I receive emails from patients, prospective patients, and concerned parents around the world on a regular basis. Many of these questions are often very similar in nature. This is in part why I have the website I do, with the amount of information that is on it. I endeavor to provide a resource to help my patients and others sift through all that is out there to help them find answers and guidance.

Recently I received questions from a concerned mother in Alberta. Her son was diagnosed with some cavities and she wasn’t sure what to do to prevent more, and if there was a way to avoid having her child sedated to get the work done. Her concerns had her seeking new information, particularly diet related, as her family is very health conscious and currently on a Paleo diet (hunter/gather styled diet that does not include dairy or grains). In my correspondences with this person, I found my response would be relevant to many others out there and so, I am including it in today’s blog entry.

Dealing with a child with cavities:

#1. Can the cavities be reversed?

Once a child has cavities (an actual hole in the tooth, not just demineralization of the outer layer) we run into a challenging situation. Changes in diet and oral hygiene routine can slow down the rate of decay, and in some cases bring it to a halt, but damage has already been done which in the majority of cases requires some form of attention to repair or help stabilize.

As each child is different, the degree of success in stabilizing and preventing cavities will vary. Some only require minor modification to daily routines and/or diet to prevent future cavities, where others require very drastic changes that will take time, more time than needed to stabilize and prevent further damage.

Ultimately, the best practice is prevention before any cavities start, and this begins during pregnancy.

#2. Oral Hygiene routines to prevent cavities:

Adequate cleaning of the teeth is a very important part in maintaining oral health and preventing cavities. For kids at low risk for cavities, brushing after breakfast (or lunch), and at the end of the day, with flossing at the end of the day as well, will go a long way to help prevent cavities.

If your child is at high risk for cavities, ensure your child has his/her teeth brushed after every meal, including snack time. If your child has his back molars in, ensure to floss between those teeth, as well as the front teeth if the teeth have no spaces between them (there are flossers made that work great for kids). This should be done at least once per day, and for high risk kids, they would benefit from twice a day. Also, ensure an adult is the one brushing/flossing the teeth. Most kids do not have the manual dexterity to brush/floss their own teeth properly until the age of 12 (my son is turning 8 and I am in the process of training him to brush his own teeth and can tell he is not fully ready to take over the job yet, and he is very skilled manual dexterity wise). This is a very important part as we need to keep food debris off the teeth so the bacteria do not have a continual food supply.

#3. Fluoride Toothpaste and Children:

This is a more controversial topic, and worth mentioning. Everyone will have a slightly different perspective on this, and even in the dental community there is debate and controversy. This is really an area where everyone must decide for themselves how to proceed, and do so as much on fact as possible, rather than other people’s scare tactics.

My recommendation for children under 6 is to not use fluoridated toothpaste. After age 6, I gauge more on risk of decay as to when to start using fluoridated toothpaste.The reason for this is based on the following:

Fluoride in toothpaste is at adult concentrations as it has been found to be ineffective at reduced levels.
Fluoride has its biggest benefits when applied to the surface of teeth, and can do its most harm when ingested.
Adults can be good at brushing and spitting out the vast majority of toothpaste (fluoride) and minimize swallowing any toothpaste.
Children tend to swallow the toothpaste, or even down a tube of it because they like the taste (have caught my daughter drinking hers on a couple of occasions). If the toothpaste contains fluoride, not only can it make the child sick, but it can do serious damage to the developing adult teeth.
Even if my child had some cavities, I would rather have them get one extra cavity the fluoridated toothpaste might be able to prevent, than to have them swallow enough fluoride to damage the adult teeth (the forever teeth).

For reference, currently my children are fluoride free and have no cavities. My focus with them is on diet and brushing/flossing routines. My son is almost 8 and my daughter is turning 6 tomorrow.

#4. Dietary influences on Cavities:

Snacking and meal frequency/duration: For young children, there will likely be 3 main meal times, with up to an equivalent number of snack times (usually depends on number of naps and whether a child is still nursing – which is also considered a meal/snack). These meal and snack times should be kept short. I have seen some kids essentially have one continuous meal time all day long, only separated by sleep. Food should come in smaller/shorter amounts multiple times a day with significant breaks in between. This allows the acidity level in the mouth to stabilize after eating as well as to flush out the food, minimizing nutrient supply for bacteria that contribute to cavities. Interestingly enough, multiple smaller meals throughout the day is also better for metabolism and overall health.

Meal/Snack contents:

For people with cavities and at higher risk for developing cavities, meals and snacks should not contain things like: juice, pop, dried fruit, candies, chocolate, honey, jam, etc. Fruit in general should be avoided while there is active decay as it contains a high source of natural sugars and is generally acidic.
Milk and water should be the only drinks a child at risk for cavities should have (and good idea for people of all ages all the time). Fruit juices are very acidic and packed full of sugar, both of which contribute highly to cavities (apple juice is by far the worst, and can do more damage to teeth than Coca-Cola). Milk can still contribute to cavities due to natural sugars in it, but cleaning the teeth afterwards will negate this.

Natural Sugars vs White Sugar: I have seen many people comment on how they only use natural sugar in their diet and wonder why they are still getting cavities. Well, sugar is sugar. Natural sugar can be healthier, but still has a lot of negative impacts on our system and should be minimized (eg. Adding honey to tea instead of white sugar is still bad, and would be better to drink the tea without any additives). My rule for sugar is this: If it does not already contain natural sugar, I am not adding it in. If I want to sweeten up my breakfast omelet, I add some red peppers (a fruit), I don’t add sugar. I drink my tea straight, avoid jams that are made with added sugar in an attempt to sweeten it or to combat the acidity of the jam, etc.

