The weekly dose: Baby has teeth! (and how shall I care for them?)

{About once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children.  You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion.  Sometimes, “more research is needed”  really is the best answer that can be given.  Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}

Last week I spilled the beans that Baby has two little teeth.  They're so cute! (Or at least I think they are.)  Even though it's recommended that you wipe your baby's gums with a wet washcloth from the time he's born, I really haven't been that consistent at caring for his gums, but the advent of actual teeth is certainly motivation enough for me to become consistent and establish a good oral care routine for Baby.

I have a fairly high risk for cavities, or caries, so unfortunately that puts Baby at a high risk too.  Because of this, it's especially important to me to establish good habits for Baby to minimize (hopefully prevent!) cavities both with his baby teeth now, and then later with adult teeth.

It is known that diet plays a huge role in oral health, and that certain feeding habits are strongly associated  with early childhood caries(1), but today, I will be focusing only on the actual oral care routine and not the other factors that may contribute to early childhood caries (ECC).  I just want you to remember and know that simply using the right toothbrush and toothpaste, even if used consistently,  is probably not enough to ward off all early childhood caries.  In technical terms, caries are an infectious disease with a multifaceted etiology (2).

Before we go any further, the question I seek to answer today is, what is the best way to care for a baby's (< 2 years old) teeth?

After a quick Google search, it became evident that there are many different opinions about what is the best way to care for a baby's teeth, the main differences being whether to use a fluoride-containing toothpaste, or "training" toothpaste, and whether to use a baby washcloth, or a baby toothbrush.  To highlight this disparity, the American Dental Association (ADA) recommends against fluoride toothpaste for children under two unless told otherwise by a dentist, while the American Academy of Pediatric Dentistry (AAPD) says a qualified yes for fluoride for children under two(2).

The best resources I found this time where the policy reviews by the AAPD.  Fortunately, the policy reviews are well notated and not based solely on expert opinion.  I tried a few PubMed searches, but was sadly fairly unsuccessful on that front.

In regards to infant oral hygiene, the AAPD's policy is that:

"Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size. In children considered at moderate or high caries risk under the age of 2, a ‘smear’ of fluoridated toothpaste should be used. In all children ages 2 to 5, a ‘pea-size’ amount should be used." (2)

They even included a picture of what a "smear" versus "pea-size" amount of toothpaste is.

It makes me happy to see recommendations that allow for flexibility to be tailored to an individual's needs, since truly, one size rarely fits all. I suppose also that this flexibility could explain the difference between the AAPD's policy and the ADA's policy-- maybe the ADA is assuming a low risk for people reading their webpage(?).

Well, the suggestion to use a smear of fluoride toothpaste is in line with what my dentist recommended when I asked him about it a few weeks ago.  As far as toothbrushes versus baby washcloths go, my dentist suggested the washcloth until baby has more teeth since it's probably a little easier to get into Baby's mouth and actually clean the teeth than it would be with a toothbrush.  Once Baby has molars, if not before, I'll certainly plan on switching over to a baby toothbrush though.  

We can't forget about flossing though! Well, maybe we can since without teeth that touch, there's no need to floss.

Happy toothbrushing!

(1) American Academy of Pediatric Dentistry. (2012). Policy on the Dietary Recommendations for Infants, Children and Adolescents. Reference Manual V 34/No 6. pages 56-58.  
(2) American Academy of Pediatric Dentistry. (2011). Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Reference Manual V 34/No 6. pages 50-52.  
http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf.  Accessed 4/11/13.