Today I've got an easy tooth question and a tougher one.
Amber writes:
"Is it okay to brush my son's teeth. He is 9 months old? If so what kind of toothpaste do I use?"
Yes! There are a couple of ways you can go with tooth-brushing, but they both involve xylitol. Xylitol is a sugar from birch trees, and it kills the bacteria that causes tooth decay. It's got a pleasant, mild flavor. The children of mothers who use xylitol toothpaste and/or gum in the first two years of their children's lives have fewer dental problems up through age five than kids whose moms don't use any xylitol products. So the first thing you could do is switch to xylitol toothpaste yourself (there are some great brands online like Squigle and Epic, and I love Tom's of Maine CinnaMint flavor) or start chewing gum with xylitol.
But even if you don't use xylitol toothpaste your kids can. Tom's of Maine makes a liquid toothpaste for kids with xylitol that comes in a few flavors (our favorite is grape), and it's in Gerber baby toothpaste, too. For a 9-month-old you want to use just a teeny bit of the toothpaste with some water. You can use an extremely soft-bristled brush, or one of those things that fits over your index finger with little nubbly parts that lets you brush by sticking your finger inside the baby's mouth. (Be warned, though, that if your baby has a tooth and chomps down the soft toothbrush will not protect your finger and it will hurt like you didn't think possible).
If your baby is too young for toothpaste or a brush (gags or won't open mouth or otherwise resists), you can get Spiffies xylitol wipes to wipe their little baby teeth. They're individually-packaged wipes (the size of wet wipes) coated in a xylitol solution. They taste like very mild grape, and you just use them to wipe the surfaces of all the teeth and gums.
If you nurse to sleep and can't imagine waking up your baby to brush, you can still brush or wipe with Spiffies right before you nurse. Some of the xylitol will stay on the teeth, and since the nipple squirts milk in the back of the mouth instead of the front, the milk won't wash all the xylitol off.
Now for the rougher question. Jennifer writes:
"I just got back from our first trip to the pediatric dentist with my 17 month old. Peanut has white spots on her teeth, and we're told they are early signs of caries forming, eek! (My worst nightmare realized.) She's a nursing toddler who is totally attached to Mama's boobs during her naps, and she's an all night nurser. The dentist recommended brushing her teeth with flouride at least 3 times per day, using a concentrated flouride gel at night before bed, flossing at night, and swiping her mouth after each drink besides water. I don't know about your toddlers, but mine is pretty typical and eats and drinks all day long! What a pain in the tookas, not to mention having to pin your child with the figure four... i never knew i was a natural born wrestler (poor little Peanut.)
In case you were wondering what we feed Peanut, she eats a moderately organic diet, generally low in sugar, some meat and dairy. No juice, no sweets, but an occasional Hug A Bear cookie or Graham cracker (whole grain and organic, of course). She's been a picky and small eater until most recently, which I think may have contributed to some potential vitamin deficiencies. (I read somewhere that deficiencies in calcium, vitamin A and phosphorus can weaken tooth enamel.)
The dentist did not say that nursing has damaged her teeth, but certainly any sugars in her mouth will promote further demineralisation of the tooth enamel. Daddy-o's been expressing a desire to put Peanut down lately so changing our bedtime routine seemed to make sense (even though I would have nursed her to sleep as long as she wanted.) For the last 1 1/2 weeks Daddy-o has been putting her to sleep and I'm usually called into action by about 1-2am when I nurse her back to sleep, (we've all been sick especially my husband, so cutting out all nursing until early morning has been put on hold.) We are doing our best to try to keep her mouth as clean as possible while also trying to reverse the damage to her enamel the acid has done. Boy does this suck!
This is all very stressful for me as I worry about the prospect of dental work, and it really bites to have to pin my daughter down to brush her teeth several times a day... and it's very likely she'll still have a cavity after all is said and done. Has anyone gone through this process and what was it like for them? What could I expect if she really needs cavities filled (I can't even imagine the torture of that day!) We're going for a follow up to the dentist in 3 months."
