make them feel satiated and energized while making their teeth, mouth, and of course their dentist smile! 

Sugar Bug Poop – The Source of Tooth Decay

Tooth decay, cavities or dental caries – Where does it begin and why does it end in a filling, crown, root canal or worse, extraction?  As some of you know from my previous article “The Modern Tooth Brusher”, I have a young infant, and sometimes it feels like poop preoccupies a whole lot of the day – so today I am making the science fun and talking in those terms.

Cavities are caused by an interaction of many events. My fun explanation goes as follows: Sugar Bugs (bacteria) eat the food we eat and POOP on our teeth (make acid). The Sugar Bugs’ POOP destroys the hard surface of our teeth leading to holes, which are commonly called CAVITIES.

Sugar bugs are actually pretty picky eaters, but that doesn’t mean only candies will cause cavities.  In fact, nearly every carbohydrate (bread, rice, pasta, cookies, crackers, chips, cereals etc.) going into our mouth is broken down by spit (saliva) into simple sugars. These simple sugars are the food bacteria use for energy, and the POOP (waste product) they make is an acid (among other things).

Even before a hole occurs, there are early warning signs of decay. Fuzzy white sticky film (plaque) hides sugar bugs by the millions upon millions.  Their mere presence puts us at risk; it is only a matter of time before they leave cavity-forming POOP.

So what’s the big deal if Sugar Bugs are Pooping all over your teeth anyways? Aside from how gross this realization is, that Poop is really harmful stuff.  The Poop is a combination of acids, with the primary ingredient being vinegar (acetic acid).  Take pause from the dental world and think of the ways we use      vinegar – especially cleaning and descaling your kettle or coffee maker.

Try this fun experiment: take an uncooked egg and paint a smiley face on it with clear nail polish. Let it dry completely.  Now place it in a cup of vinegar on the counter and leave it there for up to two weeks. Take notes daily.  The smiley face is protected from the vinegar.

Acids dissolve minerals, and our teeth are made up of minerals just like the eggshell.  The bottom line is if you expose your teeth to acids for long enough, they will break down.

If you scratch off that sticky white stuff from your teeth (a tooth brush works well), you may see hiding under the film a white spot. A WHITE SPOT on a tooth can be the first visible sign of mineral loss. WHITE SPOTS are strong risk factors for developing a cavity, and aggressive risk management should be taking place on a daily basis. Left unmanaged, the Sugar Bugs’ Poop will wash away the hard surface of our teeth and a cavity will develop.

Start managing the sugar bugs daily: be cognizant of what you eat and how often, brush your teeth, floss, use a fluoride toothpaste and visit your dentist regularly for continuing care.  An ounce of prevention is worth a pound of cure!

Dr. Daniel Charland BMSc, DDS, Cert Ped. Dent., MS, FRCD(C)

Certified Specialist in Pediatric Dentistry

Burlington Pediatric Dentistry

www.mybpd.ca   

The Modern Tooth Brusher

                       

I’ve recently entered the world of parenthood, and I finally relate – children can be consuming. With all of the daily must-dos, plus taking a moment to enjoy their charm, it’s hard to add on extras. However, we are losing the battle against dental decay. When half of children will have had dental decay by grade one and nearly all the rest by the time they finish high school, it is vital to make time for brushing and flossing your little one’s teeth. I remember being given an hourglass and told to brush my teeth until all the sand emptied to the bottom compartment. While old-school tactics are still valid, the digital age has many exciting tools to make oral hygiene more fun in your home.

Watch While You Brush

A short video clip is a great distraction to increase brushing duration. 2min2x.org has a parent resource section and a series of videos each about 2 minutes long from the Cartoon Network that can be watched during tooth brushing. 

There’s a Free APP for That

Toothsavers Brushing Game can be played in real time while brushing.  It incudes an interactive brushing chart that rewards children, a parents section for monitoring progress, and different characters for each child. Key features are a 2-minute timer, a brushing tracker, a flossing reminder and FUN.