The Good Snacks: There are many healthy snacks that kids can have that will not only help prevent cavities, but also contribute to proper overall nutrition.

raw veggies with no dip: My kids love veggies and only as they have gotten older have we started to let them have some dip with them, but that is more of treat than a norm.
Lots of cheddar cheese: Cheddar cheese is packed full of nutrients that help strengthen teeth as well as containing bacteria that compete with those that cause cavities. If my kids have a snack like raisins (sugar and acid containing), they get carrot sticks with it to help clean the raisins out from in the grooves of their teeth so they do not sit in the mouth for extended periods of time (I do not recommend raisins for kids with cavities, and raisins are a treat to be eaten with other foods, not an everyday food).
Yogurt: Yogurt is a good snack with lots of nutrients and good bacteria as well. However, you have to be careful with yogurt as store bought yogurt often has way too much sugar added and may have the bacteria neutralized. And with yogurt, a little goes a long way.
Grains: There is a lot of controversy over grains, but are safe and healthy when used properly. Grains should be kept closer to their natural source (eg. whole weat vs white flour), and grains should be taken with dairy (dairy helps neutralize potentially harmful aspects of grains and improves their digestion/absorption into the system). My kids eat a lot of grains, particularly at breakfast, but it is always with dairy, and I have yet to see any negative impact on them from eating grains. On the flip side, white flour buns/bread are a big contributor to cavities for many of my patients.
In general, always strive to have at least three food groups in each meal/snack to help ensure proper nutrient absorption. Also ensure all food groups are represented throughout the day. Foods rich in calcium, Vitamin A, and vitamin D are essential to help prevent cavities. If you child does have deficiencies in nutrients, you can look at supplementation (vitamin D and C are the most common supplements in some areas due to accessibility to certain foods and sunlight), but ultimately you will want to work on the diet over time to ensure adequate nutrients are present. Your family doctor should be able to help guide you as to if there are any nutrient deficiencies present.

#5. General development of the teeth:

Another factor to consider is the formation of the teeth. I have seen many cases where kids have terrible diets and no cavities, and kids with “ok” diets and lots of cavities, or even significantly different decay rates between kids in a family, despite same diet and oral hygiene patterns. From assessing these cases I have noticed a trend that relates to the formation of the teeth. If during pregnancy the mother was deficient in nutrients (either from diet or illness), this impacts the development of the child’s baby teeth, which are formed during pregnancy. If the teeth are weaker and deficient in mineral content, they will be very vulnerable to decay and break down easily. In these cases the diet needs to be extra rigid to help protect the teeth. As a side benefit, the healthy diet can help ensure proper formation of the adult teeth and have very long term effect. However, if the diet was the cause of the mothers nutritional deficiency during pregnancy, and continues for the child, the adult teeth will be affected as well. So if your child is having problems with cavities, time to assess overall eating habits in the family.

#6. Final Comments:

Night Nursing: There are a lot of opinions on night nursing and feeding on demand. Ultimately, to each their own in my opinion (pros and cons to all sides on topics of this nature). Whichever approach you decide to take, there can be an impact on the child’s oral health that needs to be considered, and is generally not addressed until cavities develop. For protecting the teeth, the biggest problem I see with night time nursing/nursing on demand is it is usually accompanied by a lack of adequate oral hygiene. Ie. The child nurses, then goes back to sleep without having the teeth cleaned. This routine is what can contribute to cavities, which usually starts on the front teeth, and this occurs because a nutrient supply for the “cavity causing” bacteria is perpetually there.

Breast Feeding Vs. Formula: This is another hot topic, however, I think many would agree that breast feeding is the ideal from multiple aspects. Unfortunately, the ideal is not always achievable for various reasons, which will lead some to use formula for their child. There are a couple aspects to keep in consideration when both buying, and using infant formula:

Sugar and PH: Infant formula often contains a lot of sugar and can be very acidic. Some brands are better than others, and when choosing which formula to buy, please read the nutritional information. Watch for how much sugar is present, and do not let your child suck on a bottle of formula for 4 hours. Keep the feeding times short.
Fluoride: If you read the information on infant formula containers, many manufacturers add something to the effect of, “do not use fluoridated water when preparing the formula for children under 6 months of age”. This is the biggest reason I want fluoride out of municipal water supplies. Newborns are in critical stages of development and should not be exposed to toxins. Although fluoride can be relatively safe for adults, it can have disastrous effects for a newborn, one of which is damaging the development of the adult teeth and contribute to what is known as fluorosis.

#7. The End:

There is a lot of information here, but not exaustive. This is a big subject and often more questions than answers. I hope what I have written hear can help spur you on to learn more and take control of your oral health, and that of your children. How we live gets magnified in our children, and our bad habits perpetuated for multiple generations. Cavities do not need to happen and can be prevented. Learn from the past, find ways to change and improve, and not only will your oral health improve, but your overall health will as well.

For as they, never look a gift horse in the mouth. Why? Because the state of the health of one’s mouth is a good indicator as to the health of the entire body.

Here’s to your health,

Dr. Schau