Health Reference / Children's Health / Tooth Decay: Prevention

Tooth Decay: Prevention

Date Posted: February 23, 2000

Tooth decay causes toothaches, lost teeth, malocclusion, and costly visits to the dentist. Fortunately, modern dentistry can prevent 80% to 90% of tooth decay.

Flouride

Fluoride builds strong, decay-resistant enamel. Fluoride is needed from 6 months to 16 years of age (1995 American Dental Association recommendation). Drinking fluoridated water (containing 0.7 to 1.2 parts per million) or taking a prescription fluoride supplement is the best protection against tooth decay, reducing cavities by 70%.

If fluoride is consumed in drinking water, a child must take at least I pint per day (preferably I quart per day by school age).

If your city's water supply doesn't have fluoride added or you are breast-feeding, ask your physician for a prescription for fluoride drops or tablets during your next routine visit. The dosage of fluoride required for prevention of tooth decay is 0.25 mg per day in the first 3 years; 0.5 mg from 3 to 6 years of age; and 1.0 mg over age 6. Give fluoride on an empty stomach, because mixing it with milk reduces its absorption to 70%.

Bottled water usually doesn't contain adequate fluoride. Call the producer for information. If your child drinks bottled water containing less than 0.7 parts per million of fluoride, ask your child's physician for a fluoride supplement.

Fluoride is safe. Over half of all Americans drink fluoridated water. Fluoride has been added to water supplies for over 50 years.

One concern about fluoride is white spots or mottling on the teeth (fluorosis). This can occur when a child ingests 2 mg or more per day. The preventive dose is I mg or less. Children can ingest excessive fluoride if they receive supplements when it is already present in the city water supply. Occasionally they ingest it by eating toothpaste. A ribbon of toothpaste contains about I mg of fluoride. Therefore people of all ages should use only a drop of toothpaste the size of a pea. This precaution and encouraging your child not to swallow the toothpaste will prevent fluorosis.

Toothbrushing and Flossing

The purpose of toothbrushing is to remove plaque from the teeth. Plaque is an invisible scum that forms on the surface of teeth. Within this plaque, mouth bacteria change sugars to acids, which in turn etches the enamel.

Toothbrushing should begin before I year of age.
Help your child brush at least until 6 years of age. Most children don't have the coordination to brush their own teeth adequately before then.
To prevent mouth bacteria from changing food caught in the teeth into acid, brush the teeth within the first 5 to 10 minutes after meals.
Brush the molars (back teeth) carefully. Decay usually starts in the pits and crevices there.
If your child is negative about toothbrushing, have him brush your teeth first before you brush his.
A fluoride toothpaste is beneficial. People of all ages tend to use too much toothpaste; a drop the size of a pea is all that is needed.
If your child is in a setting where she can't brush her teeth, teach her to rinse her mouth with water after meals instead.
Dental floss is very useful for cleaning between the teeth where a brush can't reach. Flossing should begin when your child's molars start to touch. In the early years, most of the teeth have spaces between them.

Diet

A healthy diet from a dental standpoint is one that keeps the sugar concentration in the mouth at a low level. The worst foods contain sugar and also stick to the teeth.

Prevent baby-bottle caries by not letting your infant sleep with a bottle of milk or juice. If your baby, after the teeth erupt, must have a bottle at night, it should contain only water. It is better to put your child to bed after finishing the bottle.
Discourage prolonged contact with sugar (e.g., hard candy) or any sweets that are sticky (e.g., caramels or raisins).
Avoid frequent snacks.
Give sugar-containing foods only with meals.
Parents worry needlessly about soft drinks. The sugar in these products does not bind to the teeth and is cleared rather rapidly from the mouth.
Since no one can keep children away from candy completely, try to teach your child to brush after eating it.

Dentist Visits

The American Dental Association recommends that dental checkups begin at 3 years of age (sooner for dental symptoms or abnormal-looking teeth).

Dental Sealants

The latest breakthrough in dental research is dental sealing of the pits and fissures of the biting surfaces of the molars. Fluoride does little to prevent decay on these surfaces. A special plastic seal can be applied to the top surfaces of the permanent molars at about 6 years of age. The sealant may protect against decay for 10 to 20 years without needing replacement. Ask your child's dentist about the latest recommendations.

Instructions for Pediatric Patients, 2nd Edition, OD1999 by WB Saunders Company. Written by Barton D. Schmitt, MD, pediatrician and author of Your Child's Health, Bantam Books a book for parents.