Establishing a “Dental Home” for your Child.


Did you know that The American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a “Dental Home” for your child by one year of age?

The American Academy of Pediatric Dentists says this about a dental home, “The American Academy of Pediatric Dentistry (AAPD) supports the concept of a dental home for all infants, children, adolescents, and persons with special health care needs. The dental home is inclusive of all aspects of oral health that result from the interaction of the patient, parents, dentists, dental professionals, and non-dental professionals.

Establishment of the dental home is initiated by the identification and interaction of these individuals, resulting in a heightened awareness of all issues impacting the patient’s oral health. This concept is derived from the American Academy of Pediatrics’ (AAP) definition of a medical home which states pediatric primary health care is best delivered or supervised by qualified child health specialists.”


Why?


Children who have a dental home are more likely to receive appropriate preventive and routine oral health care which can improve the quality of life and health in your child. Children that go to the dentist early in life and have routine dental visits, grow up with less dental anxiety and therefore seek-out routine preventative dental care as adults, thereby avoiding more “painful”, complicated or costly dental care.

In fact, the Year One Dental Visit can actually save money. A study in the Journal of Pediatrics showed that children who have their first dental visit before age one will have 40 percent lower dental costs in their first five years than children who do not. The increase in costs can be attributed to due to the cost of dental and medical procedures that may be necessary as a result of poor oral health.

When you expose your child to a fun and welcoming dental environment from the start, with an emphasis on the prevention of dental disease, they will grow up to be healthier children, and eventually healthier adults.


In fact, the Year One Dental Visit can actually save money. A study in the Journal of Pediatrics showed that children who have their first dental visit before age one will have 40 percent lower dental costs in their first five years than children who do not. The increase in costs can be attributed to due to the cost of dental and medical procedures that may be necessary as a result of poor oral health.



Let’s review what to expect at your child’s one year old check up.


1

Infant Exam

An “over-all” and comprehensive look at what is happening with your baby’s tooth development. How do we accomplish this with baby or toddler? We use a “knee to knee” technique that provides maximum comfort to your baby during our examination allowing you to get a “good view” while observing proper brushing and home-care technique.



2

Infant Nutritional Counseling

Nutrition is one of the most important aspects in the prevention of dental disease. We discuss feeding practices including breastfeeding, bottle feeding, the appropriate usage of “sippy-cups,” as well as assess the frequency of snacking and drinking in between meals and bedtime routines. We will review “what’s working well” for your family and offer suggestions and strategies in areas that may be more of a struggle.

It is important to understand that as soon as a tooth erupts, it is prone to decay. What you eat, drink and your oral hygiene regimen will determine whether that tooth will develop a cavity of not.

A TOOTH + BACTERIA (dental plaque) ON THE TOOTH + EXPOSURE TO A CARBOHYDRATE (even “natural” sugars) + TIME= DECAY!


IN SUMMARY:
So, as soon as a tooth appears in the mouth, the more frequent the exposure of any carbohydrate (milk, juice, watered-down juice, breast milk, “crackers,” “puffs”) to the teeth throughout the day (and night), the higher the risk of getting a cavity.

An excellent early preventative dietary practice is to follow-up breastfeeding, bottle-feeding, “sippy cup” drinking (with anything that has any kind of sugar in it ) or snacking is to follow up with at least as few sips of water to “rinse-off” any sugars or carbohydrates from the teeth AND to avoid giving your child juice (this includes even watered-down juice), especially in-between meals.

REVISED AMERICAN ACADEMY OF PEDIATRICS (AAP) RECOMMENDATIONS REGARDING JUICE CONSUMPTION (MAY 2017):
Current Recommendations build on the original but takes into further consideration new evidence that has been released since then. In summary we recommend that children don’t drink juice.

RECOMMENDATIONS FOR DAILY INTAKE OF JUICE PRODUCTS:

  • Follow with a gulp of water
  • Max amount of juice intake per day should not exceed 4 ozs

At Nighttime/Bedtime, when we say “never put your baby to bed with a bottle,” what we mean is this: ideally before your baby goes to sleep, their teeth should be brushed to remove any plaque build-up and the last “thing” to touch your baby’s teeth after brushing is plain water- that is the goal.

