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Oral Health Care For Baby

Baby's first teeth basics and daily care guide

Typically, we don't think of cavities or gum disease in connection with babies. But in fact, oral diseases begin very early, from the time bacteria begin to live in the oral cavity.

As new teeth come in (called "eruption") and the diet of the infant and young child becomes more sophisticated, bacteria continue to produce acids and toxins that are harmful to hard and soft tissues in the mouth.

Baby's First Teeth

Baby's first teeth (called "primary" teeth) are key to healthy adult teeth. Primary teeth hold a space for permanent teeth. If your child loses a tooth because of decay, the permanent tooth may erupt at an angle, causing crowding of the adult teeth. Early loss of baby teeth can also affect speech patterns, chewing ability and the use of the tongue.

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There are 20 primary teeth. They usually erupt beginning with the central incisors (bottom middle teeth) at 6 to 10 months, and ending with the second molars shortly after the age of 2. The shedding of these teeth takes place between 6 and 12.

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By the time they are teenagers, all children have experienced some form of oral infectious disease.

Early Childhood Caries (ECC)

Early childhood caries, or ECC, is a form of severe tooth decay in the primary (baby) teeth of infants up to 1 year of age and toddlers (ages 1 to 3). It affects more than 10 per cent of preschool-age children in Canada.

There are a number of contributing factors to ECC, including the transmission of bacteria from the caregiver to the child, the amount of sugars and starches in the diet, and the time and frequency of the feedings.
Children who experience ECC tend to remain high risk and experience caries in their permanent teeth.
In mild cases of ECC, the child's teeth will have a chalky white appearance. In moderate cases, teeth will be stained brown and may be partially eroded. In the most serious cases, teeth will be dark brown or black with partial or full loss of the tooth's crown, leaving only the root visible at the gumline.

What Causes ECC?

Bacteria
ECC is an infectious disease primarily related to cavity-causing bacteria called streptococci mutans ("strep mutans" for short). Strep mutans are passed from mother to child through frequent and intimate contact (for example, through saliva).
Babies and toddlers are most likely to become infected between the ages of 19 and 31 months, when the primary and secondary molars come in. Infection may occur even earlier, around the age of 12 months, when the incisors come in.
Diet and Nutrition
Diet also plays a significant role in the development of ECC.
Sugars - Oral bacteria thrive in an environment that is rich in carbohydrates. When sugar combines with plaque, an acid is created that removes calcium from the teeth. When the teeth are free of acid, the calcium, carried in saliva, moves back to the teeth. Cavities form when more calcium is removed from the teeth than returns over a long period of time.
There are natural sugars present in many of the nutritional foods we want our children to eat - including dairy foods, grains, fruits and vegetables. Therefore, it is not possible to remove all carbohydrates and sugars from the diet. Instead, the goal is to give children the right amount of the right sugars, and at the right time. Your health care provider can also advise you on this.

Daily Care for Infants and Toddlers

To reduce the risk of oral infection and the development of ECC:
    * Keep your own teeth and gums as healthy as possible to minimize transmission of strep mutans bacteria.
    * Develop a routine for cleaning your baby's mouth. Wipe baby's mouth and gums using a clean, wet, cloth or piece of gauze after each feeding.
    * Gently clean newly erupted teeth with a gauze or washcloth, or use a small soft toothbrush (with no toothpaste) especially designed for baby teeth.
    * To make cleanings more pleasant for your baby, work together with another caregiver. Sit opposite each other knee-to-knee, with the child across your laps.
    * Keep non-nutritious, sugary fruit punches and other drinks out of baby bottles.
    * If you do use a bottle at naptime or bedtime (it is best not to), or a sip cup during the day, avoid juices, milk or formula - all of these contain some amount of sugar. Use plain water instead.
    * Reduce the frequency of nighttime feedings.
    * If your baby uses a soother, check the packaging and shape of the soother to be sure it has an orthodontic design. The best ones are nipple-shaped, keep the baby's lips closed and encourage natural nasal breathing.
    * Never dip soothers in anything sweet. Honey is one of the worst offenders.
    * If your baby is on liquid medication (usually sweetened for taste), rinse and brush the mouth with clear water immediately after the medication is given.
    * Check for early warning signs of ECC by lifting up baby's lips. White, chalky teeth signal a mild case; brown or black stained teeth indicate a more serious case. Contact your dental hygienist immediately.
    * Gradually introduce foods such as fresh fruits and vegetables to the diet. These foods, which require chewing hard or chewing long, stimulate saliva to flow, which removes the acid and returns cavity-protecting calcium to the teeth.

* Contributed by The Canadian Dental Hygienists Association

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