07 March 2012

Extensive dental caries in preschoolers

Devon Koester, age 2 ½, getting anesthesia at the Center for Pediatric Dentistry in Seattle 
for an operation that included a root canal.  Photo: Stuart Isett.
In the surgical wing of the Center for Pediatric Dentistry at Seattle Children’s Hospital, Devon Koester, 2 ½ years old, was resting last month in his mother’s arms as an anesthesiologist held a bubble-gum-scented mask over his face to put him under. The doctors then took X-rays, which showed that 11 of his 20 baby teeth had cavities. Then his pediatric dentist extracted two incisors, performed a root canal on a molar, and gave the rest fillings and crowns...

Dentists offer a number of reasons so many preschoolers suffer from such extensive dental decay. Though they are not necessarily new, they have combined to create a growing problem: endless snacking and juice or other sweet drinks at bedtime, parents who choose bottled water rather than fluoridated tap water for their children, and a lack of awareness that infants should, according to pediatric experts, visit a dentist by age 1... And because some toddlers dislike tooth-brushing, some parents do not enforce it...

It’s not just about kids in poverty... Affluent families may have nannies who “pacify kids by giving them a sippy cup all day,” Dr. Lindemeyer said.
There are more details at the New York Times, including recommendations for good dental health in preschoolers (all of it basic common sense).


  1. I know a child who, when handed a new toothbrush by the visiting dental nurse, handed it back saying "Daddy won't let me use it".
    And yes - their teeth are a mess.

  2. "bubble-gum-scented mask" kind of speaks volumes.

  3. Hi, this news was in the Australian papers online as well. What surprised me about the dentist's advice for dental hygiene was that there was not a mention of the importance of proper daily flossing of teeth before brushing. I had bad teeth and bad breath for years despite brushing and Listerine that "kills 99% of bacteria", leaving 1% free to multiply. If you don't remove food particles that get forced between the teeth - and toothbrushes and toothpicks won't do this - you are sooner or later going to get decay between your teeth. Why don't the dentists recommend flossing? Maybe because if it removes food particles before they rot, and you brush also, you'll have less need to visit a dentist? But far be it from me to suggest... Keep up the great blogging. Always something of interest. Thanks, Alex

    1. I would guess (and it's only that) that the baby teeth of preschoolers are sufficiently widely spaced that flossing is less important, compared to the mouths of adults whose teeth are typically more closely crowded together.

    2. True, baby teeth would be more widely spaced but during the teenage years, when successful social relationships can affect both later personality styles and romance, if they don't understand about flossing, and get ostracised due to bad breath, the consequences can be negative to a greater or lesser degree. And of course, the effect of fixing cavities, etc, is not so good on the parents' wallets either.

    3. Floss is important to remove subgingival plaque, so it's important to floss even if you have spacing between teeth.

  4. My dental hygienist says brush then floss.

  5. There is child in my son's pre-school class whose mouth is absolutely full of fillings. If they still used lead, he wouldn't definitely have been poisoned by now. That is just ridiculous.

    The time of teeth dwelling makes a huge difference, too. Not just purely the amount of sugar. Not applicable to kids, but a shot may have a lot of sugar in it, but it doesn't really touch your teeth. Where gum, hard candies, gummy candies, juice sipping, etc. spend a lot of time with exposure to the teeth bacteria. They go nuts when they are in contact with the sugar source.

  6. Much of the advice in caring for little one's teeth is, as you say, common sense. But not all of it. Here's the highlights from a post I wrote recently (http://myideaofparadise.blogspot.com/2012/01/earn-top-dollar-from-tooth-fairy.html):

    Best ways to prevent cavities (in order of most to least effective):
    1. More frequent fluoride. This is the single most important item on the list as it strengthens teeth and makes them resistant to decay.
    2. Less frequent sweets. Best time for sweets is with meals. Juice, even diluted ones, are worst for teeth. If you're going to eat a bag of candy, do it all at one time and with a meal; same goes for glass of juice.
    3. Regular check-ups. Every 6 months to a dentist who will monitor teeth development closely and build a friendly relationship with your child so they don't fear going.
    4. Brushing. Twice a day with fluoride toothpaste.
    5. Sealants. This is done on molars when they start to appear around 6 years of age to seal the deep grooves that toothbrush bristles cannot reach.

    And by the way, flossing helps prevent gum disease and does little to fight cavities. Since little kids don't have issue with gingivitis, flossing isn't important for them.


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