Anne Baum (00:00):
Why is dental health important for kids? When should kids start brushing and flossing their teeth? What are some tips for making the dentist more fun and less scary? All that and more on this episode of Because They’re Kids.
And we are back for another episode of Because They’re Kids, a podcast that’s built just for kids and their parents. For those of you tuning in for the first time, I’m your host, Anne Baum, mom of two and president of Lehigh Valley Reilly Children’s Hospital. Today, we’re going to talk about the importance of taking care of your kids’ teeth. Here to help us talk about everything you need to know regarding dental hygiene for kids is Deborah Campbell, DMD, Chair of the Dental Department at LVHN. Welcome, Dr. Campbell.
Deborah Campbell (00:49):
Thank you, Anne. I’m really excited to be here today.
Anne Baum (00:52):
Great. We are so excited to have you. And obviously, teeth are a really important part of everyone’s life, and I think sometimes they get forgotten as part of our health. So let’s tell our audience why keeping your teeth healthy is an important part of keeping your kids healthy.
Deborah Campbell (01:12):
Yeah, so it’s a great place to start. So first of all, we know today, now more than ever, that dental, health and diseases of the oral cavity really affect overall health. And I know today we’re talking about kids, but I just want to say that there’s been a lot of research recently that talks about the relationship between the oral cavity and adult diseases like cardiovascular disease, diabetes and rheumatoid arthritis. So it’s really important to start with those early habits so that they go into adulthood. Kids really are affected by dental decay, or what we know as cavities, and it’s still really a significant public health crisis. Dental decay is known as being one of the chronic diseases of childhood, and dental decay can cause pain, swelling, and there’s much, much research to show that it causes poor school performance because kids can’t concentrate. And so we really need to start early with education.
Anne Baum (02:12):
And with kids, I know we say, “Brush your teeth, take good care of them,” but there’s generally resistance to that. “Oh, do I have to?” And how do we make that fun for kids? How do we make oral hygiene, from when they’re really young, a priority?
Deborah Campbell (02:30):
Yeah. So again, as new parents, sometimes they don’t know or understand what they should be doing for their kids. So first and foremost, the American Academy of Pediatric Dentistry recommends that every child visit the dentist by age 1. And at that visit, really the point of it is to educate parents as to what they’re supposed to be doing and then get children used to being at the dentist – and so we can show mom and dad or a caregiver how to properly brush the child’s teeth. We usually do what’s called a knee-to-knee exam where we lay the child back on mom or dad or caregiver’s lap, and we just examine the child and just make sure that there’s nothing of early concern. And then we usually end with a fluoride application.
Anne Baum (03:17):
That’s great. So really starting really early in their life. So it’s not something you’re adding; it’s something that they just do. It’s a habit that we build.
Deborah Campbell (03:28):
Exactly.
Anne Baum (03:29):
So when should you start brushing your child’s teeth?
Deborah Campbell (03:33):
So you should actually, even when they have no teeth after feedings, you should be taking a damp cloth and just wiping the inside of their mouth. Another great product that I love, which you can get on Amazon, they’re called Toothettes. It looks like a little lollipop on a stick, and there’s a little tiny pink sponge at the end, and that’s also great. You just put it in some water and then swab it around the infant’s mouth. Then right around when the first tooth comes in is really when you want to start brushing.
Anne Baum (04:05):
OK, that’s great, and they probably like that little sponge, especially when they’re teething, right? Does it help?
Deborah Campbell (04:11):
Yeah, they like the way it feels.
Anne Baum (04:13):
That’s great. So what are some tips and guidelines for brushing your child’s teeth? How do you get them going with it once those teeth have come out?
Deborah Campbell (04:24):
So first of all, you should be brushing twice a day using a soft-bristle brush, a size appropriate for the age of the child. And at the eruption of the first tooth, you should be using a size of a grain of rice of a fluoride toothpaste. The American Academy of Pediatrics has changed their guidelines, and they do recommend that you do use a fluoride toothpaste at the eruption of the first tooth, and you should use just a size of a grain of rice. When they’re around 3 years old, you’re going to want to use the size of a pea. And then as they get older, you can give it a little bit more.
Anne Baum (05:01):
That’s great. And what do you think about those toothbrushes that they vibrate for a certain amount of time or they play a little song. Do you think those are helpful for kids?
Deborah Campbell (05:11):
Yes, absolutely. Whatever gets them excited about brushing their teeth. Electric toothbrushes are great. Some of them play songs, some of them have timers, and you should be brushing your teeth for two minutes twice a day.
