COVID-19 and Your Teeth

When I first discussed doing a blog post with my advertising guy during the COVID-19 crisis, I pretty much shut down.  Aside from feeling extremely overwhelmed with having to close my business, figure out what governmental loans to apply for and at what specific time to apply for them, I was navigating being a stay at home mom for the first time since my oldest child was five months old.  I was thinking, “You’ve got to be kidding me.  Social media is not a priority that is even close to being on my radar right now.”  Thankfully, my advertising guy is my husband’s best friend, and allows me space when I need it but gives me honest feedback.  He encouraged me to continue with my social media and blogging.  Insert eye roll here.

He was right.  As I have accepted this situation I find myself in, I have been able to see how drastically our day-to-day lives have changed.  When yesterday, I was getting up, exercising, eating breakfast, out the door, dropping the kids off to school, arriving at work, answering emails, etc, and today, I am getting up and trying to imagine how this pandemic will unfold, filling my days with anxiety-laden thoughts.  Heaven forbid I watch the news!

I have never been in a situation where I could not leave my house and have no interaction with people besides my immediate family.  When the mandate was placed that I was not able to work anymore aside from urgent dental needs, I decided to go home, take my kids out of daycare to save money, and make the best of my new situation.  It was up to me to create a new routine, and I have learned that a loose schedule is key. 

So, how does COVID-19 affect your teeth?  To my knowledge, COVID-19 has no effect whatsoever on your teeth.  But wait for it!  During this quarantine, I have found that in my own house, when we are off our routine, self-care is often the first thing to go.  The nighttime brushing typically gets completed, but in the morning it’s off to the races.  I get up early and get my husband off to work.  Then my kids are up begging for their breakfast, and soon it’s nap time and I realize I never brushed my teeth let alone my children’s teeth.  Making a conscious effort to remember to take care of ourselves during this time is important. 

One of the other things I have realized that can increase the risk of getting cavities is, I snack more when I am at home than when I am on the go.  The more frequently snacking occurs, the more often the mouth is under acidic attack and has less time to recover.  It is not always the food that is the problem, but how often snacking occurs.  A big problem that can lead to cavities is sipping on beverages that are not water throughout the day.  Oh, it’s no big deal.  It’s a diet coke.  Yes, there is less sugar in diet coke than regular coke.  Both are acidic and can cause your enamel to decay.  The person who drinks a cup of coffee with breakfast is a lot less likely to get a cavity than the person who sips on coffee throughout the day.

The last thought I will leave you with is this: kids are vaping.  Kids can sense the tension that is going on in this world and are more likely to be vaping on a regular basis because they are bored, have more time on their hands, miss their friends, and are anxious.  I have not found many studies on what vaping does to oral tissues.  It is still too early to say anything definitively, but from my own personal practice, I see more issues with dry mouth in kids that vape.  Saliva is important in maintaining a healthy oral flora and counteracting an acidic environment to prevent cavities.

I hope you find this information helpful and informative.  Please stay safe and stay home to prevent further spread of this disease!

P.S.  Are your kids as uncooperative with taking pictures as mine?  Oh well, this is the best I got!  Happy Quarantining!

What Does a Tooth, Cake, and an Ogre Have in Common?

I know you remember the scene where Shrek is explaining to Donkey that ogres are more than the frightening fairy tale lore they are known for.  “They have layers.  Onions have layers” explains Shrek huffily.  Donkey thinks for a minute and replies, “Not everybody likes onions.  CAKE!  Cake’s got layers.  Everybody likes cake.” Teeth, like cake, have layers. 

The white outer layer is called enamel.  Enamel is the second hardest compound in the world, preceded only by one of my other favorite things, diamonds!  Enamel protects the inner tooth layers from extreme temperature changes and normal wear and tear from chewing food.  Enamel is densely mineralized and is constantly responding to changes in its environment.

The middle layer is called dentin.  It is less mineralized than enamel and has a yellow hue.  Dentin is amazing because it can sense if a cavity is forming, and it will lay down more dentin to wall off the cavity and protect the nerve and blood supply inside the tooth.

The innermost layer is called the dental pulp which contains the nerve and blood supply to the tooth.  This is why a tooth can feel cold, heat, and pain.  If a cavity comes close to or reaches the pulp, it can allow a pathway for bacteria to proliferate and cause an infection.   

