Flossing your Teeth is Critical...for kids and parents!

Cavities between the teeth are slow, insidious and begin showing up between age 3 and 5 years old. They account for 90% of cavities that I see; the majority of them happening between 5 and 9 years old. I cannot apply preventive sealants between teeth. Tooth brushing will not clean between the teeth.  Flossing will, however, and will help protect those areas. Since brushing will not help prevent these cavities, lets make flossing easy and bring it up high in the parent priority list, higher than brushing.


Floss anywhere. At evening story time on the couch, they can lay with head on your lap, looking up with mouth open wide. It is easy to see in that mouth and the head is supported, making the job quick, easy and comfortable for the younger kids. It is part of snuggle time.

When my kids were 6 years old they were OK though not yet great brushers. Since flossing was the real important issue, I chose to let them brush and bring me a piece of floss afterward. They handed me the floss, turned their back to me and tipped their head way back against my stomach. Mouth is wide open, easy to see, took 10 – 15 seconds of my time, and if their brushing job was really poor I saw it and sent them back. They soon improved their brushing to avoid being sent back. By about 10 they were doing their own flossing.

Set up their flossers. Many kids want to floss themselves and can’t get the floss wound on the flossing handle tightly enough. So the flossing goes undone or severely lacking. How about winding up 7 days worth for them to have in their bathroom? Ask us for more handles if you want them. They are inexpensive and we would love to give you what you need.

There are pre-strung single use flossers in the stores which I caution against. Floss-Picks and Wild-Flossers and such are attractive, but the little piece of floss is limp and the handle is flexible. Caution: Kids get very independent minded and insist on flossing themselves. Many haven’t developed adequate hand skills yet.  They go through the motions with the limp floss that does not get between the teeth and are rudely surprised later when cavities show up.  It is too late then, when we point out to the parents that the children have not been using the floss effectively.

Is juice a problem for my child's teeth?

For over 2 generations now juice has been espoused as a health food. Though dentists have been aware for decades this is not really true, it has not been until very recently that the health industry and the medical establishment has taken a closer look at juice. It is definitely not a health food. The question arises if it is even healthy!

Juice now sits on the top of the list as a probable causative agent for the medical chronic disease pandemic facing our children; namely diabetes, obesity, high blood pressure, and osteoporosis, among others. The journals of the American Medical Association and the American Academy of Pediatrics have in recent years recommended that juice be avoided in an infant’s diet. They also recommend that if it is introduced to a toddler that it be limited to 6 oz. daily (a small glass) and consumed with a meal.

Juice is at the top of the list of causative agents for dental disease for our children and youth. For that matter, in today’s culture it probably is equally at cause for adult dental decay.

Juice is worse than soda! That doesn’t mean soda is good; it is also terrible for teeth and health. But, juice is worse. If you look at nutrition data for foods and compare juice with whole fruit, you quickly see what is lost when juice is squeezed from fruit. A couple highlights:

You do get water and calories; i.e., an 8 oz glass of orange juice has the calories squeezed from about 5 oranges. Who ever heard of eating 5 oranges in one sitting? And today we often do this at breakfast and again in the afternoon. Yikes… all those empty calories!

Lost with the fruit when we make juice is a) nearly all the vitamins except some of the water soluble vitamin C, b) insoluble fiber, roughage, c) soluble fiber, unique to fruit and an important aid in digestion, d) and minerals, key components to our enzyme systems that process our body functions. Without the minerals the enzymes cannot use the calories we consume so the calories get stored as fat.

Rarely mentioned about juice is the acid. Acid that will dissolve your teeth. Those of us that took analytical and organic chemistry in college know the issue here. Though organic acids are often called “weak” acids, they are far more effective in organic systems like mouths because of their sustaining power. They don’t register in the pH scale as strong (lower number) as inorganic acids because they hold their acid potential in “reserve.” As the acid is used (dissolving calcium out of teeth) the reserve releases more acid out of solution. This is part of the steady state (homeostasis) systems that sustain organic (life supporting) systems. When misused (juice rather than fruit) the power released can be devastating. It turns out the acid potential (titrateable acid) of juice is nearly twice that of colas!

So put juice at the very top of the destructive beverage list that includes: juice, sports drinks like Gatorade, sodas, juicers and sweet energy teas.

