Q. HOW CAN I PREVENT CAVITIES?
A. The American Academy of Pediatric Dentistry advises:

• Brush with fluoride toothpaste twice a day.
• Floss children's teeth once a day until they are able to do it themselves – around age 7 or 8.
• Visit your pediatric or general dentist regularly.
• Get enough fluoride through drinking water, fluoride products and, when indicated, through fluoride supplements.
• Have sealants applied to the chewing surfaces of permanent back teeth or molars soon after they come in.
• Snack moderately – no more than twice a day.

Q. IS DIET IMPORTANT IN THE PREVENTION OF CAVITIES?
A. Though a balanced diet is certainly important in preventing cavities, experts agree that cavities are not only the result of what children eat, but also, how often they eat. Frequent snacking without brushing leaves food on the teeth longer and fosters tooth decay.

Q. WHAT ARE GOOD AND BAD FOODS FOR THE TEETH?
A. Although foods such as milk, fruits and vegetables contribute to strong bones and healthy teeth and gums, even they can foster tooth decay in the absence of good oral hygiene. Particles of food that are trapped on tooth surfaces are considered to contribute to cavity development. Because of their texture, some foods are retained in the mouth longer than others are. However, foods that are perceived by consumers to be "sticky" are not always those that are retained longest in the mouth. Research continues in this area. Table sugar (sucrose) was once considered the sole dietary culprit in cavity formation. Recent research, however, indicates that cooked starches also play a role. When complex carbohydrate foods such as bread, corn flakes, pasta, crackers, and potato chips are allowed to remain in the mouth for several hours, the bacteria that live in the mouth break down these starches into sugars. This process produces acids that attack teeth, and a cavity will result if the mouth is not cleaned. For this reason, sugars and cooked starches are best reserved for mealtime when saliva production is increased and when naturally rinsing foods and beverages also are being consumed.

Q. CAN YOU PROVIDE INFORMATION ON SNACKING?
A. First of all, snacking in moderation is the key since children often don't brush after snacking, allowing particles of food to remain in the mouth. Research has shown that certain snack foods have anti-cavity power. Cheese, including aged cheddar, Monterey Jack and Swiss – alone or with an accompaniment – is an excellent snack choice. This is because cheese stimulates production of saliva which clears carbohydrates (sugars and starches) and harmful acids, re-mineralizes teeth, and also neutralizes harmful acids. New research also indicates that cheese coupled with good oral hygiene can heal small breaks in tooth enamel where cavities can form. Raw fruits and vegetables also are great snack choices. Should your child want something sweet, caramel or some kinds of chocolate and hard candies that dissolve and clear the mouth quickly may be alternatives. And if the child wants something crunchy, studies show that peanuts and cashews fight plaque and neutralize the bacteria that causes tooth decay. In addition to providing dentally preferred snacks, it also is important to alternate snack choices to incorporate variety, moderation and balance into a child's overall diet. Discuss snacking and snack choices with your child's dentist.

Q. AT WHAT AGE SHOULD I TAKE MY CHILD TO THE DENTIST FOR THE FIRST TIME?
A. Let the first tooth, which will surface between six and twelve months, remind you that it's time to see your pediatric or general dentist. Though this may seem early, 40% of toddlers between two and three have some inflammation of the gums and/or cavities. Be sure to get advice on tooth cleaning, pacifiers, fluoride and preventing tooth injuries for young walkers.

Q. IF OUR WATER SUPPLIES FLUORIDATED SHOULD MY CHILD ALSO USE A FLUORIDATED TOOTHPASTE?
A. Absolutely. It was once believed that dietary fluoride (fluoride taken into the body through food and water) was more effective than topical fluoride (fluoride applied to the teeth with toothpaste, mouth rinses or in-office fluoride treatments). Today, professionals maintain that both sources of fluoride are equally influential in preventing tooth decay. Toothpaste provides daily fluoride boosts that are necessary in keeping your child's teeth cavity-free.

Q. IS IT POSSIBLE TO GET TOO MUCH FLUORIDE?
A. Parents often worry about too much fluoride, a condition which can cause dental fluorosis. Your pediatric or general dentist will assess the amount of fluoride your child is receiving from drinking water, toothpaste, mouth rinses and in-office fluoride treatments and also will consider the need for a dietary fluoride supplement. The tiny percentage of children who incur severe dental fluorosis typically consume over-fluoridated water on a regular basis or eat their toothpaste. The U.S. Public standard for optimum water fluoridation Health Service assures us that water fluoridation is safe and effective. Confirm with your dentist or your local water company if necessary, that your community observes the Environmental Protection Agency's (0.7 to 1.2 parts per million). It's also a good idea to teach small children to use a pea size amount of toothpaste for brushing, not snacking.

Q. WHAT ARE DENTAL SEALANTS?
A. Dental sealants protect the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are painted onto the tiny grooves and depressions in the molars. By "sealing out" food and plaque, sealants reduce the risk of decay. They are quickly and painlessly applied to any baby teeth and permanent teeth that, in the dentist's opinion, are likely to have decay on the biting surface. Sealants must be checked periodically and replaced when necessary, though they generally last for several years.