HERE ARE A FEW “REAL WORLD” TIPS THAT CAN HELP ACHIEVE THIS GOAL:

If you are breast-feeding before bed, brush your baby’s teeth first! Ideally and the goal is to brush after you breast-feed. However, this is not always possible as most babies fall asleep at the breast; so, by brushing first, at least the teeth are clean and are free of plaque before feeding. What you can do with a sleeping baby is lightly “wipe” the teeth with a wet washcloth or gauze to prevent the “pooling” of breast-milk on the teeth. If you are co-sleeping with your baby, try to limit feedings to “full-feeds”, as opposed to little periods of short feedings throughout the night. This can be difficult at first, but remember we are trying to limit the amount of time and frequency that the carbohydrates from the breast milk are sitting on and pooling around the teeth. Keeping a wet gauze washcloth close by to wipe the teeth between feedings is very useful, as well as having brushed off the plaque before bed. If you are breast-feeding an older toddler or child, get them into the routine of learning to drink a few sips of water after each feeding; by making this the “rule”, it can extend the amount of time you may choose to breast feed and reduce the risk of getting cavities.
  • If you are bottle feeding (formula, breast-milk, milk or “milk” alternative) before bed, brush your baby’s teeth first! Ideally the goal is to brush after your baby takes a bottle of anything other than plain water. Like when breast-feeding, babies often fall asleep while having their bottle. So, brushing the teeth to remove the plaque is a good first start. What you can do with a sleeping baby is lightly “wipe” the teeth/gums with a wet washcloth or gauze to prevent the “pooling” of the milk/formula on the teeth. If your baby wakes up during the night and “must” have a bottle; do a “full feed” (do not leave the bottle in the crib with the baby) and then wipe the teeth with water.
  • A good strategy to help wean your baby off getting “milk” or formula before bed, is to have the last bottle before bed be filled plain water. Some babies take the bottle filled with plain water with no fuss – they just want the “bottle” and the comfort of it. Other babies notice right away that there is something “other than” milk/formula in it and won’t take it. Then try this; slowly begin to “water-down” the “milk” or formula over the course of a couple weeks until its nothing but plain water, so your baby barely notices the change and slowly gets used to it.
  • Now, if your baby has a bottle of plain water before bed, it won’t cause cavities.
  • It is what is in the “cup” and how often they get it that causes cavities! If a “sippy cup” is used in-between meals and before bedtime, it should be filled with plain water only! Most parents use “sippy cups” because they are convenient, don’t make a mess and are always available when you are “out and about;” but it is paramount that parents monitor what is in the cup, how often and for how long your child is drinking from the cup to reduce decay.
  • Milk, juice, watered-down juice should only be offered at meal times in the “sippy cup.” After snacks, in-between meals and before bed-time, your child should only be offered plain water.
  • Because “sippy-cups” are so convenient and kids can use them almost independently, it is easy to not recognize how often they may be drinking from them throughout the day, thereby increasing the amount of time their teeth are being coated with sugars. Even in cases where parents brush their child’s teeth 2 or 3 times a day, drinking any liquid with a sugar in it, often and throughout the day, will cause the teeth to weaken and decay.

A good strategy is to always have two “sippy-cups” on hand:

  1. Pne “sippy-cup” filled with plain water to offer between meals, after snacks and before bed.
  2. And one “sippy-cup” for either milk, juice (watered-down juice) for mealtimes only.

Although “sippy cups” are convenient and widely used, it is both valuable and important to teach your child to transition from breast feeding and/or bottle feeding to drinking from an “open” cup or regular cup.

The way a baby or toddler uses their lips, cheeks and tongue muscles when swallowing varies during breast feeding and/or bottle feeding, but is very different from how a child learns to use those same oral-facial muscles to swallow liquid that does not come from a “nipple” or “valve.” We often do not think about the difficulty of learning a “new” thing like walking, talking, eating and drinking, because we have been doing those things for so long. But for babies and toddlers, each new learned movement or action requires a coordinated and complicated amount of nerve and muscle functions in addition to the development of new brain “wiring” patterns that are repeated many times over in order for all “systems” to work together to accomplish the “new” task at hand.

