Dear Doctor:

Our daughter is only 4 years old, and she has had her first cavity already. What can we do to make sure that things go better at her next visit to the dentist, and for her new baby brother?

Dear Reader: Tooth decay is common in young children. Their small mouths can make thorough brushing a challenge, and a wriggling and impatient child only adds to the level of difficulty. In fact, studies show that one-fourth of all children have had at least one cavity by the time they turn 4. Fortunately, with consistent dental hygiene, good diet and regular visits to the dentist, you can prevent tooth decay.

Our mouths can play host to hundreds of different types of bacteria, many of them benign, and some even useful. But among their number is a bacterium known as streptococcus mutans, a sugar-loving organism that is responsible for the formation of cavities. Every time we eat, this bacterium gets a meal as well. And as it devours the sugars that linger in our mouths, it produces an acidic byproduct that gradually erodes the tooth’s enamel coating. That’s why brushing and flossing, as well as a diet that limits sugar, are crucial to good dental health. Fortunately, with a few simple steps that you follow every day, you can significantly reduce your child’s risk of developing more cavities.

Even before an infant’s first tooth emerges, you should gently wipe their gums and mouth with a clean, damp cloth after feedings. Their first tooth should be greeted with a soft infant toothbrush that you use for a gentle cleansing after each meal. Brushing with plain water is fine. If you do decide to use toothpaste at this point, make sure it’s a tiny amount, about the size of a grain of rice. As soon as your child has two teeth that touch each other, it’s time to begin flossing. Again, it’s important for you to be very gentle so as not to cause discomfort, pain or bleeding.

Children 3 and older should brush twice a day and continue flossing once a day. Young children are often not coordinated enough, or they lack the attention span, to do a thorough job. If that’s the case with your daughter, continue to brush her teeth for her until you’re sure she’s up to the task. Most kids need help brushing, or at least close supervision, until they’re 7 or 8.

Sugar increases the risk of developing cavities, so diet is also important. Limit sweets, sugary drinks and snacks between meals. And when kids do indulge, get them into the habit of brushing their teeth immediately afterward. All of this will be easier if you set a good example yourself. Be sure your kids see you brushing your teeth after meals, just as you’re asking them to. Ditto for daily flossing.

And don’t forget about the dentist, who will be an important lifelong ally in maintaining good oral health. The American Academy of Pediatrics recommends that kids see a pediatric dentist within six months after their first tooth appears, or by 12 months of age.

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