I asked about xylitol to prevent any more damage, and she updated:
"yeah, we're using spiffies now too... they came in the mail the week we went to the dentist... my understanding is that xylitol helps to combat the strep mutans bacteria present in plaque... our daughter already has damage to her tooth enamel... when this starts to happen it's called demineralisation, that's when the damaging environment has been around long enough to soften the teeth... you need the nasty bacteria plus sugars from food to interact in order for the damaging acid to form... this lovely cocktail eats away at the tooth enamel... they skinny is that i should have been using the spiffies wipes a long time ago and i should have been more diligent at "getting in there" and not just have her chew on a tooth brush before bed... at this point, flouride is needed to remineralise the tooth enamel, which basically means to make it strong again so that the white spots don't turn into irreversible, decaying holes... in essence, the flouride is the antibiotic and any other cleaning agents like xylitol are the band aids protecting from further damage....
my LLL leader sent me this link on the subject... i thought you might like to check it out... just brace yourself for the pics, they are some of the worse cases of Baby Bottle Mouth (totally freaked me out) anyway, i think we're doing all we can but i just wondered how other well-intentioned parents dealt with this issue... even if the problem was truly genetic...
thanks moxie... "
http://www.brianpalmerdds.com/caries.htm
So once again a reader answers her own question by providing a pertinent link. And, yeah, some gross pictures if you click through from that first page to the PDF presentation (the first page is fine, with no photos).
So it sounds like xylitol is the first line of defense, but once the enamel is damaged, the only help is fluoride. If anyone else can share experiences with this problem, Jen and I would really appreciate it. I have no idea how a 17-month-old will make it through the process of having a cavity filled, but it might not be rough at all. So any stories would be appreciated.
You might want to check out pro biotics like the ones from BioGaia http://www.biogaia.se/?id=28382 to see if it would help build up a good bacterial flora in the mouth.
Posted by: Mia | February 12, 2007 at 09:06 AM
First, good luck with the night-weaning thing, or at least the shortening-the-night-nursing-and-rinsing-the-baby's-mouth thing, because that's the part that would have been the biggest challenge for me, if we'd realized what was happening when our son was young enough to reverse it.
We didn't see the pediatric dentist until our son was three, because I asked our doctor about the recommendation to do it at age one and she blew that off. So I think, above all else, you should give yourself a pat on the back for making the appointment in the first place. It's not a step everyone takes. And it gives you a chance to avoid the worst-case scenario, multiple dental caries.
As for filling the cavities, should it get that far? My son, who nursed at night (for hours at a time, in stretches) until he was 29 months old, had to have two full-molar caps and three additional fillings when he was three years old. It was done under general anesthesia, because the novicaine-and-gas route is simply not appropriate for very small children. (There are dosage and compliance issues, not to mention problems with numbing a very small child's mouth.) The good news? Your child goes to sleep, has the work done, wakes up an hour later, and goes home. The bad news? It's general anesthesia. It's scary for you. But a good pediatric dentist does this routinely and it really will be okay.
Hopefully, you have caught the problem early enough to treat it and never get to the point we did. I can't imagine all that toothbrushing, but I'm hoping your child adapts quickly (there certainly must be tooth-brushing videos out there, right? in your shoes, I would ditch my normal anti-video stance for toddlers and play it often, and do anything possible to make the brushing a game) and again, I think you are WAY ahead of the game by having seen the dentist when you did. Kudos for that.
Posted by: Jody | February 12, 2007 at 09:20 AM
moxie-
does the xylitol toothpaste need to be primarily made from that ingredient? the gerber toothpaste has that listed as it's third ingredient and i was just wondering.
i don't have much advice for cavities but i do know that one of our pnuts favorite things to teeth on is a toothbrush with one of those tongue cleaners on the back. also we received one of those "baby essentials" kits at my baby shower (you know, it has scissors, thermometer, all sorts of baby things) and it had a "baby toothbrush" that pnut loves- it looks like a regular toothbrush handle with rubber nubbies where the bristles would be, and a pacifier-shaped shield near the nubbies so the baby can't shove it too far in their throat. anyway, i put some of that toothpaste on those for her and she loves it, we are hoping it inspires some good habits later on. good luck!
Posted by: pnuts mama | February 12, 2007 at 09:27 AM
The amount they put in the baby toothpaste is fine, AFAIK. I think mostly xylitol would be too goopy and not avrasive enough to clean teeth. It's good to know that the Gerber toothpaste has it, too.
Posted by: Moxie | February 12, 2007 at 09:52 AM
BTDT, four times now...