Anne Baum (05:23):
That’s great. And so when you start off, obviously, you’re helping your children learning that basic skill. At what point do you let them do it on their own?
Deborah Campbell (05:34):
Great question. So generally, the recommendation is around age 7 or 8 is when you can start to allow them to brush their teeth on their own. But you do need to still have oversight on that, because some kids kind of just wave the electric toothbrush in the air, like my own kids did, instead of actually brushing.
Anne Baum (05:52):
So they’re just holding it out there, but not actually ... So you could hear that it was going through the cycle, but they weren’t actually doing it. Why do you think kids are resistant to brushing their teeth? What do you think it is about that they want to cheat, let the song play out, but not actually do it?
Deborah Campbell (06:14):
I think it’s just an extra activity. It’s considered a chore probably in their heads. They’re anxious to get onto something else.
Anne Baum (06:22):
And do you think there’s something we could do? Obviously starting really early, so it’s just part of their life will help, but is there something you can do to make it not seem like a chore or an obligation? What might we be able to say to kids to help encourage them to do it?
Deborah Campbell (06:42):
There’s a lot of newer apps out there that you can download on your phone that attach to the electric toothbrushes, and so you get reward systems or you can collect little prizes on the app. You can get point systems. And so there’s a lot of different ways, creative ways, that we really can encourage our kids to brush their teeth.
Anne Baum (06:59):
Oh, that’s great. So I love the gamification idea of toothbrushing. That might work for some adults, too.
Deborah Campbell (07:06):
Absolutely.
Anne Baum (07:07):
Now, teeth brushing, we talked about when you start that. How about flossing? At what point do you get kids to start flossing?
Deborah Campbell (07:15):
Right. So when the primary teeth come in, and you have 20 primary teeth, and they start to erupt anywhere around the age 5 to 6 months, and they can go all the way up to about 2 to 3 years before they’re fully erupted in the mouth. Some kids have their teeth erupt, the back teeth and front teeth erupt, and they’re very, very close and tight together. And so when those teeth come in, if there’s not a good amount of space between them, you want to start that flossing process. Because kids are more susceptible to getting cavities in between their teeth if they’re tight together because they can’t clean them as well.
Anne Baum (07:48):
Sure, that makes perfect sense. And so you get them flossing, earlier if their teeth are close. How about their toothbrush? How often do you change out your toothbrush?
Deborah Campbell (07:59):
So we recommend that you change your toothbrush with the seasons. Or if your child gets very sick, then you throw the toothbrush out and get a new one.
Anne Baum (08:08):
OK. I was going to ask you that question. So if your child is ill, anything that they’ve been using in their mouth, we should get rid of that, right?
Deborah Campbell (08:17):
Absolutely.
Anne Baum (08:17):
I’m assuming the germs stay there on the toothbrush.
Deborah Campbell (08:20):
They do, and absolutely no sharing of toothbrushes whatsoever.
Anne Baum (08:23):
Oh, that’s a great point. So making sure that each one is unique and easily identifiable if you have more than one child.
Deborah Campbell (08:31):
That’s correct.
Anne Baum (08:32):
OK, that’s great. So how do you protect your kids’ teeth? Brushing them, keeping them clean is one thing, but there is more to protecting your kids’ teeth. What are some of the things you can do to protect them?
Deborah Campbell (08:46):
So we hear a lot in the dental office, “Johnny, you have to stop eating so much candy.” But we know today that there’s so many factors that go into oral health. So the process starts with bacteria, and the most common bacterium that cause dental decay is something called Strep mutans.
Anne Baum (09:07):
That sounds awful.
Deborah Campbell (09:08):
And typically, and surprisingly to a lot of people, it’s actually passed along from caregiver parent to child just by cuddling, kissing, things like that. So if mom or dad or caretaker has that bacteria in their mouth, they oftentimes can pass along to their children. But that’s not the only factor, right? So high levels of that bacteria in your mouth are worse for you. So if there’s a lot of plaque on the teeth and there’s poor oral hygiene, then children are more susceptible to getting dental decay. Additionally, foods that are very high in sugar also cause decay. So what happens is you eat something that’s sugary, the bacteria go, “Yum, yum,” and they eat the sugary food, and then they produce an acid that breaks down the enamel and causes a cavitation or a hole. That’s the beginning process of a cavity.
Anne Baum (10:06):
Which sounds so awful, and you don’t even think about it. A little piece of sugar can really get things going in there, and you don’t see it or feel it. It just gets going, right?
Deborah Campbell (10:17):
And these are little teeth. And so as you get through the enamel surface of a tooth and it gets to the next layer, then the cavity can progress pretty quickly, and then that tooth can get infected or have an abscess, and the child can be in a lot of discomfort or pain.