Each layer has its unique purpose.  It is amazing how a tooth can fight a cavity without a single action from us.  Whether it be a cake, an ogre, or a tooth, I am a fan of layers, and you should be too.  Now, please pass the cake!

What is Conscious Sedation?

To sedate or not to sedate, that is the question.  Dental sedation has been brought to light by the media in the past few years and the light has not been very complementary.  Sedation is when medications are administered to create a relaxed or peaceful state.  It is a spectrum, and depending on the patient’s needs, the provider will decide what level of sedation is necessary to accomplish the desired goal.

Dental sedation can be used for adults, but I will be focusing on sedation for children since that is my area of expertise.  When I was in residency, in our first sedation class my professor said, “Children are not little adults!  Do not sedate them like they are an adult.”  At the time, I did not know what he meant.  When working with adults, there is more standardization as far as prescribing medications.  With a child, typically, prescribing should be based off his weight and not his age or maximum dosage.  Young children do not have mature respiratory systems, do not have a large oxygen reserve, and can become overly sedated quickly.

There are hundreds of medications that can be used to sedate children and as some would say, “many ways to skin a cat.”  I will not discuss specific medications, but each provider has their “go to” medications that they use depending on the situation and the desired goal.  When the term “conscious sedation” is used, I am referring to minimal sedation.  My goal for a child is that he be awake but relaxed for the procedure.  The child should be able to follow my instructions and have all his normal reflexes intact.

Conscious sedation is safe when practicing within the guidelines set forth by the American Academy of Pediatric Dentistry.  This is not to say that there should not be some level of healthy fear anytime medications are introduced.  As I stated before, sedation is a spectrum and a child can easily slip further down the sedation spectrum than may be intended.  Whenever a child is sedated, it is important to keep in mind where the child is on the spectrum, and as a provider, “Am I comfortable with how this child is responding?”  If not, what is the causing the problem and how do I fix it quickly. 

When I was in dental school, I had several patients that were terrified of the dentist.  Many of these patients had a bad experience as a child and have carried these fears into adulthood.  Sedation was not a common practice even twenty years ago.  At that time, it was not uncommon to use restraints or behavioral techniques that are not as acceptable at this day in time.  Children are impressionable creatures and do remember bad experiences that may affect them for the rest of their life.  This is one of the reasons why I decided to go into pediatric dentistry.  If I can give a child a good dental experience, then that child will carry this mindset to adulthood and is more likely to seek dental care on a routine basis instead of waiting for an emergency to arise. 

I am not going to lie, sedation appointments are not my favorite, but if it will give a child a good experience, I will do it.  During residency, I completed over double the amount of sedation cases required and feel comfortable with the medications I prescribe.  I maintain my Pediatric Advanced Life Support certificate.  All my staff is certified in Basic Life Support.  I complete an inventory of our crash cart monthly to make sure I have everything I need on the off chance I run into a situation where I may need to rescue a child.  We have staff meetings weekly where we discuss various office emergencies, and how we will handle them.  I hope to always maintain a healthy fear that I may need to use my advanced training.  Sedating a child is never something to be taken lightly, but it can be a useful tool in creating an enjoyable dental experience for some children.

What is Silver Diamine Fluoride?

You mean you’ve never heard of silver diamine fluoride?  It is hot, hot, HOT, right now!  I’m surprised it is not trending on Twitter.  Silver Diamine Fluoride, known among dentists as SDF, is a liquid with a high concentration of fluoride that is applied to a cavity to prevent it from getting larger. 

You may ask, why would one apply this to a tooth instead of just getting a filling?  A filling or crown would be a more permanent fix, but what if the child is two years old and is unable to behave for a filling?  What if the child has special needs that make it dangerous to sedate or have the fillings done under general anesthesia?  What if the child is eight years old and will lose the tooth in a year or two and the parents insurance benefits have been maxed out for the year?  These are all reasons to consider SDF in a dental treatment plan.

As costs increase and dental insurance benefits stay the same, it is becoming more and more of a struggle for parents to pay for their children’s dental needs.  SDF may not be long term treatment, but if there is a need to defer treatment, it can be applied to the teeth to prevent the cavity from becoming larger.  Typically, SDF needs to be applied every six months until the final treatment can be completed, or the tooth falls out.   Some practitioners will place it once and follow up a week later to add another coat.  Some practitioners will place the SDF and add some type of temporary restoration to further protect the tooth from breakdown. 