Sigh.
All four of my kids have dental issues. The older two have multiple fillings, and both had near-misses with root canals (that is, the cavity went down alongside the pulp instead of into it, so when they went in, they didn't have to do a root canal after all... phew!). The oldest has reflux-thinned enamel. The second has soft enamel for unknown reasons (we took him in the first time to the dentist because a small bump shattered the corner of a front tooth). REALLY soft. One of the twins has reflux, and the other fought like crazy when we brushed her front teeth (hates having her gums touch the brush) and ended up with white line that way (from what we could tell, we were getting it, but we were wrong). All of them have had bouts of mouth-breathing (bad for teeth) as well. ARGH. Fortunately, the adult teeth coming in on the oldest look like they're nice and hard, and the reflux is medicated. Even being on top of things from experience won't necessarily save your child from this... sucks, but my kids did NOT inherit my hard-as-rock teeth.
If you've got a good pediatric dentist, you'll probably have fine experiences.
We've had very encouraging and supportive technicians (each child gets the same one over and over, so they develop a rapport), and that plus topical and local anesthesia has made even multiple fillings a not-awful experience. Toothbrushing is still going to be a fight for a while - at 2 1/2 to 3 or so, they seem to start being more willing to be brushed without being pinned down, but I still have to hold them at this point (26 months) to get the job done well (brushing 2 mad 25-lb octopi... whee.).
Flossing is hit and miss, though at least with those little flossers you can buy, they're interested in doing it themselves, and the dentist doesn't ask for daily flossing (several times a week, instead).
We swab the remineralizer on with a cotton swab - they'll do it themselves at about 2, and then I do it again for them if it doesn't look like they did a good job (One note from the dentist - caries will get DARKER once they start to remineralize, so if they look worse after a week or so, you're doing it right). I'm not worried about them swallowing the amount off a cotton swab if they suck on it, either.
Other things we've learned in the process of this:
1) Salty/starchy snacks are as bad as sweet/sticky snacks, especially for around the gums and between teeth. Goldfish and pretzels... bad bad bad.
2) Solid chocolates are one of the BETTER treats for teeth.
3) Even when they can do it, you have to check and do it again for them if they didn't do it well. Until they're about ten!
4) The worst part of night nursing for their teeth may be just holding on after they're done. It is the lack of saliva movement that makes things escalate with bottle mouth, and the same is true of night nursing. There are a few studies that show that babies who hold onto the nipple all night have the worst dental issues - though anything that blocks the saliva in their mouths can make things worse.
5) Snoring, congestion, and mouth breathing make things worse, faster, so if they're sick, you can't cut them a break. (BTDT, *bad* plan... sigh.)
Good luck! Once it starts, you're in for a long fight to keep it from taking over. It is exhausting to NEVER let it slip up, and I'm afraid I'm not perfect. However, the last couple of visits with the older two (maybe 3) have been all clear for caries (okay, so their major flaw spots are already filled...). And the younger two are holding steady where they are, even though they'll both likely need one incisor filling on the front in a year or so.
I will say that it is nice to not have the dentist blame night nursing for everything... ours used to use 'mandatory cold turkey night weaning' as a scare tactic to convince extended nursing moms to get with the program. She's toned it down some, though - she now says 'night-weaning by 12 months is best for their teeth, period... but maybe that's not always best for the whole child.' It's a balancing act, for sure!
Posted by: hedra | February 12, 2007 at 10:52 AM
I have a quick question on this subject: can the amount of sugar a breastfeeding woman intakes affect the sugar content of the breastmilk? i.e. even if a child has really healthy/low refined sugar intake, could this all be thwarted by mom snacking on chocolate all day?
I hadn't really thought about this enough!
Posted by: Rebecca | February 12, 2007 at 11:55 AM
Another sugar-related question. We have some Tom's of Maine kids' toothpaste (Silly Strawberry), and I don't have the ingredients in front of me but I remember being surprised that a couple of the ingredients looked to me like other names for sugar. Fructose, maybe. Or fruit juice. At the time I briefly wondered whether this was kind of a bad thing, and now all this talk about scary dental outcomes is making me wonder again how foolish I really am to be using this on my kid's teeth. Any clue?
