My last column focused on dental care in the mature population and I have requests to have more information for the pediatric population. So here we go. Let's go through some of the most common questions that I hear asked.

One question is when children should first be seen. Although it may seem young, the American Academy of Pediatric Dentistry recommends that children be seen by a dentist by their first birthday. This is to be thought of as a “well dental” visit.

The main focus for the visit should be to examine the teeth that have erupted and ensure that there is no intraoral pathology. Just as importantly, we dentists or our assistant or hygienist should spend time with the parents demonstrating how to keep the baby's teeth clean. There are a number of soft brushes and finger wipes that are effective for cleaning the plaque from the teeth.

This first visit can also evaluate any adverse habits such as thumb sucking, which can be very detrimental to the skeletal growth of the jaw bones. Diet can be a topic of conversation for this visit as well. I have taken my share of children that are age 2 to 2.5 to the operating room to restore extensive caries due to poor diet.

It is very important to stress to parents that if a child must have a bottle with them when they fall asleep that there is only water in that bottle, not milk or fruit juices. I like to be able to stress to parents the damage that soda can do to teeth. The enamel jacket on an adult tooth is eaten away fast enough by the acid and sugar in soda. Just think of the last time one of your children lost a tooth and you saw how thin the enamel is. That child's tooth doesn't stand a chance from an acid attack like that.

Let's talk about brushing and flossing for kids. My recommendation is that parents help out their children with flossing and brushing until about age 8. It is around this age that children will finally have the dexterity to be able to coordinate the floss and the brush so that they can completely and thoroughly remove the plaque.

There are a number of different disclosing tablets and drops which are available to ensure that the self care that kids are doing is proper. When it comes to brushing and toothpaste, there are some parameters that are important. I am well aware that to some people in this area, fluoride is a hot topic. I'm not going to debate that here. The important idea for this discussion is that until a child is able to spit out thoroughly on their own, they should be using a non-fluoridated toothpaste or a fluoridated toothpaste, but a very tiny small amount.

The recommendation for amount of fluoride in water is .5 parts of fluoride per every 1 million parts of water. The average dental toothpaste contains in the range of 1,800 to 2,500 parts per million of fluoride. The manufacturers of toothpastes market to us to coat the toothbrush with paste. This is great for them because they sell more products. In a child this can cause some issues with the permanent teeth having blotchy enamel if too much is ingested. A young child can have toxicity from too much ingested fluoride, as with any medicine.

Another question that is often asked is why should I have my child's baby tooth filled when it is going to fall out anyway? The first reason right off the top is that a cavity is caused by bacteria so having a cavity in a tooth is having a cesspool of bacteria in your child's mouth. These bacteria can cause an infection that will spread to the surrounding gum tissue and bone and potentially cause bacteria to enter the bloodstream and travel through the whole body. If that sounds far fetched to you, just last year a 12-year-old boy in Maryland died from this reason.

Beyond the disease process is the structural reason that a tooth should be restored and maintained until it falls out naturally. If a baby molar is left to decay or is extracted early, the 6-year adult molar will come into the mouth tipped to the front. The bicuspid teeth do not come into the mouth until age 11 or 12. Once the bicuspid teeth try to erupt in the mouth, they aren't able to come up due to the tipped molar being in the way.

Now the whole sequence of teeth is set off by this one missing baby tooth. Think of what happens when you take a book off of a shelf of books. It leaves a space which is quickly filled by the books on either side falling in. This is what will happen to teeth when one is missing.

As I write this, there are several other topics that come to mind to discuss. These will be the topic of a future article. I hope I have helped share some insight on the care of children's teeth. As always, speak with your dentist for advice regarding your own individual situation.

Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com