It sounds too good to be true, right?  There is always a catch, isn’t there?  The downside to SDF is, it turns the cavity black.  When I say black, I mean black!  It not only turns cavities black, it turns anything it touches black, as well.  If it were to touch a child’s cheek, the soft tissue would be black for a week.    For some children, if they cannot follow instructions and will be fighting the treatment, they are not candidates for SDF.  For some parents, the esthetics would eliminate SDF as a treatment option completely.  Attempts have been made to make SDF more esthetically pleasing, but at this time, they do not look as natural as a traditional filling. 

If SDF is placed and a white filling is indicated later, the dark staining can be removed with a dental handpiece, but it is not always completely successful.  This is one reason why SDF is not commonly used on adult teeth.  It is great for baby teeth, because they fall out in a few years and you get a “do over.”  In the past when treatment needed to be delayed, the cavity sat exposed for six months or a year until treatment could be completed and what originally needed a filling now needs a crown or extraction.  SDF prevents cavities from getting larger, so in theory, a cavity that requires a filling should still require a filling in six months following SDF application.  SDF is not recommended on teeth that have been deemed non-restorable and need to be removed to prevent the risk of infection. 

What are the advantages of SDF?

  1. No injection is required
  2. Sedation can be prevented or delayed as the child matures
  3. Lower cost than a filling
  4. Promotes a positive dental attitude for the child

I hope you found this post informative.  I love working in this time period because we are blessed to have so many treatment options at our disposal, and we can customize it to the needs of the individual.  I am happy to have this option in my wheelhouse, but I very much hope it does not put me out of business!


American Academy of Pediatrics:

Jeanette MacLean Placement of SDF between teeth:

Water Fluoridation: To Drink or Not to Drink

In my last post, What Is Fluoride, I discussed what fluoride is and how it affects our enamel.  It aids in remineralizing enamel and prevents the demineralization of enamel.  It can also prevent bacteria from producing cavity enhancing acid. 

Community water fluoridation began in the 40s because studies showed that residents with higher naturally fluoridated water had fewer dental cavities.  To this day, it is touted as the most equitable and cost-effective method of delivering fluoride to all members of most communities.  Over the years, a significant decrease in dental cavities has been seen.  In the United States, the amount of fluoride in the water is from a range of 0.7-1.2 mg fluoride ion/L part per million (ppm). 

There are several classes of people that I run into:

  1. Those that believe fluoride works and is beneficial
  2. Those that think fluoride is toxic and harmful
  3. And people who do not care either way

I get asked on a regular basis if I actually believe in fluoride.  It’s almost the same as if someone asked me if I believed apples came from apple trees.  Through my four years of college, I learned about the how fluoride effects our teeth at an atomic level.  During my four years of dental school, I read countless articles that have undergone meta-analysis and systematic reviews (highest level of validated research).  And during my two years of pediatric dental residency, I have seen how fluoride has been beneficial to one of the poorest and most underprivileged communities in the nation.  I believe in fluoride because I have seen its benefits first-hand.  But I do understand that not everyone has had the same experiences I have had so it is normal to be skeptical.  Is it possible that I live in the Truman Show and everything I have learned is a big hoax?  I sure hope not!

To the people who believe that fluoride is toxic and harmful, all I can say is, “You are absolutely right.”  Just about anything in excess is not good for you.  Even drinking too much bottled water when drunk too fast at a large amount can cause your sodium levels in your blood to drop and be fatal.  It is well known that when a small child ingests too much fluoride (typically by eating toothpaste from a full tube), the side effects can affect their gastrointestinal system by causing nausea, vomiting, diarrhea, and abdominal pain.  If a very large amount is ingested, it can affect the central nervous system and symptoms of convulsions, numbness, and possible cardiovascular collapse.  So, yes, I would say it is toxic and can be harmful when used outside of its recommended guidelines.