Posted by: caro | February 12, 2007 at 12:04 PM
I have a 20 month old, but I don't want to give him the fruity flavored childrens toothpaste (he likes the taste of regular toothpaste, so why should i get him hooked on specialized childrens sweet toothpaste). My question is what do i need to look for in toothpaste for him if i'm not buying something like the Tom's Childrens? Just floride free with xylitol?
Posted by: dot | February 12, 2007 at 12:28 PM
Wow ! i was told by nurses to brush my 10-month old daughter's teeth with general adult toothpaste with fluoride, a very tiny pea-size amount. Is this wrong, then ?
Posted by: Kathleen | February 12, 2007 at 01:52 PM
Kathleen, you can use a tiny amount of adult toothpaste. Some people are concerned with overal fluoride consumption (our dentist is not a fan of letting kids get too much fluoride swallowed, it can cause tooth flaw in the adult teeth, and some people consider it a toxin). The 'toddler' pastes are safe to just eat if they want to (my kids will suck the toothpaste off the brush if you let them).
Caro, I hadn't checked Tom's for fructose... argh, since Brendan and Meriel can't have fructose straight... just checked their website, and it has sorbitol. ARGH. That's another one they can't have (due to a carbohydrate intolerance). The things I never thought to check! BUT, they're *not* issues for dental hygeine - Tom's is a reputable company. I've used Tom's for ages - and my kids have equally poor results with Colgate and Tom's. Sigh.
If what you were seeing was the sucrose cocoate that's not sugar, that's like a soap/sudzing agent, I think. Nothing in there is going to feed bacteria.
Dot, I think fluoride-free with xylitol is what you'd want.
Posted by: hedra | February 12, 2007 at 02:38 PM
Sort of off the subject, but not really - if you have any products containing xylitol in your house (toothpaste and/or gum), PLEASE make sure to keep these products away from your pets. Dogs are especially prone to eating large quantities of xylitol-containing gum, and while their breath may be minty-fresh, their livers may go into failure. Xylitol is toxic when ingested in large amounts for members of the canine persuasion, causing severe drops in blood sugar and occasional liver failure. For more info, see: http://www.aspca.org/
Thanks - good luck with the brushing. I'm a Tom's of Maine fan, too!
Julie (a DVM from MN)
Posted by: Julie | February 12, 2007 at 03:08 PM
I've been using the finger thing for several months now and am wondering when people switched to a baby toothbrush? My daughter is now 14 months old and bites my finger like the dickens!
Posted by: Jennifer | February 12, 2007 at 06:31 PM
I have a related question. Our water is not fluoridated and our pediatrician prescribed fluoride drops for our son starting at 6 months (he's now 11 months). This seems to be standard procedure, but I also hear murmurs about the dangers of giving fluoride supplementation. I don't want to threaten my son's teeth as he's got a genetic predisposition to cavities, but I don't want to endanger him either. I know this can be a heated argument. Can anyone direct me to information on this issue?
Posted by: Scotti | February 12, 2007 at 07:06 PM
Well, answering not as a parent for once...I was given fluoride supplementation as a baby because my parents went to live in Taiwan for an extended stint. Turns out I got too much, and it shows up as white mottling on some of my teeth. I believe there are worse things that can happen, but that's the most typical. On the upside, my dentist says nothing can get a purchase on my enamel. Whee.
All this is making me think I ought to get Mouse to the dentist--one more thing for the list!
Posted by: Charisse | February 12, 2007 at 07:10 PM
Jennifer, if she's biting your finger and it hurts, it's time to switch to a toothbrush. :-)
Posted by: Moxie | February 12, 2007 at 09:54 PM
two things i thought of:
i know i've read somewhere that some people (kids, adults) are just prone to cavities, and some are not. something to do with enzymes in the saliva, i wish i wasn't too tired to google it.
also, there is a tiny bell ringing somewhere in my head connecting some medications in infancy/early childhood with later tooth decay- the only reason i bring this up is our 11 year old nephew has had tremendous dental issues- and i do remember somewhere my sister in law had mentioned they had possibly connected it to some antibiotics he had taken earlier in life. please let me be clear, i am *not* advocating not using antibiotics when necessary (our nephew is in a house with smokers, and is constantly sick, not to mention the kid eats candy and soda all day long, so i thought it was a pretty weak excuse to blame medicine when clearly there are other factors, but i digress) i just remember the link between the two.
