February's National Children's Dental Health Month is the perfect opportunity to think more carefully about your children’s dental needs. With 10 burning questions, we turned to our Gold Daisy winning pediatric dentists at Bellevue Kids Dentist for the answers. Dr. Cody Mast, Dr. Dorothy Nelson, and Dr. Jenny Lee, members of the ADA (American Dental Association) and AAPD (American Academy of Pediatric Dentistry), each chimed in to share the benefits of good oral health for our kids, including how mom's oral health during pregnancy makes an impact, why writing in cursive is a good indicator for independent brushing, the most helpful and effective oral apps, how fast bacteria grows, and a handy guide to the best snacks for your kids' teeth.
What are the biggest misconceptions about pediatric dental health?
Dr. Cody: I think the biggest misconception is parents feel like most cavities are genetic and they have little influence beyond better brushing habits and going to the dentist regularly. While it is true most cavities come from their family members, those cavities are caused by specific bacteria that infect the child's mouth rather than get coded in the child's DNA and spontaneously appear through their genes. Like many things in life, good hygiene and good dietary habits are the best approach to keeping one healthy, and the earlier that starts the better!
Dr. Dorothy: I agree with Cody here. I also think that parents are unaware that dental health starts with the parents or the primary caregiver. It is especially important for expectant mothers, because mom's oral health affects baby in utero and well before we even see them as their dentist! I have to tell them to file this under another category of things moms need support with that is widely unknown to the general public. I also think that when it comes to oral health care, parents delay bringing their children because they think it scary for the child, and that we will make the parent or caregiver feel guilty or judged. This is simply not true. Although it may be strange and different for the child, our patients are cared for in way that is developmentally appropriate, efficient, and based on where they can meet us. There is a difference in how we approach a baby, preschooler, school aged or teenage patients! We are all parents, too. We want to create a safe place to provide good, research backed information to care for all kids. We are just someone in your village that happens to know a lot about oral health.
Dr. Jenny: I think the biggest misconceptions about pediatric dentistry are that baby teeth do not need to be treated and that younger kids can brush themselves. It is our job to provide as much information as possible to explain why certain things are recommended for your children, as well as tips to improve proper home care.
What age should regular check ups begin?
Dr. Cody: The American Academy of Pediatric Dentistry recommends a child have a "Dental Home" by no later than 12 months of age. The "Dental Home" is any place which can provide comprehensive and high quality primary oral health care. From the question answered earlier, the sooner good habits can be learned and reliably repeated at home, the better off that child's oral health care will be. It is almost always easier to stop a problem before it occurs than it is to fix it later.
Dr. Dorothy: I also want to stress that there are a lot of feeding and eating events that occur before 12 months, too, that can contribute to not only cavity risk but jaw development risks, such as bottles, pacifiers, snacking behaviors, feeding behaviors, and speech, and general home care that we counsel on. It's not just cavities. We can also give recommendations on what's out there in the dental aisle or Amazon. There are so many products out there it can be overwhelming.
Dr. Jenny: It's recommended that we see a child at one year-old. At this age, we can discuss preventative care, tips on how to properly brush your kids’ teeth as well as review oral habits.
What age should kids brush on their own?
Dr. Cody: On average, children should be able to brush their own teeth when they are seven or able to write cursive, although I can't be certain they are teaching cursive anymore... At the minimum, they should be able to demonstrate attention to detail and dexterity, hence the cursive comment. Brushing should last for 2 minutes, should cover all surfaces of the teeth equally and should be done twice daily, preferably before or after breakfast and then just before bed. The last thing to touch the teeth every day should be either a toothbrush or water.
Dr. Dorothy: I tell families this too. I also say beyond this rule, to help as long as the child will let the parent do a once over at least before bed. There are certain phases in a child's development when risks increase and seeing us regularly, we can prep the parents to jump in or if they are doing ok. Flossing correctly takes a lot more dexterity than brushing, so unfortunately this is a parent's task for a long time and they can use their best judgement here. We also give great tips and tricks in our office.
Dr. Jenny: I also think when kids can write their name in cursive is when they have the dexterity to brush all surfaces well.
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Electric toothbrushes for kids... yea or nay?
Dr. Cody: Absolutely, but the toothbrush won't do the work for the kid just because it is electric. Sometimes it's a bit more effective just because it is a bit gimmicky and spends a little bit more time in the mouth than on the counter. A child can get perfect brushing done with a disposable toothbrush if they use it correctly. If you feel like you can brush well or your child brushes well with a manual toothbrush, absolutely get an electric toothbrush and reinforce the good habits. There are even some good apps out there for tooth brushing that tends to make brushing a bit easier. Magic Timer is a free app produced by Oral B that helps encourage good brushing by creating virtual stickers that get cleaned off as you brush. Those stickers get placed in a book and change with each brushing, and once the book it filled, it unlocks future books. The children's Sonicare Toothbrush also utilizes bluetooth technology to help teach a child where to brush by following along a virtual pet's teeth. Both have been effective for parents.