A few years back, a study came out of Harvard University called Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis.  I have provided the link below for your reading pleasure.  This paper collected studies from around the world that compared children’s water fluoridation levels and their IQ.  “The results supported the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.  Future research should include detailed individual-level information on prenatal exposure, neurobehavioral performance, and covariates for adjustment” (Choi 2012).  I reviewed the studies that were listed and the fluoride levels that are present in many of the studies are 3-4 times higher than the amount used in the United States water fluoridation.  It is very interesting that these studies are evaluating a long-term effect of fluoride on children’s brains.  This research paper was well conducted by a highly prestigious university and is something to be cognizant of.

With all of this said, it does not make a difference to me if someone “believes in fluoride.”  I do find it important that my patients are well informed so they can decide what is right for their family.  Fluoride is not essential to having healthy teeth, but it is a tool that can be helpful if there is an imbalance in the oral cavity where cavities are forming.  If you feel fluoride could be helpful for your child, drinking fluoridated water and brushing your child’s teeth with fluoridated toothpaste is a good place to start.  If you do not wish to have your child exposed to fluoride, drinking bottled or distilled water is always an option.  Newer refrigerators have reverse osmosis filtration systems which utilizes tap water but removes fluoride, as well as, other things like lead and chlorine. 

I hope this post was helpful in deciding what is right for your family.  And for those people who do not care one way or another if their water is fluoridated, keep doing what you are doing and thanks for reading!


Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis:

Link to Check Your Water Fluoridation Level:

What is Fluoride?

The short answer to this question is fluoride is an ion that bonds to enamel and hardens its chemical structure.  If you are curious about the chemistry behind it, keep reading.  If you are fine with the previous answer, there is no need to suffer through this one!

Let’s take a journey back to middle school.  Reach into the depths of your brain to find the periodic table.  The periodic table is a chart of elements.  Elements are building blocks for everything: trees, rocks, gases, skin, and food.  Everything is made up of elements.

Fluorine is an element and fluoride is the ionic (active) form of fluorine.  Most ions do not like floating around by themselves.  They bind with other ions to create molecules which are more stable.  For example, oxygen is not often found by itself.  It binds to another oxygen element to form an oxygen molecule.  Fluorine is a very special element.  It has the highest electronegativity of any of the ions, forming strong ionic bonds. 

Are you bored yet?  Let me get to the point.  Why is fluoride important in the dental field?  To answer this, I must explain what enamel is.  Enamel is the hardest substance in our bodies and is the white covering of our teeth.  Enamel, like anything else, is made up of elements, such as calcium, phosphorus, and hydrogen.  When our mouth becomes acidic after eating or drinking, the enamel releases hydroxide into the mouth to help bind the acidic ions and bring the mouth back to a neutral environment.  When this happens, the enamel has two courses of action: it can continue to breakdown further (demineralization) and result in a cavity, or ions/compounds can bind to damaged enamel to restore the structure (remineralization). 

When teeth are formed, the enamel is made up of interlocking molecules called hydroxyapatite.  The fluoride can replace hydroxide in the molecule to create a stronger substance called fluorapatite.  Fluoride changes the structure of the tooth at a chemical level to make it stronger.  Fluorapatite is stronger than hydroxyapatite and is less likely to breakdown.

I hope this post did not stress you out, because it sure stressed me out!  I am sorry it was dry and heavy in the sciences.  I am, ultimately, a scientist and am tasked with the burden of learning the “why” behind everything I do.  I am going to continue down the fluoride rabbit hole, but I think this is enough information for one blog post.  Soon I will address the sources of fluoride and its beneficial and harmful effects.  As always, I love your feedback and any additional questions you may have on this topic. 


What Age Should My Child See the Dentist?

I am going to go ahead and say it.  I have no time or space for “mom guilt” in my life.  Every single one of us is trying to do the best we can for those that we love most.  And “mom-ing” is hard.  Keep in mind that the American Academy of Pediatric Dentistry guidelines are just that: GUIDELINES.  You will never receive judgement from me, no matter what age your child is when he or she visits the dentist.  Got it?  Great!  I feel better now.

“In order to prevent dental problems, a child should see the dentist within six months of the eruption of their first tooth but no later than one year of age.”

~AAPD Guideline

I am thrilled you brought your child to the dentist by his first birthday because you would be in the 1% of parents who followed these guidelines.  Therefore, 99% of moms (or dads if “dad guilt” is such a thing) feel terrible bringing their kids in for the first time and open the conversation with an apology at their tardiness and irresponsibility.