The complicated interaction between the tongue, lips and cheeks that is required to achieve a “proper swallowing pattern” impacts the development and growth pattern of your child’s face, jaws and teeth. The way your child learns to swallow can even impact how well your child digests food. For example, if a proper “lip seal” during swallow is not achieved, your child may swallow excess air which may cause abdominal discomfort from “gas” or even colic symptoms.


3

Infant Evaluation of Oral Hygiene

Brushing your baby’s teeth is not always the easiest task, but it is a very necessary one! (think of it as a “diaper change”: not always easy to do or welcomed by your baby, but always necessary to do!)

The American Academy of Pediatric Dentistry recommends brushing your child’s teeth as soon as the first tooth appears, using a tiny amount (the size of a rice-grain) of fluoride toothpaste every day, usually before bed.

We recommend brushing be done on your lap in a safe place like a couch, bed or the floor where you can position your baby comfortably without the risk of them falling. During your visit, we will show you how to do this to help boost your confidence.

You can also learn more about your role in your child’s dental care by reviewing the section labeled “Role of Parents in Kid’s Oral Hygiene.”




4

Infant Growth and Development Assessment

From proper “teething” patterns, what to expect as your child awaits the eruption of their 20 baby (primary) teeth, evaluating soft-tissue function (the tongue, lips and cheek muscles) and the development of the jaws and facial-skeletal structures, we help you best understand your child’s growth patterns now and in the future.

We evaluate the health of your baby’s gums and discuss how to avoid the development of gingivitis and gum disease by showing you how to brush the gumline area of your baby’s teeth. If your baby’s gums “bleed” when you brush, it means that they have mild gingivitis. Even though you may be trying your best and brushing your baby’s teeth daily, you may still be missing the gum line area.

We can help by teaching you some techniques and tips to make it easier. Hint: make sure the tooth brush is angled in a way that the toothbrush touches the “pink and the white” (the teeth and the gums) at the same time. This means you have to lift the lips “up” or “out of the way” to access the gum line area – if the gums are brushed gently, but correctly every day, the gums become healthy and the bleeding stops.

We also screen for the presence of “tongue or lip ties” – the latest research in sleep medicine, oral myofunctional therapy and orthodontic literature is showing that untreated lip and/or tongue ties can be a contributing in many health and growth issues ranging rom poor feeding at birth, difficulty with and picky eating in young childhood, digestion troubles, poor jaw and facial development, malocclusion, speech issues and the development of mouth-breathing. Tongue tie, especially, is considered a risk factor for developing Obstructive Sleep Apnea.

The goal of early regular dental visits is prevention. We hope to either prevent dental decay altogether or at the very least stop the progression of any decay that is present and to prevent the formation of future decay. The earlier we identify decay, even the very beginning signs of tooth decay (like “white-spots” along the tooth near the gum line), the less invasive and more preventative our treatment options can be. Early visits to the dentist, proper brushing practices, good nutrition and feeding practices and your child’s exposure to adequate fluoride are the best places to start.
Fluoride varnish is a dental treatment that can help prevent tooth decay, slow it down, or stop it from getting worse. This can be done 2 to 4 times per year. The number of treatments depends on your child’s “risk” of developing decay. Your child’s “risk” is based on how well their teeth are brushed and how often, how often they are exposed to sugars and juices, if they are getting adequate fluoride and the quality of the enamel. Fluoride varnish is safe and used by dentists and doctors all over the world to help prevent tooth decay in children. Only a small amount is used, and hardly any fluoride is swallowed. It is easy and quick to apply. It is colorless and most kids and drink immediately after application. It is then brushed off after 4 to 12 hours. As one would expect, many babies and toddlers cry before or during the procedure, but this is normal! Fortunately, brushing on the varnish takes only a few seconds. Another way to think about it is, that applying the varnish may be easier when a child is crying because his/her mouth will be slightly open. Keep in mind that fluoride varnish treatments cannot completely prevent cavities. Fluoride varnish treatments can best help prevent decay when a child is also brushing with the right amount of toothpaste with fluoride, flossing regularly, getting regular dental care and eating a healthy diet.