The DOs and DON'Ts of Baby Dental Care

by Dr. Michele Brown

Keep Your Baby's Mouth Happy

We all love to watch an adorable baby sucking on a bottle, but breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand.

Until recently, a child would only visit the dentist after dental disease occurs. Sadly, some children with decay developed pain, infections, abscesses, chewing difficulties, malnutrition and low self esteem. Others experienced malocclusion, poor growth, difficulty in speech, bruxism (grinding) and decay of the permanent teeth. Delayed treatment was expensive and often children required general anesthesia and/or frightening restraint for needed repairs.

As if these outcomes were not terrible enough, many people have had to endure mouthfuls of fillings, crowns and bridges later in life as the conditions worsened over time. I suppose this all may seem better than the infamous wooden teeth of the George Washington era, but honestly, not by much.

Now that dentistry has, thankfully, shifted to prevention of cavities by proper oral hygiene and treatment with antibacterial and tooth protecting substances. Here are the oral care guidelines for young babies.

But My Baby Has No Teeth!

Not true! Although a baby is born without visible teeth, development of two sets of teeth has begun in earnest by the 6th week of gestation. By the time the baby is born, both the primary and permanent teeth are present below the gums in an early developmental stage.

Now that you understand that all your baby's teeth are "in there," it's clear why early preventative care will help prevent traumatic dental care issues from cropping up any time during life.

What Will a Good Dentist Do?

Children should be visiting the dentist by 1 year of age and be seen twice a year after that. Dentists should discuss diet, provide oral hygiene instructions and detailed directions for fluoride intake. They should also offer behavioral recommendations including the use of pacifiers, the ramifications of thumb sucking and the prevention of baby bottle syndrome.

Will Diet Affect My Baby's Teeth?

Nutrition continues to play an important role in prevention of tooth decay. Cariogenic foods such as crackers, teething biscuits, fruits and fruit juices, sweetened and acidic soft drinks should be limited. Carbohydrates, broken down by the enzymes in saliva along with bacteria in the mouth leave acid residue that dissolves the tooth enamel. Gums and newly erupted teeth should be cleaned after eating these types of foods. Dairy foods, especially aged cheese, can be protective.

Fluoride -- Good or Bad

Fluoride use, which prevents tooth decay by increasing the density of the enamel, helps the teeth resist acid dissolution and is recommended after birth to limit cavities (caries).

Fluoride content of water should be tested and fluoride given by 6 months of age if the water is not supplemented or if the supplementation is less than .6 parts per million. Excessive intake of fluoride is not recommended because it produces mild dental fluorosis. This can also occur when children swallow large amounts of toothpaste that is supplemented with fluoride.

Fluoride use during pregnancy is controversial, with broadly divergent opinions.

The opinions range from "absolutely not" to "absolutely, positively yes" based on studies, some of which are interpreted to find that there is great benefit provided by the use of fluoride supplements during the pregnancy, to commencing fluoride use with the eruption of the infant's teeth, to those who express the greatest concern about the generation of fluorosis and other undesirable or even dangerous conditions. Please consult your physician and your dentist for the recommendation in your individual case. Be sure to tell those you ask whether you live an an area that has a fluoridated water supply or well water. [Editor's note: Use of fluoride to prevent dental caries is highly debated. Please research thoroughly before making a choice.]

Pacifiers and Thumb Sucking

Pacifiers have both advantages and disadvantages. Pacifiers, which exert less abnormal pressure on the teeth than a thumb or other fingers, might prevent thumb sucking and thereby reduce the risk of developing severe malocclusion (overbite) and abnormal growth patterns of the structures that support the teeth (the maxilla and the mandible).

If thumb sucking continues after the permanent teeth have erupted, it has an even higher probability of causing permanent damage. Pacifier use can be controlled in a child in contrast to an appendage such as a thumb. Pacifiers have also been associated with a reduced incidence of SIDS.

It has been shown that long term use of pacifiers can cause dental problems. Misalignment of the teeth or malocclusions have been reported when infants use them beyond the age of 4. There is also a higher risk of ear infections with their continuing use. Limiting the use of pacifiers to the first 6 months or limiting their use to sleep times is recommended. Continuous use of pacifiers may also stunt speech development.

There is little evidence that orthodontic pacifiers are any better than conventional ones.

Choose pacifiers made of a more durable substance like silicon rather than latex, and be sure that the pacifier is made in one piece to avoid smaller parts from being detached and swallowed.

Pacifiers have not been associated with cavities but pacifiers should not be coated with sweets. Contrary to popular belief, pacifiers do not shorten the duration of breast feeding.

Baby Bottle Syndrome

This syndrome, resulting from excessive baby bottle use, is characterized by the development of severe tooth decay with pain and infection. It can lead to extractions and extensive dental treatment.

Bacteria in the mouth use milk and other sweetened beverages for metabolism and create an acidic environment in the mouth causing the destruction of tooth enamel and creating cavities. Children suffering from baby bottle syndrome feed poorly and often fail to thrive. The damage initially appears as white lesions on the teeth and then later progresses to brown or black discoloration.

When the damage is severe, the crowns break down and permanent teeth may also be damaged. Malnutrition, with deficiencies in calcium and Vitamin D, may also lead to tooth enamel defects which predisposes the teeth to caries. The overall incidence of baby bottle syndrome varies from 3% to 6% in the general population but can be as high as 72% depending upon the population. The teeth most affected are the maximally and mandibular primary incisors followed by the primary molars.

Breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand. Breast milk does not support the growth of bacteria, doesn't lower the acidity in the mouth and is therefore not as destructive. This is another reason why all mothers should be encouraged to breast feed their infants. Proper use of nipple gels will help heal the chapped, sore breasts that often prevent women from continuing breast feeding.

DOs and DON'Ts of Proper Infant Dental Care

Things to Do

  • Mouth cleaning in infancy should be part of a daily routine.
  • Clean gums, newly erupted teeth, (after 6 months of age) and tongue, with clean washcloth, piece of gauze, or very soft moist toothbrush after feedings and before bed.
  • Clean mouth with toothbrush or washcloth after giving sweetened medications.
  • Introduce solid foods after 6 months of age and avoid cariogenic foods.
  • Bottles should only contain plain water if being given for naps, bed or pacifier.
  • Schedule first dental visit after the first year of life.
  • Encourage breast feeding, especially for the first 6 months of life when fluoride is not recommended.

Things NOT to Do

  • Do not allow the infant to sleep or nap with a bottle filled with juice or milk.
  • Do not dip pacifiers in sweet or sweetened foods such as honey, sugar, or juice -- sugars will feed bacteria in the gums, causing tooth decay even before teeth have erupted.
  • Do not give fluoride supplementation till at least 6 months of age -- the American Dental Association does not advocate use of fluoride at this age because there is an increase of fluorosis (white spots on the teeth) in infants who are supplemented.

Like so much about having a new baby in the house, dental care may seem daunting. My advice to new parents is to find yourself a reputable dental professional, carefully follow the advice given, and then watch your baby's teeth arrive sparkling, white and pain free.

Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.

Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.