Health and Development | Child Health + Development | Ages 0–2 | Ages 3–5

Beyond Brushing: Understanding, Preventing and Treating Common Childhood Dental Problems

From early decay to enamel issues to thumb sucking, here's what you need to know about common kids' dental health issues and how to prevent them

Hollie Walsh’s son had his first dental checkup when he was 5 years old. The mother of three was diligent about early dental care, which proved wise. Even so, her son began developing cavities soon after his first visit to the dentist. By age 8, part of one of his molars fell out, and Walsh realized there was more to dental health than good care.

“It was such a big issue in a small mouth,” Walsh says. “A quarter to a third of the tooth just broke off. He wasn’t in pain, and it wasn’t discolored or soft. It just didn’t look like what you’d expect.”

While parents typically start thinking about their child’s teeth after teething, when the first pearly whites pop through the gums, critical dental development happens long before.

Teeth develop in utero. Baby teeth typically appear within the first year, sometimes as early as 4 months of age. Permanent teeth begin erupting around age 6. Even very young children can be at risk for dental issues such as early decay, discoloration and tongue thrust, according to Dr. Christopher Delecki, Seattle Children’s Hospital dentist and director of the Odessa Brown Children’s Clinic Dental Program, “I didn’t have it on my radar because I’ve always had good teeth. I didn’t think about it that my kids might experience it differently,” Walsh says. “I’ve learned a lot.”

By learning about all the factors that can impact a child’s dental development, and by monitoring it closely, you can help keep chompers healthy.

Early decay

Decay can strike as soon as teeth come into the mouth, according to Dr. Elizabeth Palmer, a pediatric dentist and clinical assistant professor at the University of Washington School of Dentistry.

Decay, she says, can cause serious problems. “Decay is caused by a bacterial infection that can spread into the middle of the tooth, where the nerves and blood vessels are,” Palmer says. “It can spread into the jawbone with infections going to the body and brain.”

Three factors are needed for decay to take hold: a genetic predisposition, the presence of sugar, and bacteria.

“The bacteria consume the sugar, which produces an acid. The acid then attacks a susceptible tooth, which causes decay,” says Dr. Larry Kuhl, senior dental consultant for Delta Dental of Washington.

Bacteria can easily pass from a caregiver to child. Experts say we should avoid sharing utensils, cups or even licking a finger to wipe a child’s face. Adults, including pregnant mothers, should practice good dental health to reduce the presence of oral bacteria.

Also, be aware of sugar intake. Foods with processed sugars, such as cookies, candy and soft drinks, are more obvious culprits. Kuhl says, however, that sugar from fermentable carbohydrates, such as bread, crackers and cereals, can also contribute to decay.

“From a dental health perspective, it’s not so much the amount of sugar, but the frequency,” Kuhl explains. “Eating six candy bars at once won’t be as detrimental to the teeth as eating bite after bite for hours, which provides a constant, rich source of sugar for bacteria.”

For children, sippy cups containing sugary substances pose a serious threat to tooth health. Kuhl advises parents to serve water to children whenever possible.

Regularly clean teeth with either an infant toothbrush or even a washcloth. According to the American Academy of Pediatrics, the appropriate dose of toothpaste for children younger than the age of 3 years is an amount the size of one grain of rice. For those older than 3, the amount should be the size of a pea. Toothpastes containing fluoride are recommended, but avoid whitening varieties.

Enamel issues and discoloration

It is possible for an injury to cause discoloration. A child’s gums might bleed after a fall, but appear to heal without damage. From three to six months later, the tooth begins darkening into a brownish color.

“Trauma discoloration is caused by bleeding going into the tooth,” Delecki says. “It’s like a bruise. When that happens on the skin, the body cleans it out, but it can’t do that in the tooth.”

Fortunately, such discoloration does not generally cause pain or impact permanent teeth. According to Delecki, further treatment is usually unnecessary. If a child has a tooth injury, he recommends taking the child to a dentist to ensure there isn’t unseen damage, infection or an abscess.

Fluorosis, caused by early overexposure to fluoride, can also cause discoloration. According to Palmer, it often appears as chalky white or brown areas on the teeth. It is relatively rare in the modern age. Exceptions are found in certain geographic areas where drinking water comes from wells, which can have naturally occurring, high concentrations of fluoride.

“Sometimes when a tooth is forming in utero and the parent has a fever or illness, that can also disrupt the formation and result in tooth spots [after birth],” Palmer says. “As long as the spots aren’t sensitive or decayed, we just monitor them.”

Lastly, the use of tetracycline antibiotics in early childhood can cause brown, gray or yellow staining. It potentially alters the internal chemical makeup of developing permanent teeth. While mainly an aesthetic issue, it is difficult to treat.

“It’s much rarer now because physicians and dentists are aware,” Kuhl says. “Still, when a child is experiencing health problems that require antibiotics, I encourage parents and caregivers to engage their physician. Ask about medicine combinations and which ones, such as tetracycline, can result in discoloration.”

Tongue thrust, pacifiers and thumb sucking

Tongue thrusting, also known as reverse swallowing, is when the tongue protrudes forward through the teeth.

“It usually occurs during the natural swallowing process. The tongue moves forward, pushes on the teeth and eventually can create an open bite [when upper and lower front teeth don’t overlap]” Delecki says. A parent or teacher might notice tongue thrust because of the impact it can have on speech, or it might go unnoticed until later on.

A speech pathologist can help retrain the tongue to position appropriately. If that isn’t successful, dental appliances can be made to physically restrict it.

“We don’t fully understand the scientific reasons why. There is a genetic component, but we don’t know to what degree. There is something, though, in the development of some children that somehow encourages or permits it,” Kuhl says.

Likewise, prolonged pacifier use and thumb or finger sucking can result in speech issues and have an impact on jaw development.

“Almost all kids will do it to some extent, and it’s not a problem in most cases,” Kuhl says. “If they’re under 5 and doing it occasionally, be aware and see if there is a low-intensity intervention. If they’re getting to be 7 or 8 years old, you probably need to seek professional help.”

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