The reason I am writing this blog post is not to make you feel guilty or anxious.  I am here to set the record straight.  Similarly, to the “fluoridated toothpaste” blog, the guidelines have changed in recent years, so the answers are all over the place.  The old recommendation was to see the dentist by age three and still, most general dentists prefer to go by this recommendation.  Typically, any child under the age of three is going to cry when a stranger gets close to looking at his teeth.  And yes, rarely are children under the age of three able to tolerate a typical dental cleaning.  So, why do we have the visit at one year of age?  Math and science.

Scientific studies have shown that it takes an average of six months for dental decay to work its way through the enamel (hard, white outer layer) of a baby tooth.  And the average age for the first baby tooth to erupt is around six months of age, so mathematically, the first dental visit should be around one year of age to prevent cavities from forming.  Prevention is the goal!

The first dental visit is as important for the parent as it is for the child.  It is my job to educate parents on taking care of their child’s teeth at home, discuss the amount of fluoridated toothpaste they should be using, discuss the child’s diet and habits like thumb-sucking and pacifiers, evaluate for possible growth discrepancies, and make sure the child is on track with his tooth eruption.

Why are so few parents bringing their children to the dentist by age one?  First and foremost, they did not know they were supposed to and secondly, FEAR.  I am going to let you in on a little secret.  I did not bring my oldest daughter into my office for her first cleaning until she was two years old.  Why do you think that was?  I was afraid she was going to throw a temper tantrum, and I was going to look like a bad mom in front of my staff and fellow doctors.  I fell into the trap of fear.

Some parents fear that their child will be traumatized by starting early and crying for each cleaning appointment.  Once again, the goal is prevention of cavities!  I much prefer having a young child who is nervous for cleanings, where a problem can be prevented than have a well-behaved five-year-old that comes in for his first visit, and we find a cavity requiring an injection and using the handpiece.  Children’s behavior will improve for cleanings.  Children’s behavior does not typically improve with multiple dental filling appointments.

But one year old… really?  When I started my pediatric dentistry residency, I thought the exact same thing.  I was blessed to attend a residency where the patient population is one of the most underserved populations in the nation.  Many of the patient families I served in south Florida lived on a level of poverty I did not know existed.  Many came from other countries and did not speak English.  All my patients were on some type of government assistance and almost all these children had mouths full of cavities. 

One of the most vivid memories I have from my time there was when an 18-month old child came to our office, and we had to pull all four of her front teeth because they were decayed beyond saving.  It broke my heart knowing that she would go six years with a gap where her teeth should be, she would have difficulty learning to say her T’s, and kids would notice and say things about her missing teeth.  But I also knew that if I left those rotten teeth in her mouth, that she could get very sick and the infection could cause damage and might discolor her permanent teeth.  I do not know whether she would still have all her front four teeth if she had come to see us at one year of age.  Maybe the decay would have been where we could have put crowns on the teeth and corrected the dietary choices that caused her teeth to deteriorate.  Maybe we still would have had to pull them.  But I will always remember that little girl and impact she made on me.  This is why I will advocate for having your child seen by the dentist by the age of one.

How Do I Floss My Child’s Teeth?

When I was a child, my parents gave me chores to do around the house, and one of those chores was to vacuum.  From the age that I began vacuuming until I was in college, I vacuumed in no certain way.  I just made sure that I vacuumed all of the floor.  As I got to know my future husband in college, I learned that there was a specific way that vacuuming “should be done.”  It should be completed in straight lines, slightly overlapping the previous line to create an orderly vacuuming pattern on the carpet that looks neat and precise.  After I finished a very directed eye roll, I decided vacuuming was not my thing.

I feel like flossing can be similar.  People try it off and on again but never consistently, then the dentist or hygienist shows them how they should be flossing.  It can put people off, and they decide they are never going to be good at flossing, so why bother?  Please do not be put off by this blog post!  I am going to display how and where the floss should go to be effective.  I am also going to discuss a few different tools you can use, so you can decide what works for you and your child.

When should you begin flossing your child’s teeth? 
When your child’s teeth begin to touch.  This is typically around the age of 2-5.