Dr. Dorothy: I tell parents what Dr. Cody does too. I add that a manual brush used correctly is just as effective. Also, from a parent's point of view, once a child is cooperative enough to control their lips/drooling it's not as messy. Usually that is 3 years old but it depends on their development. Some brushes flick more and cause more of a mess but being parents I guess something is always messy, sticky, or splattered.
Dr. Jenny: I think electric toothbrushes are great if the kids can tolerate it. For younger kids using electric toothbrushes, I also think it’s best if a parent supervises while they brush.
Kid's toothpaste... fluoride or no fluoride?
Dr. Cody: Absolutely, but it depends on the age of your child and their risk for decay. In general, children under the age of 2 should not use fluoridated toothpaste because swallowing it can create fluorosis of the teeth. Fluorosis is the incorporation of that swallowed fluoride into the developing adult teeth under the gums and makes them look mottled with yellowish/brownish/whitish spots. At the age of 2, the amount of fluoridated toothpaste should not be greater than a lentil or grain of rice. When the child is able to spit effectively, the amount should be graduated to about the size of a pea.
Dr. Dorothy: I actually recommend starting fluoride as soon as teeth come through based on AAPD guidelines and if I feel that based on their history they are at high risk. This is another area that I don't give a blanket recommendation. I think it warrants a discussion. Plus, we have lots of ideas with tastes, textures and ingredients to offer... not all toothpastes are the same and no child is the same. I'm the "it depends" person.
Dr. Jenny: Yes, but not until your child can spit really well. We recommend you start off with an amount similar to the size of a grain of rice and when they can spit more, a pea size amount of toothpaste is recommended.
What are the best/safest toothpastes and mouthwashes for kids?
Dr. Cody: If a child is under 2, a non-fluoridated toothpaste is safe to use. Many use a sweetening agent called xylitol which is safe to swallow and does not cause cavities. It is an organic product derived from corn cobs and birch trees, and some studies have shown xylitol to be effective in slowing the growth of cavity producing bacteria. Once the child is able to spit, however, fluoride remains the gold standard. The amount of fluoride in children's toothpaste is the same amount that is in adult toothpaste, about 1200 parts per million. The main difference between them is the flavor and how they are marketed. My own daughter thinks brushing with mint toothpaste is like brushing with napalm, so she sticks with the bubblegum flavored toothpaste. As for mouthwash, our favorites are Listerine with fluoride or ACT. Both are safe to use as long as the child isn't swallowing the mouthwash. Mouthwashes with fluoride usually have about 200 parts per million of fluoride. In my opinion Scope, on the other hand, is a better mouth rinse for dating, not oral hygiene.
Dr. Dorothy: I only recommend a rinse if the child can spit very well. The type, the effect we are going for depends on the child and what we are trying to achieve :)
Dr. Jenny: I like to recommend Spry for toothpaste and Act for mouthwash.
When can they start using adult’s products?
Dr. Cody: Pretty much from 2 on but most kids don't like the mint flavors.
Dr. Dorothy: The short answer for me is: It depends on the product, the child's age, what they are trying to achieve.
Dr. Jenny: “Adult products” with fluoride, when they get to the age where they can spit really well.
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What are the best treats and the worst treats for kids' teeth?
Dr. Cody: Great question and I believe to be the crux of decay in children. Cavities are bacterial infections driven by the frequency of exposures to fermentable carbohydrates. You might want to read that one again. IF that bacteria is present in the mouth AND it is exposed to fermentable carbohydrates, it WILL produce acid as a byproduct that lasts in the mouth for about 45 minutes. That acid reduces the pH of the mouth during which pieces of the teeth are literally crumbling into the saliva. A child who grazes on carbs and has this bacteria will essentially grow that bacteria in 45 minute increments. Proteins, on the other hand, do not promote the growth of that bacteria. It will instead foster the growth of non-cavity producing bacteria. This is powerful, because if it is truly followed, parents of young children have the ability to grow the healthy bacteria simply through snack selection. I don't want to throw brushing under the bus, but brushing is really only effective for about 3 or 4 minutes before that bacteria starts growing again. The key is to first starve the bacteria by denying it the carbohydrates it wants (sugar, starchy foods like goldfish crackers, dried fruits, granola bars, Z bars, juice boxes, fruit roll ups, candy, soda, Gatorade- all the good stuff) and second getting those colonies off the teeth by regular brushing and flossing. That combination is what leads a mouth toward a healthy result. Unfortunately, you cannot eat something sweet and then immediately brush and call it good. In fact, one study showed it was better to brush 45 minutes AFTER the snack because brushing immediately after was more damaging to the teeth since the environment was so acidic. The analogy is like scrubbing a countertop with Comet- you can actually scrub the top right off. If you can't brush 45 minutes after, at the very least you should rinse with water because 60% of the acids can be removed that way.