Anne Baum (10:31):
So there are lots we can do. Obviously getting teeth cleaned, and how often do you get your child’s teeth cleaned? Is it the same as adults?
Deborah Campbell (10:38):
It is. So most of the recommendations are that you come every six months. Sometimes when you’re an adolescent and you have orthodontics or braces, sometimes if the oral hygiene is really poor, very commonly in teenagers, we do recommend more frequent cleanings.
Anne Baum (10:55):
OK, great. And what about sealants? At what point is that a recommendation? Is that something you should do for your kids?
Deborah Campbell (11:03):
Yeah. So sealants are a clear coat that we typically put on the six-year molars of teeth because they have a lot of grooves in them. And even though they’re about 13 percent of the entire chewing surface of a tooth, they account for about 88 percent of all dental decay in permanent molars. So they erupt right around age 6, and we typically like to get them sealed as soon as they erupt within about six months of the erupting. And then we go on sometimes to seal second molars around age 12. And then in very high-risk patients, sometimes we will even seal the premolar teeth.
Anne Baum (11:36):
OK. So seeing your dentist regularly, that’s going to get you on that right schedule, making sure the sealants are getting applied at the right time and really protecting our kids’ teeth.
Deborah Campbell (11:47):
Absolutely.
Anne Baum (11:48):
So what are some things that you can do to improve your child’s oral health?
Deborah Campbell (11:54):
So you want to, again, have the early habits, brushing, flossing. Sometimes, a dentist may recommend that you use a mouthwash. High-risk patients sometimes may be prescribed a higher-concentration fluoride toothpaste, commonly known as PreviDent or PreviDent 5000. Listen to your dentist’s recommendations about any sealants. Get fluoride treatments. Check to see if you have fluoride in your water. The Allentown area does have fluoride in their water, but many of the surrounding counties in Lehigh do not have fluoride in their water. And so just drinking that fluoride really helps to protect those teeth, because the fluoride goes into the enamel and strengthens it and helps prevent against dental decay.
(12:39):
The other really big thing is the beverages. A 12-ounce can of soda has 30 to 40 grams of sugar in it. That’s eight to 10 teaspoons. And with something like soda, very different from, say a candy bar, you constantly are sipping it. And so every time you take a sip of it, it’s just coating the teeth in the sugar and then producing a low pH in the mouth. And then that’s just a haven for the bacteria to do their thing and cause holes. It’s interesting when a lot of the – I guess around here it would be Wawa or Sheetz, my hometown, it was 7-Eleven – they started to come out with the big, supersize.
Anne Baum (13:20):
Yeah.
Deborah Campbell (13:21):
We called it the sipping cup phenomenon, because kids would get these big, giant cups of Mountain Dew or soda, root beer, and they’re constantly sipping from it all day long. And that just really does a lot of damage to the oral cavity.
Anne Baum (13:33):
And just eats away at their teeth. Now is the same true, when you say eight teaspoons of sugar and picturing that, you don’t really think of that much sugar in the drink? You know they’re sugary, but when you think eight teaspoons, visibly, that’s a lot.
Deborah Campbell (13:48):
It’s a significant amount.
Anne Baum (13:50):
What about juices like apple juice, cranberry juice, orange juice, juices that kids like?
Deborah Campbell (13:57):
Yeah, so same thing. They don’t have quite as much sugar in them, but they still have significant amount of sugar. So the recommendation actually for any child under the age of 6 years old is only to have breast milk, formula or water with fluoride, and that is it.
Anne Baum (14:13):
And no juice whatsoever.
Deborah Campbell (14:14):
And kids develop preferences to flavors. If they’re not exposed to the flavor, then they don’t know any differently. But if they are given it early, they’re given that juice early, then they start to develop a preference for it, and then they ask for it or want it more.
Anne Baum (14:30):
Sure. So we’re going to do everything to prevent cavities, but they happen.
Deborah Campbell (14:38):
They do.
Anne Baum (14:38):
What are some of the signs that your child might be, other than your dentist finding it, what are some of the signs you should watch for as a parent that your child may have developed a cavity or some sort of problem?
Deborah Campbell (14:52):
So when they’re really tiny cavities, they can develop as a little white spot. Sometimes they’re little brown spots, so you can look in the mouth and when you’re helping to brush at night, check on the biting surfaces of the teeth. Another common place to get dental cavities would be on the front, we call the anteriors of the teeth. And then the next place would be in between the teeth. So if you see a breakage or a hole in between the teeth where there’s a gap where there wasn’t a gap before, that can be a sign of a cavity.