Q. CAN ALL CHILDREN BENEFIT FROM DENTAL SEALANTS?
A. Studies show that 4 out of 5 cavities in children under age 15 develop on the biting surface of back molars. Molars commonly decay because plaque accumulates in the tiny grooves of the chewing surfaces. Though fluoride works to prevent cavities on the smooth surfaces of teeth, it is not as effective on the biting surfaces of back teeth. Sealants prevent the cavities that fluoride cannot effectively reach. As a preventive mechanism, sealants are an important part of a cavity-free generation.

Q. WHEN SHOULD MY CHILD BEGIN TO BRUSH HER TEETH?
A. Brushing should actually begin before children are capable of doing it themselves. A wet cloth or gauze effectively cleans gums and removes plaque after nursing and establishes a good habit early on. Gentle brushing with a soft bristle brush begins with the first tooth and flossing, when most primary teeth are in. At six or seven, children can brush on their own, with careful supervision. And by eight or nine, they can floss on their own too. The American Academy of Pediatric Dentistry says "a good rule of thumb is this...When children are accomplished enough in caring for their own needs that they can get up, bathe and dress themselves and comb their hair without your help - then they are ready to accept full responsibility for their mouth-cleaning program!"

Q. HOW CAN I HELP MY CHILD DEVELOP TOOTH BRUSHING INTO A HABIT?
A. If you want to motivate your children, start by being a good role model with your own daily brushing, flossing, and limited snacking program. Let them also notice that you follow a regular dental checkup schedule. You can interest young children by making mouth cleaning a family event they would not want to miss. As they grow, praise their efforts as well as their newfound independence with the habit and it will instill a sense of pride in a job well done.

Q. IS IT IMPORTANT TO CARE FOR MY CHILD'S BABY TEETH SINCE THEY WILL EVENTUALLY COME OUT ANYWAY?
A. Proper care of baby teeth is instrumental in enhancing the health of the growing adult teeth. The primary teeth guide the permanent teeth into position and allow normal development of the jawbone and muscles. Because primary teeth hold space for their successors, early loss or damage can severely affect the outcome of the permanent teeth. As with adults, children need healthy teeth and mouths to chew food easily, learn to pronounce words properly and speak clearly, and smile with confidence.

Q. WHAT SHOULD I DO IN CASE MY CHILD CHIPS OR KNOCKS OUT A TOOTH?
A. If a tooth is broken, save any fragments and make an emergency visit to your dentist's office. If a permanent tooth is knocked out, find it, and if it is not broken, rinse it in cool water and gently replace it in the socket. Hold it there while you hurry to see your dentist. If the tooth does not seem replaceable, bring it with you to the dentist in a glass of milk or cool water. Never delay – the faster you get to the dentist, the better your chances of saving a tooth. Remember that the dentist should examine all injuries to the mouth. A chipped or broken tooth can usually be repaired.

Q. WHAT DOES IT MEAN IF MY CHILD'S TEETH ARE SENSITIVE TO HOT AND COLD?
A. Sensitive teeth are not uncommon and can be symptomatic of anything from a harmless sinus headache to more serious problems such as bruxism (teeth grinding), cavities, loose fillings, or receding gums. Sensitivity also can be magnified by tiny cracks beneath the outer enamel created by chewing on hard objects. And dental treatment sometimes inflames the pulp or nerves inside the teeth making them sensitive. If your child complains of momentary pains caused by hot or cold elements, consider all possible causes and consult your pediatric or general dentist. Fleeting sensations are rarely grounds for worry. If these pains tend to linger, however, see your dentist for an examination.

Q. MY TEETH HAVE ALWAYS BEEN CROOKED. IS THERE ANYTHING THAT CAN BE DONE TO MAKE SURE THAT MY CHILD'S TEETH COME IN STRAIGHT?
A. Fortunately, orthodontic treatment has come a long way, especially with early intervention procedures. As your pediatric or general dentist monitors your child's development, he or she can teach your child to avoid oral habits that encourage orthodontic problems. Your dentist also can identify malocclusion (abnormal dental alignment) right away and actively intervene to guide the teeth as they emerge in the mouth. Many times, early orthodontic treatment can prevent more extensive treatment later. Though your child may need braces, new preventive techniques can minimize time needed to wear them. Q&A Acknowledgements: Sources of information for this fact sheet include: 1990 and 1991 American Academy of Pediatric Dentistry publications; Kashket, S., et. al. Lack of Correlation Between Food Retention on the Human Dentition and Consumer Perception of Food Stickiness. Journal of Dental Research 70:1314, 1991; Shultz, D., Fluoride: Cavity Fighter on Tap. FDA Consumer 26(l):34, 1992.

Reviewed by Steven M. Adair D.D.S., M.S., Professor and Chairman, Department of Pediatric Dentistry, Medical College of Georgia, Augusta, GA.

Q. HOW OFTEN SHOULD MY CHILD RECEIVE FLUORIDE TREATMENTS?

A. The American Dental Association recommends fluoride treatments twice a year for you child's teeth.  Please be aware that your insurance company may only pay for this treatment once a year.