Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
What to Expect the Toddler Years (170 page)
The full complement of early childhood teeth can be expected by a toddler’s third birthday. The teeth usually come in in a specific order, 1 through 20, though occasionally they stray from the standard pattern.
When your toddler begins to show an interest in brushing, encourage him or her. And don’t worry about teaching a particular method of brushing; the dentist can offer instruction in the proper technique later on. Until your child’s at least seven years old, you should continue to help with the brushing, even if he or she is able to do part of the job solo. If your toddler resists brushing (or your help), see page 274.
FLUORIDES FOR FIGHTING DECAY
Though fluorides have been around for millennia, their cavity-fighting properties weren’t discovered until 1945. Since then, many clinical studies have confirmed that fluoride is effective in reducing the incidence of dental caries, or cavities. Because the evidence is so persuasive, both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend fluoride supplementation for infants and children in communities where water is not fluoridated or does not contain enough natural fluoride, or when a child does not get enough water or food containing water in the course of the day. (If your toddler is still breastfed, don’t count on breast milk as a source of fluoride—it contains very little.) Fluoridated toothpaste (safe to use once you’re sure your child won’t swallow it) strengthens enamel but does nothing for teeth not yet erupted; on its own, it’s not considered adequate protection. Over-the-counter fluoride rinses are not recommended for young children, since they may swallow harmful amounts.
The fluoride dosages prescribed for a toddler depend on the child’s age, how much fluoride is in the local water, and how much water he or she drinks (assuming the child drinks water at all, or consumes drinks—such as reconstituted frozen juice—or food prepared with water). If you use well water or bottled water at home for drinking, or if your toddler never drinks water, let the doctor know, so that this can be taken into account in deciding on appropriate doses for fluoride supplementation. Fluoride supplementation is important during tooth formation and should continue until all permanent teeth have erupted.
In general, when local water fluoridation levels are below 0.3 parts per million (ppm), it is recommended that children under two take 0.25 mg a day of fluoride, and children between two and three, 0.5 mg daily. When drinking water is fluoridated at levels between 0.3 and 0.7 ppm, those doses are halved. When water is fluoridated at 0.7 ppm or above, no supplementation is needed.
Topical fluoride treatment (in which the dentist applies fluoride directly to the teeth, where it is absorbed by the enamel) is also used to combat dental caries. Though not a substitute for internal fluoride supplements, fluoride treatment strengthens enamel, can attack plaque directly, and can even arrest tooth decay in progress.
If you rely on fluoridated water for your toddler’s daily fluoride intake, dilute fruit juices with water to assure some daily water consumption. You can also use soups, sauces, and hot cereals as vehicles for getting water into your child, and thus getting the fluoride down. When cooking pastas, save some of the water for making the sauce (the cooking water contains vitamins as well as fluoride); when a recipe calls for milk, use dry skim milk reconstituted with water (if your toddler is under two, also add a spoonful or two of half-and-half).
Rinsing is an essential part of the brushing process. Not only does it remove the toothpaste before it’s swallowed, but it eliminates bits of loosened food that would otherwise just resettle elsewhere on the teeth. Children should be taught to rinse their mouths after brushing as soon as they are able to—usually around age two. Each family member should have his or her own cup for rinsing (use different colors to eliminate confusion and territorial disputes); be sure to wash the cups regularly.
When your toddler can rinse and spit, you can begin to put a pea-size amount of fluoridated toothpaste on the brush (do without it or continue using the toddler cleanser if your toddler
doesn’t like the taste); but watch out for toothpaste eaters (see page 275).
Flossing is as important to good dental health as brushing and rinsing. Just when it should begin, however, is controversial. The American Dental Association says it should begin as soon as all the primary teeth are in. Many dentists, however, recommend waiting until children can floss on their own. Check with your child’s dentist for advice and for tips on how to floss, when the time comes. You’ll have to be in charge of flossing until your child is at least seven or eight, and is capable of taking the job over. Which is easier said than done, both because it’s difficult to maneuver large adult hands in the tiny toddler mouth and because most toddlers will not sit still long enough to get the entire job done.
Unless you have an unusually cooperative toddler, you will probably not be able to floss the entire mouth every night—at best, you may be able to get to the top teeth one night, the bottom the next. It’s more important to focus on the molars than the front teeth, so always work from back to front. And remember, getting into the habit is as important as getting the job done.
Teeth-safe diet.
Cavities form when bacteria found in healthy mouths (especially
Streptococcus mutans
) feed on sugars and starches in food residue in the mouth, producing an acid that wears holes in tooth enamel. It’s long been known that foods high in sugar can start this process, but recent research has shown that foods high in other carbohydrates (for example, breads and cereals), which break down to sugar in the mouth, can also contribute to cavity formation. Sticky foods, such as cookies and cakes, containing both sugars and other carbohydrates may do the most damage. Eating cheese, on the other hand, may inhibit cavities and actually strengthen tooth enamel.
How long a food remains on the teeth is more signficant than how much is eaten. For example, a box of raisins nibbled throughout the morning will be more likely to lead to decay than the same box eaten at breakfast with milk and cereal. For much the same reason, children who nip on a breast or on bottles of milk or juice all day long are particularly vulnerable to cavities (see pages 27 and 32). Decay-promoting foods are less likely to do their dirty work if they are eaten with other foods, especially if they’re chased with a serving of cheese. (Peanuts and sugarless chewing gum—particularly brands sweetened with xylitol—also can counteract cavity-causing foods, but they’re not recommended for toddlers, who might choke on the peanuts or swallow the gum.)