The younger the child is, so is the plaque in that mouth. The earlier you grow the good stuff with proper snacks, the faster you will grow the good stuff and harder it will be for cavity producing bacteria to be effective. There are many people who go to the dentist every 5 years with no problems at all or people who actually don't brush well and still don't get cavities. There are also those that have every cleaning device under the sun and are religious about regular check-ups yet continue to get decay. If you dig deeper into their cavity history and present diets, however, you will see the carbohydrate trend that continues to foster cavity growth despite fastidious care. Like most things, it all comes down to diet.
Dr. Dorothy: Yep this is what I say too. I like to say simply, the less processed it is the better. It is difficult in our modern lifestyle because convenience foods are easier to pack, store, and have on hand but food in its most natural and less processed state is not only good for our bodies but our teeth as well. I also say to not deprive our kids if they must have a treat, give it sparingly enough that it is considered a treat, and make sure it melts or is out of the mouth quickly. Chocolate is my favorite treat I give to my kids. Anything sticky like jelly beans or sour patch kids are pretty rough on the teeth. We also have to keep in mind that dehydrated fruits/freeze dried fruit is the same consistency as jelly beans too so really think about how fresh the food is that we give our kids.
Dr. Jenny: Best snacks include raw fruits and veggies, cheese, nuts and eggs. Worst snacks would be goldfish crackers, pretzels, fruit snacks and juice. Please see here for the snack sheet we like to pass out at our office.
What about drinks? Soda, juice, water, milk... how do they affect teeth development and decay?
Dr. Cody: See above. Along these lines, breast milk by itself does not cause decay. Breast feeding at will while still consuming other manufactured carbohydrates, on the other hand, will cause tremendous decay if left unchecked. In most cases, milk and water are the best liquids to consume when trying to keep decay away.
Dr. Dorothy: Nothing better than water. If we must indulge in a beverage, I tell my families to serve it with a meal and then it needs to be done at the end of mealtime. It also stays at the table. No sipping or taking it to go.
Dr. Jenny: I would recommend to avoid all but water and milk.
What's your best trick to calm a hysterical kid who is sitting in your chair?
Dr. Cody: It's funny, but the best trick isn't calming the child but rather checking in with the parent of the hysterical kid. We are parents too and we are also concerned with how they are going to behave in strange situations. The best thing we can do is let the parent know that it is all natural and totally OK. We are just as much about building rapport with the child as we are addressing tooth-related issues. There is an entire person sitting in that chair and not just a tooth with a cavity! So no matter what happens or how that child behaves, it will be OK. We can adapt to the needs of the patient and the parent and no matter what, it will be OK. Another thing to consider about especially young children (think 3 and younger), a hysterical reaction to someone else brushing their teeth is just like home. In fact, I usually tell parents I prefer it if their child throws a fit while brushing, because that is often reality of doing it well at home. If they just sit there and the parent says, "Wow! My kid never behaves like this!! Can you come home tonight and do it again for us???", I tell the parents it's a complete disservice to them. Our job is to help show parents positioning and give them verbal skills and management skills to turn something which traditionally feels like a chore to everyone in the room into a common, uneventful routine. So no matter how a hysterical a child is today, we tell the parents we always get 'em in the end. They may scream, cry and kick on the first visit when they first enter the door, but they may do the very same thing 15-18 years later when they leave that same door to find a new adult dentist.
Dr. Dorothy: It's not a trick, and it really depends on what we are doing and when it occurs but truly hysterical crying to me signals that we just need to stop or get to place to stop quickly and safely, repair the event and plan how to move forward. If that means we conclude, we conclude. If we can work together to talk about why the child is upset and they are willing to continue, we continue. I feel that gives them the most respect to offer choices that are within the bounds of what I need to do and what they can handle developmentally and emotionally. There is always a reason why a child behaves a certain way. Every situation is different but if we treat our children, even our babies with the respect that they are just communicating to us the best they can, we can adapt and help them appropriately. In the end, it's not always how the appointment goes in that moment of hysteria, it's how the next and future appointments will go. Again, this is so specific that it’s hard to give one answer.
Dr. Jenny: For the younger kids, I like to play with them until they’re calm. I use the “Show-Tell-Do” method to show them what we’re going to use, tell them how and why we do it and demonstrate so they know exactly what to expect. With other kids, I feel like we need to talk it out to figure out what’s going on, what’s bothering them and to find a solution in everyone’s best interest.
 | At Bellevue Kids Dentist we are committed to providing the best dental care possible to your children in a fun and comfortable environment. Bellevue, WA pediatric dentists Dr. Cody Mast, Dr. Dorothy Nelson, and Dr. Jenny Lee are experts at working with children and easing their fear. Our amazing team of children’s dentistry professionals will walk you through every step of the process and ensure that your child leaves our office feeling both healthier and happier! |
Bellevue Kids Dentist was voted as a 2019 Neighborhood Favorite through the Next door app!
We were also a Gold Daisy Award Winner in 2018 as the best pediatric dentist through the Eastside Macaroni Kid!
Drs. Cody Mast and Jenny Lee have both been listed as top dentists in the Seattle Met!