How should I start flossing?
Children tend to imitate their parents, so when it is time to start flossing, have your child watch you floss.  You can let them hold the floss, taste the flavor, and let it pique their interest.  Do not let your child use floss or play with floss unsupervised.  It can be a strangulation hazard or damage gums if used inappropriately.  Always watch your child while playing with floss.  Once they have gotten used to seeing floss and looking forward to “flossing time,” you can start adding it to their daily routine.  Maybe one day you get one tooth flossed and the next day you get two teeth flossed.  The key is being consistent with it.

What kind of floss is best?
I get this question frequently.  My typical response is, “Whatever kind of floss you will use.”  I have learned in dental school that traditional floss is what is the “best.”  But some people are not able to use that, especially parents who are flossing young children’s teeth.  I have found that a lot of times when parents are told this, they go home, try it once, fail, and decide that it is not worth the fight.  With my own child, I have found the flossers most successful.  Children like the bright colors, and it is less of a mouthful than a bunch of fingers and string.  But if your child allows you to use traditional floss, go for it!

What are my flossing options?
1. Traditional floss
2. Disposable floss picks
3. Non-disposable floss picks (use traditional floss to wrap around the pick and replace the floss after every use)

What is not a flossing option?
1. Interdental brushes or dental picks – these can remove plaque between teeth, but it can never get the little bit right beneath where the two teeth contact.  The contact point is where cavities begin.  These brushes and picks can be helpful in cleaning the gums but are not a substitute for flossing
2. Water picks or flossers – the same reason as the interdental brushes and picks.  You need something that goes straight down between the teeth to remove all the plaque that can cause cavities

What if my child’s gums bleed when I floss?
Many times parents say that they see their child’s gums bleed when they floss, so they must be flossing too hard and they stop flossing.  Is it possible to floss too hard?  YES.  Is this likely the problem?  No.  The reason our gums bleed when we floss is because, the plaque that has been collecting between our teeth irritates our gums.  Our body’s response to an irritant is to increase the blood flow to that area to aid in stopping a bacterial invasion.  You do not need to stop flossing.  You need to floss more!  As you become consistent with flossing, you will have less bacteria between the teeth and the gums will have no need to have extra blood flow to these areas, and the bleeding will stop.  When you first begin flossing, your gums may be sore.  That will also subside as the gums become less inflamed. 

When flossing, try to stay against the tooth. Plaque does not stick to your gums; it sticks to your teeth. Slide the floss down the side of the tooth until you have just reached below the gum surface.
You do not need to put pressure on the gums. Simply slide the floss below the gums surface and curve the floss to cup the side of the tooth to clean as much tooth structure as possible. Before pulling the floss back through the teeth, do the same thing to the tooth next to it. Then repeat between each tooth.

Why Do I Need to Floss?

I hear it repeatedly: “How often do you brush your teeth?” “Twice a day, morning and night.” “How often do you floss?” Crickets…


“I don’t know why they have cavities. They eat well, and we brush their teeth.” “How often do you floss?” Crickets again! After I figure out how these crickets got into my office, I begin to set the stage for a flossing discussion.

Flossing, in my mind, is one of the most misunderstood aspects about oral health care. We’ve heard it our whole lives. Flossing is good for your teeth and gum health. But what does it really do? It clears plaque and food debris from between our teeth and from under our gums. You know this! But do you know what plaque is?

70% of plaque is bacteria and the remaining 30% are sugars and proteins that help bacteria stick to your teeth. The next question is, what does plaque do to my teeth? We all have bacteria in our mouths whether we clean our teeth or not. Every time we eat and drink, the bacteria eat and drink. When we eat, our body breaks down the food, keeps the nutrients and gets rid of the waste. Bacteria are the same, but bacteria’s waste is in the form of acid. This acid attacks our enamel and makes our teeth susceptible to cavities (a hole created by the acid attack). This process occurs on any and all surfaces of the teeth. Between the teeth is no different…well, I guess it is. It is the hardest place to reach and clean effectively. Our saliva does not rinse the area as well as the other tooth surfaces, and it is easier for bacteria to gather in these spots.

What is the one thing that motivates people to floss their teeth? They can feel or see food in between their teeth. In my mind, the reason people brush two times a day is they can visibly see and feel a difference on their teeth. Brushing is seen as effective; thus, it is incorporated into our daily routine. Flossing, on the other hand, is subtler with its effect, so it is under-valued and seen as a hassle.