(15:23):
Additionally, when the cavity starts to grow, the child will start to develop some type of sensitivity. So if they complain about sensitivity to hot or cold foods, it can be an indication that the cavity is growing. And finally, when the cavity progresses to an infection or an abscess, there can be a bubble on the gum, which is known as a fistula, or they can develop actually swelling in their face. That requires usually antibiotics and probably an extraction.
Anne Baum (15:50):
And by the time you’ve gotten to that point, is that a dental emergency?
Deborah Campbell (15:57):
It can be considered a dental emergency. We have seen some children in the ED that have been admitted for a dental infection in primary teeth.
Anne Baum (16:06):
I hope that most people listening do not get to that point and that you’re on top of it, watching for those cavities. All right. So what are some signs of poor oral hygiene?
Deborah Campbell (16:20):
Right. So poor oral hygiene looks like there’s bleeding in the gums, there’s a lot of plaque around their teeth. And plaque is the soft, gooey stuff that forms from food particles and that has bacteria in it. And the longer that it sits on the teeth, the more it can break down the enamel. Bad breath is a sign because it indicates a buildup of excess bacteria in the mouth, any type of swelling, those kinds of things.
Anne Baum (16:49):
And what about the gums, too? Obviously gum health is a big piece of oral health. What are some things to watch for in that regard?
Deborah Campbell (16:58):
Yeah, so gingivitis is the early sign of periodontal disease, and gingivitis is when you get swelling and irritation in the gums, and that’s because they’re not cleaned properly. And so brushing twice a day and flossing in between those tight teeth help to prevent the gingivitis. A lot of people think that if you see bleeding or you have bleeding when you floss or brush your teeth, that you should stop, and you should do the exact opposite. It means there’s inflammation there, and you have to do a better job of keeping it clean.
Anne Baum (17:Opens in new tab 27):
OK. So that bleeding right out of the gate is a sign that you need to continue to do more, not pull back from what you’re doing.
Deborah Campbell (17:36):
Correct.
Anne Baum (1Opens in new tab 7:37):
That is really good to know. We talked a little bit about juice and soda. People have heard about baby bottle mouth. Tell us a little bit about that, how you prevent it, what it is.
Deborah Campbell (17:49):
So baby bottle syndrome, that is now actually re-termed early childhood caries, or ECC. And the definition, the formal definition of it, is that is one or more decayed, missing or filled tooth in a child under the age of 6. So that’s what they call it. And basically the anterior front teeth are usually the most affected, and that is because breast milk and formula do have sugar in them. And so if you’re doing a nighttime or a before-nap feeding and you don’t wipe the child’s teeth off, that sugar is sitting on the teeth. And so that over a prolonged period of time can cause rapid deterioration of the teeth.
Anne Baum (18:35):
Wow, great advice. So we’ve been to the dentist, we’re doing all the sealants on time, flossing, brushing, doing everything we can to keep that child’s oral hygiene at the tip-top. What about things like screenings with X-rays? At what point do they have their first X-rays?
Deborah Campbell (18:57):
Yeah. So that varies by dentists, and it varies by child. Most dentists choose to take an X-ray if they see signs of early decay, so sometimes they may take it earlier. But also when those back molars start to close up and they can’t easily visualize what’s going on in between the teeth, and then they’ll take X-rays.
Anne Baum (19:16):
Got it. And again, as they age, sometimes, and we would all wish that the children’s teeth come in perfectly straight, but that rarely happens. At what point do children get that referral to an orthodontist?
Deborah Campbell (19:33):
So most orthodontists like to see a child by age 7 to 8, and not every child needs early-intervention orthodontics, but they like to at least evaluate them, evaluate their bite or their occlusion just to see if they might be in any need of early intervention. And if not, they usually just put them on a watch and see them every six months and then wait until they’re a little bit older for braces if they need them.
Anne Baum (19:56):
So you don’t necessarily wait for there to be a clear indication of a problem. You get that screening to see if there’s that early intervention that’s needed.
Deborah Campbell (20:06):
Yes.
Anne Baum (20:07):
That’s great. So what are some tips and tricks to make the experience of going to the dentist as exciting as possible or a happy experience for kids? I would imagine most kids, like mine, were terrified. They didn’t like the idea of going, and it was a scary experience until they got to know the dentist.
