Dear Dr. Lanny:
Q: I buy expensive, special toddler toothpaste for my 18-month-old because he hasn’t learned how to spit yet (and he loves the berry-flavored one), and fluoride, I thought, is bad for kids to ingest in large quantities. When can I start giving my child a regular fluoride toothpaste that I don’t have to pay through the nose for?
A: Although I may get in trouble for treading on my dental colleagues’ turf, your question provides a good entrée into children’s oral health. While it is certain that your dentist knows more about teeth than I do, the tooth of the matter (a little dental humor) is that I see more young children’s teeth than any other health professional. This is mainly because many families have no dental insurance, and those that have Medicaid find almost no dental providers available to them.
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For those among us with dental insurance there are several pediatric dentists in the community. The pediatric dentists have additional training in the care of children’s teeth, as well as support personnel and equipment specific and hospitable to children. This is not to say that general dentists cannot provide excellent care to your child, but it is wise to look for a generalist with the right interest and personality to care for kids.
I’d like to begin with some discussion about teething. It is my experience that in parents’ eyes, there are two things that are responsible for almost every problem in children: changes in the weather and teething. If your child is teething when the weather is changing—watch out!
The average age for the first tooth is 5 to 6 months. Normal children may, however, have a first tooth as early as 4 months, or as late as the first birthday. Drooling, putting everything in the mouth, and chewing on everything are typical infant behavior around 4 months of age. This does not mean your child is teething, as you can see this behavior in children who still don’t have teeth 6 months later. Regardless of bumps and spots on various parts of the gums, the first tooth is almost always bottom center.
It is difficult to know when fussiness is due to teething. The only person who can tell you his gums hurt refuses to talk. Textbooks say that teething does not cause fever. Parents are skeptical, and grandparents are convinced otherwise. Even if some fever is possible, temperatures of 102 degrees and more are not from teething—or changes in the weather. Alcohol on the gums is a no-no, and topical anesthetics are probably of limited value. Ibuprofen and acetaminophen are good for pain, but as with any medicine their use should be minimized.
Now that your child has a tooth, how do you care for it? The American Academy of Pediatric Dentistry (AAPD) recommends cleaning with a soft cloth or a toothbrush made for infants. A very small amount of non-fluoridated toothpaste may be used, and flossing is recommended as soon as you feel able. Care at this age should probably be seen as beginning good lifetime habits and getting your baby accustomed to daily care rather than resulting in an immaculate tooth. Clearly, flossing the teeth of an infant is not an easy task. Care should be taken to avoid irritating the gums; nor should your attempts lead to a major meltdown. Back off if necessary and try again at a later age.
The AAPD uses the following slogan for when to first visit a dentist: One tooth + one year = zero cavities. I do not think many people will be going to the dentist at such an early age, and indeed a 2005 study showed that only 10 percent of 1-year-olds and 24 percent of 2-year-olds had been seen by a dental professional. A local pediatric dentist told me, however, more and more parents were taking their 1-year-olds for a “tot exam.”
There are skeptics and critics of fluoride in our water supply, as there are for other public health measures. Although I understand the hesitance people have about our mainstream institutions, I believe this is a clearly resolved question. In the 50- to 60-year history of fluoridation of public water supplies, cavities have dropped dramatically without significant problems. Fluoride added to the Onondaga County water supply is carefully managed to provide a concentration of 1 part per million (ppm). This minimizes cavities without causing side effects. There is considerable variation of natural fluoride in local ground water ranging from trace amounts to 1 ppm.
Over the past year I have been on a campaign against bottled water. In addition to the fact that it is no healthier than Onondaga County water, it is an unnecessary expense, it creates more plastic to pollute our environment and it requires gas to transport it from wherever it came from. If that’s not enough, it either has no fluoride or the amount it contains is unregulated. Do you want to know how I really feel about it?
As to your original question: Is it bad to swallow fluoride? If you swallow a lot, and you do it often, the answer is yes. Not dangerous bad, but possibly leading to tooth discoloration. Use no more than a “smear” of toothpaste for your less-than-2-year-old and a pea-sized glob in the next few years. As soon as your child can understand, encourage him not to swallow, but spit it out.
Before writing this column, I went to the drugstore to check out the “toddler” toothpastes. Surf’s Up, Dora the Explorer, Sponge Bob Square Pants—all of them with saccharin to charm the kiddies and encourage them to swallow it. The main thing is, once your child is age 2 years or older, to find a toothpaste that includes fluoride, which the AAPD recommends for the greatest protection against cavities.
While at the drugstore, I checked out the toothpastes for adults. A less than complete inventory included: Whitening, Extra Whitening, Extra Clean, Brilliant and Sparkle, ProHealth, Natural and my favorite…Age Defying. Guess which I bought.
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.