Acid foods can also damage tooth enamel, so have your toddler rinse after eating an orange or pasta with tomato sauce, or chewing a supplement containing vitamin C (ascorbic acid). Drinking acidic beverages (citrus juices, tomato or vegetable juices, even sodas) through a straw may help keep more of the liquid off the teeth.
OST COMMON TEETH AND MOUTH PROBLEMS
Dental caries.
What is it?
Tooth decay.
Who is susceptible?
Most children. Some individuals are particularly susceptible, while others seem to inherit teeth that are resistant to caries. Children whose mothers took fluoride prenatally and who had fluoride supplementation while their teeth were forming tend to be more resistant, too.
Signs and symptoms:
Decay, characterized by black or brown spots, and eventually pain, in teeth.
Causes:
The acid produced by the action of naturally occurring bacteria in the mouth
(especially
Streptococcus mutans
) on sugars and starches eats into the tooth enamel, beginning the decay process.
Transmission:
Not contagious.
Treatment:
Prevention is the best treatment, as described above. Once caries are formed, they should be cleaned out and filled by the dentist as soon as possible. Not repairing cavities leaves a child at risk of serious infection and tooth loss. When a tooth is lost to decay, it is usually necessary to maintain the space with a dental appliance to make sure there will be adequate space for the permanent tooth when it erupts.
Malocclusion.
What is it?
Irregular positioning of the teeth and jaws, which can affect the bite, the ability to clean the teeth properly, the health of the gums, jaw growth, speech development, and appearance.
Who is susceptible?
Any child, but most often children with an inherited predisposition and those with persistent sucking habits or early tooth loss.
Signs and symptoms:
Teeth are crooked, come up in the wrong places, turn in the wrong direction; often the top and bottom teeth don’t meet as they should.
Causes:
Heredity, which determines the shape and size of the mouth, jaws, and teeth (inheriting a small mouth from one side of the family and large teeth from the other, for example, can lead to malocclusion) and environment (having a persistent thumb- or pacifier-sucking habit or losing baby teeth prematurely).
Treatment:
Examination plus plaster models of the teeth, photographs, and/or X-rays may be used to evaluate the problem. A serious malocclusion is usually treated promptly—most often with the insertion of some kind of orthodontic appliance—to keep it from getting worse and affecting new teeth as they erupt, as well as to prevent it from impeding speech development. A minor malocclusion in a toddler can usually go untreated until the permanent teeth are in; in fact, it may actually correct itself.
Herpes labialis (cold sores, fever blisters).
What is it?
An infection that usually strikes the mouth, lips, and area around the lips, but can also affect a facial nerve and the eyes.
Who is susceptible?
Anyone, but most primary infections occur in childhood.
Signs and symptoms:
With the primary, or first-time, infection, there are usually sores on the gums and inside the mouth, often accompanied by fever and irritability, and sometimes sore throat, swollen glands, bad breath, drooling, and loss of appetite, though some young children display no obvious symptoms. Since the symptoms may mimic those of teething (the sores may even look like teeth about to poke through the gum), fever (sometimes as high as 106°F, or 41.1°C) may be the only tip-off parents have that an infection is brewing. Once the initial infection clears up, the virus generally lies dormant, ready to reappear when the body is under stress. In secondary, or recurrent, eruptions, a welt, which tingles and itches, forms on or near the lip (herpes labialis). The lesion then forms a painful, oozing blister. Finally, it crusts and forms a sometimes itchy scab. In untreated cases, the scab usually falls off within three weeks. The flare-ups can also cause headaches and affect the eyes, causing conjunctivitis or even more serious eye infections. Occasionally, the infection spreads to one or more fingers in the form of a pus-filled inflammation, called an herpetic whitlow. Rare complications include HSV encephalitis, which can be very severe, and HSV meningitis, which is usually mild and self-limited.
Cause:
The herpes simplex virus (HSV). Subsequent flare-ups can be triggered by physical stress (colds, flu, fever, teething), fatigue, emotional stress, or by a period of prolonged exposure of the lips (unprotected by sunscreen) to direct sunlight.
Transmission:
Person to person, year-round, via direct contact with oral or eye secretions or the lesions themselves. It’s not clear how long an individual with
an active infection is contagious, and the virus can be shed even when no sores are visible, so precautions to avoid transmission should be continued until the lesions have healed. The incubation period is believed to be two to twelve days.
Treatment:
With primary infection, soft, nonacidic foods. For routine flare-ups, topical medications are available without prescription for easing the discomfort of herpes lesions; at the height of an infection, acetaminophen can be used to reduce pain. Applying ice to the sore can also reduce pain, though most children won’t tolerate this treatment for long. Some chronic HSV sufferers find that taking acidophilus-lactobacillus tablets or capsules at the first twinge stops a flare-up in its tracks. For toddlers, the chewable tablets can be crushed and served up in yogurt or milk (they taste milky and sweet); check with your child’s doctor for dosage. Call the doctor if your child seems ill. When a child has a severe HSV infection or has a compromised immune system (due to another illness or a medication), an antiviral medication (such as acyclovir or vidarabine) is usually prescribed. Because the drugs have not been tested for safety in healthy children, they are not routinely prescribed for them. If there is eye involvement, antiviral eye drops will be given.
Prevention:
Avoiding stress when possible; getting adequate rest; using lip balm with sun-screen in bright sun.
ARING FOR YOUR LITTLE GIRL’S GENITALS
Keeping a little girl’s vaginal area clean and irritant-free is the best way to fend off infection. You can do this in the following ways:
Always wipe your daughter front to back when changing her diaper or after she uses the toilet. Teach her to do the same as you prepare her to take over the task herself. If she’s still in diapers, it may be necessary to spread the labia, or lips, of the vagina to clean up after a particularly messy bowel movement.