Posted by: pnuts mama | February 12, 2007 at 11:01 PM
There's also a possible link between some heavy-hitter allergy meds and tooth flaw... I've heard antibiotics a few times, as well.
We don't know what it was, necessarily, though I did take Singulair for part of each pregnancy... it was that or cease breathing.
And yes, some people are more prone to caries than others, though a lot of that has to do with how well their mouths harbor the strep mutans bacteria.
Scotti, I don't know where to find detailed information on fluoride toxicity levels and/or tooth development, but I usually start by searching on PubMed. (.org?)
Posted by: hedra | February 13, 2007 at 09:01 AM
When my dd was about 2 her front teeth started to chip. The first pediatric dentist I took her too took one glance (practically from across the room) and declared it "baby bottle tooth decay" and asked me if she had any pain. I said no, he said bring her back if she does, otherwise there is no reason to fix baby teeth. Now I did NOT like the man or his attitude, but I didnt think that his advice was too bad. A year or two later when I did take her to her first regular dental visit, the dentist told me there was absolutely NO decay on her front teeth, she just had very thin enamel, and there was nothign Much I could have done. She did however have cavities in her molars and needed a "pulpectomy" which is basically a pediatric root canal. They did it under "conscious sedation" for the first visit, which means she was very calm, but awake. It took maybe 15 minutes and she came out smiling and joking with the staff. They even told me they could do the next two without even using the sedation. It wasnt bad.
My youngest three havent been to the dentist yet. My current dentist suggested age 4 for the first visit. So we waited. Now my kids are 3,3, and 4 and it is about time. But unless a child develops a toothache, I see little reason to get invasive dental treatments before age 4 or so. Especially when that means general anesthesia.
As for preventing cavities. WEll, I personally think it is so enormously genetic that parents beat themselves up unnecessarily.
I think that in those pictures for example we are either looking at situations where the parent was extremely lax on dental care, or the child was overwhelmingly prone to cavities due to genetics that there was little the parents could have done.
And some parents do fight and fight a losing battle over their children's teeth, because the kids have thin enamel. Adn even when they do Everything right, the child gets cavities, and so the mandatory list gets longer and longer. But seriously, some of these dental regimens just dont seem to be worth it for such little kids and baby teeth. And it seems like a losing battle. I dont think that just because a toddler is developing cavities, he is on the downward spiral to serious cases like in the pictures.
Joline
Posted by: joline | February 13, 2007 at 10:26 AM
Back to the Silly Strawberry: I looked at the ingredients again last night and it was "fruit extracts" that had concerned me. Though I guess that could be just flavor without throwing any sugar into the mix? I also discovered Silly Strawberry doesn't have xylitol after all (but no sorbitol, either, hedra). So off to the co-op for a different type of Tom's...
Posted by: caro | February 13, 2007 at 04:21 PM
I read somewhere that adult saliva (as in, you pick up the pacifier off the ground and clean it off with your saliva and hand it to the baby, etc.) is a way that cavity causing bacteria are introduced into babies
mouths.
Posted by: Mellie | February 16, 2007 at 11:25 PM
Don't over look the MI PASTE with 6% Recaldent for those kids, no flouride in that product which is a valid concern for small children. The product is sold to the dentist, The Recladent is Claciumd and Phospahate delivered to the tooth thru a milk casein. If the child does not have a true Milk Protein allergy then this is the product to use to help reverse the white spot lesions by strengthing the enamel. Go out to GCAMERICA.COM or have the patient's dentist look over product.
Posted by: Elaine | March 14, 2007 at 11:08 AM
Its okay to brush your sons teeth, as long as you do it in a right way and of course with the gentle tooth paste. because baby teeth and gums is so soft and sensitive.
-heather-
Posted by: orange county teeth whitening | March 13, 2009 at 01:55 AM
Well for me,i cant see any problem if you brush you sons teeth in the first that would be better to your son. :-)
florence
Posted by: riverside cosmetic dentist | July 07, 2009 at 02:24 AM
These are the problems of the toothpaste made for babies. Scientists aren’t yet sure if the amount added to toothpaste plus the amount you get in tap water equals a hazardous dose. To be safe, we recommend that young children (who swallow more of their toothpaste) should use fluoride-free toothpastes.
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