Your Child's First Dental Visit Before the First Birthday

Really? Well, here is the data. Dental Caries (cavities) is the most prevalent contagious disease in the world. Dental caries (besides pain and suffering) is the most common cause of absence from school. It is also the most common reason for lost time at work for parents. In the grand picture, it is also the most costly disease in the world to treat. 50% of preschool/kindergarten children have cavities.

As an aside, from the 1950s through the 1980s the efforts of our dental profession to educate (and the use of fluorides in drinking water and toothpastes) created an incredible reduction in cavities. We dentists talked jokingly about putting ourselves out of business. Seriously, the American Dental Association put on their business agenda the suggestion that Pediatric Dentistry was in decreasing demand and should be considered for elimination as a recognized specialty. Then came the 1990s and a skyrocketing increase in cavities in children. We now see cavities surpassing the levels we saw in the 1940s and 50s and increasing at an alarming rate. (The cultural shift in adult society that is feeding this problem is a subject for a different article.)
So, that is all disturbing news, but it still doesn’t explain the first dental visit before the first birthday. The reality is, ­all cavities are 100% preventable and of course you need to know how before the cavities start. Preventing cavities is easy while stopping cavities and preventing cavities in a mouth of already existing cavities is immensely more difficult.
And for your pocket book, a study published by the American Academy of Pediatrics, showed overall dental costs in the first 5 years to be 40% lower for children who started with the dentist before age one.
The first visit at age 3 is just too late. To become a believer, you need only step into a pediatric dental office and see the 3 year olds having cavities filled. Or accompany me to the hospital operating room where, with general anesthesia, I treat 12 young children (average age 3 yrs old) per month. These children have cavities so extensive I could not accomplish the work with the child awake in the office.
An appropriate age one dental visit will include:

1. A visual examination to assess growth and development.
2. An oral health risk assessment to determine if the child has high or low risk for cavities.
3. A discussion of diet with emphasis on the common mistakes that cause cavities.
4. A discussion of habits that affect both oral disease and growth.
5. Simple techniques to take the hassle out of cleaning a child’s teeth so you know they are clean in a matter of seconds.
6. And ultimately a prevention plan appropriate to the child’s risk of disease.

Hypocalcified Teeth: White, Yellow and Brown Blemishes

Teeth occasionally experience a disturbance during development that results in the enamel developing atypically. It is usually observed as a discoloration; white, yellow or brown. I most commonly see it on the first permanent molars and central incisors (two front teeth) though it can happen to any of the teeth.

When this anomaly occurs on the front teeth, there may be some cosmetic concerns to address. In its mildest form it shows as white marks on the teeth, typically near the chewing edge, though it may be anywhere on the tooth. They are often hydration dependent meaning if the tooth dries out the white spots become prominent and when the tooth remains wet the spots diminish or disappear. These are a cosmetic concern only and since an adult’s facial posture keeps lips closed more than children, these blemishes typically remain wet and diminish. We do not recommend any treatment procedures until at least the mid teen years when a more adult facial posture has developed.

White blemishes that are larger and more opaque will likely need removal of the blemish and filling with a cosmetic filling material.

Blemishes of a more yellow or brown nature are often improved with bleaching techniques that can be done at any age. If the blemish does not respond to bleaching we can offer other cosmetic procedures to remove discolorations and refill the blemishes with cosmetic filling materials

If the aberration is severe enough it will result in soft enamel that chips and/or decays easily. It may also result in an atypical shape for the tooth. I usually observe this on the molar teeth. When this occurs, it is important to remove the very soft enamel and place a filling in the area. I do this in a conservative fashion by bonding on a filling material to replace the lost or decayed portion of the tooth. This usually needs “touching up” as the tooth grows and exposes more of the compromised enamel. The soft enamel may also chip around the bonded filling necessitating occasional repairs. Occasionally the aberration in the enamel is extensive enough that we recommend a stainless steel crown as a temporary crown during the growing years. A large percentage of these molar teeth will be best served with a full crown restoration after all permanent teeth have emerged, growth is finished and the occlusion has stabilized (age 18 or older). In the mean time we will maintain the integrity of the teeth with conservative repairs.

These teeth can also be very sensitive teeth for reasons we do not know. Restoring or covering the hypocalcified enamel will occasionally help this. Toothpastes for sensitive teeth (i.e. Sensodyne, Thermodent) can also be helpful. Avoiding highly acidic snack patterns (carbonated beverages, fruit juices, sour candies) will likely be very helpful as well.