Important information for children and their parents

Michelle and Caroline recently attended a course on improving early childhood dental health.  As with every course, the purpose of attending is not just to learn;  it is to change.  We‘ll be making some changes with the routine in our office based on the information we acquired.
Some highlights from the course:
—When a child has decay, the goal of dental treatment is not just to remove the decay.  The bacteria that cause decay are still present in the child’s mouth.  To prevent future decay, home care needs to improve and diet may need to be better managed (fewer carbs;  bacteria love a diet of carbs!).  A fluoride varnish should be applied to the teeth of all children under six who have had decay;  some experts recommend that fluoride varnish should be used (instead of fluoride gel applied in foam trays) for all children under age six.
Note:  fluoride “varnish” isn’t a real varnish with fluoride in it.  Rather, it is fluoride applied as a coating that sticks to teeth for hours after it is applied.  The teeth have a much longer time to absorb the fluoride, which also has an anti-bacterial effect.   People who are especially prone to decay—children, and older adults on medications which cause dry mouth—should have fluoride varnish applied to their teeth on a very frequent basis.

—Fluoride rinses are recommended for home use in decay-prone children once a child is old enough to spit out (rather than swallow) the rinse.

—This is vitally important.   How do children “catch” strep. mutans, the bacteria that cause tooth decay?  Typically, children get the bacteria from saliva-to-saliva exposure from the mother (e.g. from kissing on the lips).  Toddlers can also pick up these germs from relatives, nannies, day care, etc.  It’s fine to hug your child and give kisses on the cheek, but saliva-to-saliva contact between children and others—including sharing of food—should be minimized.  As soon as baby teeth come into the mouth, it’s time to start cleaning them on a daily basis.  Start with a wet cloth or a small baby-sized toothbrush with water. 

—We now recommend that children come in for their first dental visit at age two (we previously recommended age three).  If you can reason with your child and he or she can follow instructions (like sitting still for a few minutes), your child is probably ready for a first “happy visit” to our office.

—Children under age three should be encouraged to brush their teeth with a moist toothbrush (no toothpaste—kids in this age group will swallow too much fluoride because they’ll try to “eat” the toothpaste).  Parents should be brushing their children’s teeth with a very small smear of toothpaste on a baby toothbrush.  Use a small child’s toothbrush (we have samples in the office) and a pea-sized amount of toothpaste for children age three to five.

There are many factors that make it difficult to determine exactly how much fluoride is just right for your child.  If your child is drinking exclusively bottled spring water or there is no fluoride in your drinking water, you probably need fluoride drops or chewable pills to supplement fluoride intake.  If you pay your water bill to Chester Water Authority, your water should be properly fluoridated, as is Media Water.  Most Aqua Pennsylvania-supplied water is not fluoridated.  It’s always best to call the water company to check.

Can a child have too much fluoride?

In a word, yes. If a child is exposed to too much fluoride, it can cause white or brown ‘fluorosis’ spots to appear on the permanent teeth. Today, it is almost impossible to tell you exactly how much fluoride your child should be getting. If your home water is fluoridated, your child should not be on fluoride supplements. If your water is not fluoridated (most customers of Aqua Pennsylvania do not receive fluoridated water; a notable exception to this is Media water), your child usually will need fluoride supplements, as follows: no supplement before age 3, 0.5 mg fluoride a day (or 1 mg every other day) from age 3 to 6, and 1 mg every day from age 6 to 12. I like to keep fluoride supplements separate from vitamins; when pediatricians recommend fluoride-vitamin combinations like PolyViFluor, the risk is that your child will get too much or too little fluoride.

What about infants? A recent study in the Journal of the American Dental Association showed that most concentrated infant formulas had low fluoride levels; the amount of fluoride in the water used to reconstitute the formula was a much bigger factor in how much fluoride an infant was exposed to.

Another issue: do you live in an area with fluoridated water, but your kids are exclusively drinking spring water or purified water? If that’s the case, they may not be getting enough fluoride.

Coming up with the exactly correct amount of fluoride for your child is an amazingly complex issue, and studies are ongoing.

New recommendations for fluoridated water

Baltimore Sun; January 7, 2011:

ATLANTA (AP) — Fluoride in drinking water — credited with dramatically cutting cavities and tooth decay —may now be too much of a good thing. It’s causing spots on some kids’ teeth.

A reported increase in the spotting problem is one reason the federal government will announce Friday it plans to lower the recommended limit for fluoride in water supplies — the first such change in nearly 50 years.

About 2 out of 5 adolescents have tooth streaking or spottiness because of too much fluoride, a surprising government study found recently. In some extreme cases, teeth can even be pitted by the mineral — though many cases are so mild only dentists notice it.

Health officials note that most communities have fluoride in their water supplies, and toothpaste has it too. Some kids are even given fluoride supplements.

The U.S. Department of Health and Human Services is announcing a proposal to change the recommended fluoride level to 0.7 milligrams per liter of water. And the Environmental Protection Agency will review whether the maximum cut off of 4 milligrams per liter is too high.

The standard since 1962 has been a range of 0.7 to 1.2 milligrams per liter.

The Centers for Disease Control and Prevention reports that the splotchy tooth condition, fluorosis, is unexpectedly common in kids ages 12 through 15. And it appears to have grown much more common since the 1980s.

Buzz’s note: If you have Media or Chester water, your water has been fluoridated. However, the fluoride levels in water supplied by Aqua Pennsylvania have varied from zero to approximately 1.0 milligrams. This would be a good time to check with your water supplier to see how much fluoride is in your water—it may be a different level from the house on the next block! If your water is not fluoridated, your child still needs fluoride supplements, which I would be happy to prescribe in the proper dose for your child. Remember, the recommended fluoride supplement varies according to the age of  your child. That is why I strongly recommend against Poly-Vi-Fluor and similar vitamin-and-fluoridesupplements frequently prescribed by pediatricians. From birth to age six months we now recommend NO fluoride supplement; from six months to three years the amount should be 0.25 milligrams a day. That is why fluoride and vitamins should always be prescribed separately.