Go Electric

Use an electric toothbrush, but don’t cheap out! Independent studies have shown a quality electric brush cleans teeth better than a handheld toothbrush, most of the time.  Select a toothbrush with a RECHARGEABLE battery and a SMALL REPLACEABLE head.  A built in timer (2 minutes) is helpful. Pick a brand you trust, such as Sonicare kids or Oral B. If the design isn’t fun, decorate the brush with stickers.  

Don’t Forget to FLOSS

The math is simple, there are 5 surfaces to each tooth (front, back, inside, outside and chewing top), and where teeth touch tightly together our toothbrush can’t clean. That means, for even the best tooth brushers, not flossing leaves 2 out of 5 spots on each tooth dirty.  Try cute, child-friendly floss picks to make the job easier.

Get Involved

Be creative! Get out of the bathroom and have a brushing dance party, brush during TV time or all together. Finding a way that works in your household to make oral hygiene a family activity will turn brushing and flossing into quality time spent together, and will improve the oral health of your whole family.

Remember until a child can tie their own shoes, they need adult help for tooth brushing. Flossing is harder yet and not usually mastered until about age 12.  Take your children to a Pediatric Dentist for regular cleanings, exams and motivation!

Dr. Daniel Charland BMSc, DDS, Cert Ped. Dent., MS, FRCD(C)

Certified Specialist in Pediatric Dentistry

Burlington Pediatric Dentistry

www.mybpd.ca     

Why First Tooth, First Visit?

It used to be that women smoked during their pregnancies, that infants were carried on a parent’s lap in a moving car, and that children rode bikes without helmets.  All of these sound like stories that my parents told me, but why don’t we do those things anymore? It can’t just be because a parent told us not to, or that we “know better” now.  And it’s unlikely the anti-tobacco lobby is out-campaigning Big Tobacco to reduce smoking during pregnancy, it is more likely the reduction of pre-term delivery, surrounding complications and decrease risk of SIDS. The CDC states car seat use reduces the risk for death to infants by 71%[1] and bicycle helmets reduce the risk of brain injury from a moderate speed crash from 99% to less than 10%[2], amazing! Even with all these statistics, the simple answers to why we don’t do these things anymore are all pretty similar – making a change in our behaviour results in better health outcomes for our offspring.

The problem is that even though the recommendations are pretty clear on car seat use for example, what is the probability that using a car seat will help your child? If you never get in an accident and are gentle in your actions, again the risks are low, but how can you predict that you will never be in a car accident? You simply cannot, statistics are against you, unless you’re a gambler, but I am not encouraging leaving your child’s well being to chance. The changes in recommendations must be considered on a population level, not at the individual level.

What does all of this have to do with the title, Why First Tooth, First Visit?  Just because historically children were not seen by a dentist until the age of three or older does not mean it is in the child’s best interest. Early visits, at the time of a child’s first tooth can help provide the tools and resources to families that lead to a lifetime of good oral health. Just like the investment of a car seat, early dental visits can help give you the information required to lead your children to safety. Think of the well child visits that a paediatrician or family doctor recommends, and add one more wellness check to the list: When you see your child’s first tooth, your child should see a dentist.

Dr. Daniel Charland

BMSc, DDS, MS, Cert. Ped. Dent., FRCD(C)

Dr. Daniel is a certified Pediatric Dentist, he is the owner of Burlington Pediatric Dentistry and Adjunct Professor at University of The Pacific.

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[1]  Durbin, D. R. (2011). Technical report—Child passenger safety. Pediatrics, 127(4). Advance online publication. doi:10.1542/peds.2011-0215

[2] Cripton, P.A.et al. (2014) .  Bicycle helmets are highly effective at preventing head injury during head impact: head-form accelerations and injury criteria for helmeted and unhelmeted impacts. Accid Anal Prev.  Sep;70:1-7. 

Healthy Habits at the Holidays

The holiday break is a great time to help your kids establish and maintain healthy dental habits. This includes good brushing, flossing and eating habits that are essential for healthy teeth. Parents and caregivers can learn more in this American Academy of Pediatric Dentistry holiday themed tip sheet.