Research shows that cavities form more frequently between the teeth than on the biting and smooth surfaces of the teeth. It also shows that cavity rates are highest in younger populations than older. For these reasons, I will always be vigilant about educating my patients and their parents about flossing. Cavities, for the most part, are preventable and implementing flossing will help tremendously!

At What Age Should My Child Use Fluoridated Toothpaste?

“Parents should use a smear of fluoridated toothpaste on a soft-bristled infant toothbrush twice daily as soon as the first tooth erupts.”
~AAPD Guidelines~

WHAT?!? My child cannot spit. What if my child swallows it? This is too much too soon! For many years, the standard was: no fluoride toothpaste under two years of age. What we’ve found is this age group is very vulnerable to decay due to frequent snacking. They have since completed quite a bit of research and found that fluoridated toothpaste can and should be used in young children at smaller amounts than adults. This is not a post on Fluoride. You will get all those juicy details at a later date. For now, let’s stay focused. I love guidelines because they get a discussion started. “What did you do last weekend? Did you grow up around here? Do you use fluoridated toothpaste for your child?” Everyone loves a good conversation starter so, let’s chat.

Firstly, does your child have teeth?
No — you do not need toothpaste, but you can always get your child familiar with cleaning their mouth using a warm washcloth or Dr. Brown’s Xylitol Tooth Wipes.
Yes — there are a few options:

  1. Water/dry toothbrush – I used this method to allow my child to get adjusted to using a toothbrush. I taught her what it was for and where it was supposed to go. This way, we did not have to dig toothpaste out of her ear canal. She is such a party animal.
  2. Non-fluoridated toothpaste – this option is basically a flavored incentive to encourage the child to brush their teeth. Many of these toothpastes contain Xylitol which is a sugar that does not cause cavities. While it is helpful in getting children to let us brush their teeth, it does not remineralize (harden damaged enamel) like Fluoride does.
  3. Fluoridated toothpaste – many children’s toothpastes have the same amount of Fluoride as adult toothpastes. Excuse me! What are we going to do about those deceptive toothpaste makers?? They have come to realize that people don’t frequent the toothpaste aisle to read the labels. If only they had met me…sigh. What makes kids toothpaste “Kids Toothpaste?” I hate to tell you this…but the Peppa Pig on the front and the bubble gum flavor on the inside.
    Can I use my adult toothpaste for my child? Yes! But kids seem to be partial to the tube with the character on front and the mint flavor is “too spicy, Mama.”
    Often, I hear, “My child cannot spit very well. I am worried he will swallow too much fluoride.” If I see a small child that has no cavities, and the parents are helping the child to brush at home, I do not insist the parents use fluoridated toothpaste. In fact, a lot of times, I will recommend brushing with water or non-fluoridated toothpaste in the morning and fluoridated toothpaste at nighttime to protect the child’s teeth while he sleeps. If the child has cavities or has dietary habits that increase his risk of getting cavities, then I do recommend fluoridated toothpaste for the morning and evening brushing. For example, if a child is older than one and is still waking up to eat through the night, the child would be at a higher risk for developing cavities than a child who is sleeping consistently through the night.
    The key to using fluoridated toothpaste is using the correct amount for your child’s age. I hope these pictures help clarify things.

This fun cloth fits over the parent’s finger and can be used to wipe a child’s mouth, gums and teeth. It is great for very young children. You can also use a regular wash cloth and get the same results. You can use this dry, but my child seemed to like it in the bathtub with warm water.

Here we have three toothbrushes for different stages:

The blue monster toothbrush on the left is for children 3 and younger. The cool thing about this brush is that the color bristles indicate the amount of toothpaste you should be using for this age child. See how little it is? You should be estimating a smear or rice size amount of fluoridated toothpaste. (Disclaimer: the package says for age 2+. The reason for this, is they are following the old guideline of no fluoride in children younger than two.)

The center Princess Tiana toothbrush can be used in kids age three to six and a pea-sized amount of toothpaste. (Disclaimer: the package on this toothbrush says age 5-7, but the brush head size is not the issue here. It is the pea-sized amount of fluoride that is the main point.)

On the right, this toothbrush can be used by a person older than six and a thin ribbon of toothpaste can be used. The amount of toothpaste becomes less important at this age because most children can spit effectively by this age and will not be ingesting the fluoride.

A big thank you to my dear cousin for letting me use her two children as my dental models alongside my own kiddos!!