I think most of us know the basics of good dental hygiene. We brush and floss our teeth and see the dentist. We learned those basics in elementary school, when the dentist visited school and made us chew on those tablets that turned our plaque colors. When I became a parent, I was less sure how to care for my little baby’s newly emerging teeth. I knew I needed to brush my baby’s teeth, but could I use fluoride? At what age would he need floss? When should I take him to the dentist? I just had no idea. Little tiny baby teeth were new to me.
I figured it out eventually, thanks in part to the amazing pediatric dentists that my kids have been lucky to visit over the years. Dr. Justin Chafin is the owner of Firefly Pediatric Dentistry in Franklin, TN. He has walked our family through some complicated dental work with my middle child, some run-of-the-mill cleanings with my oldest, and my baby girl’s first appointment is on his books as we speak.
Dr. Justin, as my kids affectionately call him, agreed to talk to Scary Mommy to give parents a little crash course on dental care for the littlest teeth among us. Here’s what he had to say:
When should a baby see the dentist for the very first time?
“The recommendation (AAPD, ADA, AAP) is the first visit by the first birthday. Honestly, most of the time people don’t do that. But the earlier you can see patients, the quicker you can catch things. Cavities, dental caries, is technically an infectious disease. It’s caused by bacteria. It’s the most common chronic disease of childhood. So, if we can catch that quicker, we can do stuff [like remineralization to avoid an extraction later.] The quicker we can catch things, the easier the treatment is, and along with that, the less costly,” explains Dr. Justin.
Do I need special baby stuff to care for my child’s baby teeth?
“It doesn’t matter that much. Just get something they’ll tolerate. The best toothbrush to use is the one that they’re going to use! If a fun banana-shaped toothbrush is what they’re going to use, then by all means, use that. Get them what they’re going to use. I will say that I like extra-soft toothbrushes because they get in the nooks and crannies a little bit better,” Dr. Justin recommends.
You don’t really need to floss a baby’s teeth until the back molars make contact, around age 2 or 3.
Can I use fluoride toothpaste on baby teeth?
“As far as fluoride, I know that’s kind of a hot topic. There is no scientific, evidence-based reason to avoid fluoride. It’s a very tried and true, long-tested, long-studied thing. It’s okay to use fluoride even on an infant that has their front two teeth barely poking through. The main issue is the amount. On babies that can’t adequately spit out, use an amount the size of a grain of rice. At that amount, even if they swallow every single bit of it every time you put it in their mouth, it’s not going to be enough to cause fluorosis, upset stomach, anything in their body,” Dr. Justin explains.
If you’re avoiding fluoride anyway, try to get 6-8 grams of Xylitol in their mouths per day. It won’t work as well as fluoride to aid in the remineralization of the teeth, but it’s better than nothing.
What can contribute to poor dental health in a baby?
“Dental health is a multi-factorial thing. There are four big ones: The tooth itself, the bacteria in the mouth, what you put in the mouth, and then the time that it stays in there. If any of those are compromised, the risk of getting a cavity goes up and up.
You can’t really do anything about the teeth you are born with or the strain of bacteria in the mouth. You usually get the strain of bacteria from your mother or your primary caregiver. That’s why we brush. To keep that at bay.”
The main things we can control are what that goes in the mouth and the time it stays there
“Anything that is a sugar or a carbohydrate can cause a cavity. The bacteria doesn’t care if it’s organic, non-GMO coconut water or straight table sugar they’re eating with a spoon. It doesn’t matter to them. They can feed off of that. We see a lot of cavities, especially across the front teeth, if kids go to bed with a bottle of milk or if they feed on demand throughout the night for long periods of time.” replied Dr. Justin.
Yup. Even breastmilk can hurt the teeth if it sits there pooling in the mouth.
“It’s less cariogenic than, like, Mountain Dew or something, but it does have levels of lactose in it. The vitamins, minerals, protein usually protect decently well, but that lactose in there, if it stays on the teeth long enough, then the bacteria can surely eat that lactose and produce the acid to make a cavity,” he says.
Let’s talk about pacifiers:
“Ideally, a child should stop using a pacifier around age two. If you go past age two, you start seeing more effects. A pacifier is basically like having braces. Braces cause very light forces that, over time, move the teeth. A pacifier is like a removable orthodontic appliance. If they use them for years and years, they can cause an open bite,” cautions Dr. Justin.
He went on to explain that if you stop pacifier usage at age 3, there’s about a 2/3 chance that any effects the pacifier had on the mouth will go back to normal without intervention. At four years old, that chance drops under fifty percent, and some kids will need a lot of orthodontia to get their mouth back into a healthy position.
My baby is a year old and doesn’t even have any baby teeth! Should I panic?
According to Dr. Justin, the average first tooth comes in at seven months old, but that’s just an average. Things like genetics and gestational age at birth can affect the timeline, which is already kind of a broad range.
“I would say if they’re older than a year and they still don’t have any teeth, that’s another reason to come in by the first birthday. Sometimes there’s a little cyst that’s formed that is just kind of blocking those first teeth from coming in. That’s something that we can identify, maybe even do a little procedure and encourage those teeth to come into the mouth and get back on track,” Dr. Justin explains.
I’m embarrassed to bring my baby to the dentist because I think they might have a cavity already.
“I have Doctor in front of my name but not Honorable. I have no reason to judge. I don’t know your circumstances. There’s no point in me coming in judging you, sharing horror stories. You’re there now. Any step in the right direction is progress,” he assures.
Caring for baby teeth is a lot like caring for your own. Keep them clean, establish a relationship with a pediatric dentist, and let go of the idea that you can fully control what happens to their teeth. Dentists exist because teeth need maintenance. If your kid needs a lot of dental work throughout the years, that’s okay! A good dentist can guide you through it while also encouraging you to set up good habits early on to give those little chompers their best fighting chance.