Tooth Wisdom

It's never too early to start taking care of your baby's pearly whites.


Your baby's dental care may not be at the top of your concerns list, but it should be. When I learned that my 3 1/2-year-old son had extensive tooth decay, I felt incompetent and embarrassed. Dentists blamed Isaac's problems on long-term nursing, although no one had warned me that there could be any dental dangers from breastfeeding. I decided to educate myself.

First I learned that early childhood caries, or "baby bottle" tooth decay, affects one in every five children in the United States younger than 14 months. I also discovered that certain factors may increase a child's susceptibility: family history of tooth decay, mother's use of antibiotics during pregnancy and premature birth — in which case the enamel may not have formed properly.

Baby teeth need attention even though they'll soon be gone. Untreated cavities can lead to pain, poor eating habits, problems in speech development, crooked teeth (malocclusion) and damage to the permanent teeth.

Breast milk itself cannot cause decay, says Pamela R. Erickson, D.D.S., a University of Minnesota Twin Cities researcher and mother of three. But the combination of nursing and eating other foods can cause problems. Therefore, once breastfeeding moms introduce other foods to baby's diet, it's time to start cleaning gums and teeth. (The American Academy of Pediatric Dentistry recommends weaning from breast or bottle by 1 year, but author and pediatrician William Sears, M.D., cautions that this could be like throwing out the baby with the bath water, given the overall advantages of long-term breastfeeding.)

Sorting through contradictory advice can be a challenge, so here are some clear guidelines:

Prenatal Care: Babies are born with a full set of primary teeth waiting to erupt, so while you're pregnant, safeguard their health by making sure to eat a diet high in calcium and phosphorous.

Cleaning: Even before teeth appear, wipe gums with a clean, damp, soft cloth or small brush after each feeding. Begin brushing teeth with a small, soft-bristled toothbrush after they first erupt.

Nursing: Once he has teeth, don't allow your child to fall asleep while nursing or sucking a bottle (unless it's filled with water). Liquids containing sugar pool around the gums, feeding the bacteria that cause teeth to decay.

Snacks: Sugar can also cause damage during the day, so limit sweet snacks. Crunchy vegetables and apples are good because they can remove food residue and stimulate saliva production, which naturally rinses the teeth.

Pacifiers: Pacifiers can inhibit normal saliva and, because they force the lips against the teeth, cause the mouth to retain sugar.

Exams: A dental visit at age 1 will identify any problems your child might have. Unless your dentist is experienced in treating small children, find a pediatric dentist. Prepare your child for a positive experience by playing dentist at home. And during your visit, ask for a demonstration of proper at-home tooth cleaning and an assessment of your child's fluoride needs.

As it turned out, my son needed a mouthful of fillings. Fortunately, I'd found a great pediatric dentist, and Isaac sailed through with flying colors (though his father and I were wrecks). Even if efforts at prevention fail, take heart: Infant tooth decay, properly treated, does not necessarily lead to problems with permanent teeth.