Deborah Campbell (20:32):
Yeah. So first and foremost, starting early really, really helps. So if they get used to that process, it can become very fun for them to go to the dentist because they’re not having work done. So you come into the dentist, you get your tooth polished, Mr. Thirsty can suck up the water from your mouth, and you make it very positive. Sometimes, we allow children that are very young to watch mom or dad or a sibling to go first, and they see how fun it is. And again, most dentists have a reward system, like a treasure box or a treasure chest where they get a reward or a prize at the end.
Anne Baum (21:09):
That’s great. And is it necessary to go to a pediatric dentist, or is any dentist who’s open to kids and experienced with kids a good choice for a family?
Deborah Campbell (21:20):
So certainly a pediatric dentist has more training in more complex pediatric dental issues, but a lot of general dentists are feeling very comfortable to see kids. So either/or is totally OK. Sometimes, if a child needs extensive work done, they will refer them out to a pediatric dentist.
Anne Baum (21:37):
OK, great. So you’ve got a great dentist, you’re doing everything to make them comfortable, and the child is still terrified. Any ideas on what you can do to help them feel more comfortable or help calm them down?
Deborah Campbell (21:55):
Well, so first of all, advice to parents is we don’t go to the supermarket or the library or Dorney Park, and we say, “It’s OK. Don’t be afraid,” because it puts it right into their minds that there’s something to be afraid of. So that’s the first thing. Second of all, choice of words. Don’t tell your child, “Don’t worry. The shot doesn’t hurt that much. The needle’s OK. It’s really small,” because we as dentists use words like, “We’re going to put some sleepy medicine in your mouth, and you’re just going to feel me wiggling around with my finger.” We use words and narratives to make the child feel comfortable, so they don’t quite understand what’s happening, but they still understand. And of course, we always do “show, tell, do,” right? We really talk them through the process, and we really make them feel great and comfortable.
Anne Baum (22:44):”So basically, you are saying that it’s our fault as parents that in our effort to make them feel more comfortable, we’re terrifying them about something that they shouldn’t be afraid of.
Deborah Campbell (22:57):
Yes. Well, it does happen. I think parents themselves get very, very nervous for their child. They’re worried how they’re going to react. They themselves don’t like going to the dentist, so they project their own fears on them. They get them in the room, and they grab their hand, and they go, “It’s OK honey, and nothing’s happened yet.” So really, just if you’re a parent and you have a fear, take a step back. Kids do much better without parents around in the room. If you want to observe your child, just kind of take a back seat and let the dentist and the dental assistant really do their job that they’re trained for.
Anne Baum (23:32):
That’s really great advice. I could completely see how I probably did that to my own kids. That’s great. So we’ve gotten through our entire list of questions. What would you like to share in addition to what we’ve talked about with our audience? We really appreciate everything you’ve had to share, Dr. Campbell.
Deborah Campbell (23:52):
Of course. Caries risk comes in many different forms. There are kids that don’t brush and don’t floss and don’t get cavities, but then the opposite can occur, and really, there’s many, many factors that go into play. One of the other things that we didn’t discuss is that certain medications that children take, one of the side effects can be dry mouth or xerostomia, so that’s also just something to be really aware of. If the child doesn’t have a lot of saliva in the mouth, they’re at an increased risk for getting dental caries because they don’t have the saliva, which is a buffer, and it washes away a lot of those acids.
(24:30):
Sodas, and juices, even your Gatorades and your energy drinks, have a lot of sugar in them. And so the advice there is if you’re going to let your child have the occasional soda, have them drink it with a straw and have them drink it in a short amount of time. Don’t give it to them while they’re watching a movie and have them sip over a two-hour time frame. Have them drink it in a short amount of time. Avoid really sticky things, Laffy Taffies, caramels, things like that. They’re going to stick right in the teeth and stay there for quite some time. Forty percent of children age 2 to 11 have cavities in their primary teeth, and by adolescence 59 percent of ages 12 to 19 have had cavities in their permanent teeth.
Anne Baum (25:16):
Wow.
Deborah Campbell (25:17):
We need to stop this, and we need to really, really make sure we focus on oral health, especially as we go into adulthood because of all of the possible complications.
Anne Baum (25:28):
Great. Well, thank you so much for this amazing advice. It’s clear that prevention is our friend with oral hygiene, and starting early and staying on top of it is the magic formula.
Deborah Campbell (25:42):
Absolutely. Thank you for having me, Anne.
Anne Baum (25:44):
Thanks for being here. For more kid-focused health tips, advice and must-know news about Lehigh Valley Reilly Children’s Hospital, follow us on Facebook and Instagram @lvhnchildren. And remember, every parent needs a partner through parenthood, so make sure to leave us a review and subscribe to or follow Because They’re Kids wherever you get your podcasts, so you never miss an episode.
