Although the responsibility for a child's oral health rests with the parents, childcare providers play an important role in maintaining the oral health of children in childcare settings. Knowing a few basic oral health guidelines can greatly help a childcare provider's ability to do so.

Although tooth decay is not as common as it used to be, it is still one of the most common diseases in children. Many children still get cavities. While fluoridated drinking water and fluoride-containing toothpaste have helped to improve the oral health of both children and adults, regular tooth brushing and a well-balanced diet are still very important to maintaining good oral health.

Primary, or baby, teeth commonly begin to come in or erupt in a baby's mouth at about 4 to 6 months of age and continue until all 20 have come in at about the age of 2-1/2 years. This eruption of primary teeth, or teething, can cause sore and tender gums that appear red and puffy. To relieve the soreness, give the baby a cold teething ring or washcloth to chew on. Teething medicine is not recommended.

Many primary teeth will not be replaced by permanent teeth for 10 to 12 years. Until that time, they need to be kept healthy to enable a child to chew food, speak, and have an attractive smile. Primary teeth are at risk for decay soon after they erupt. Tooth decay is caused by germs (bacteria) and sugars from food or liquids building up on a tooth. Over time, these bacteria dissolve the enamel, or outer layer, of the tooth. This damaged area is called a cavity. Regular brushing prevents the build-up of bacteria and sugars and the damage they cause.

Baby bottle tooth decay (or nursing bottle mouth) is a leading dental problem for children under 3 years of age. Baby bottle tooth decay occurs when a child's teeth are exposed to sugary liquids, such as formula, fruit juices, and other sweetened liquids for a continuous, extended period of time. The practice of putting a baby to bed with a bottle, which the baby can suck on for hours, is the major cause of this dental condition. The sugary liquid flows over the baby's upper front teeth and dissolves the enamel, causing decay that can lead to infection. The longer the practice continues, the greater the damage to the baby's teeth and mouth. Treatment is very expensive.

The American Academy of Pediatric Dentistry has developed the following guidelines for preventing baby bottle tooth decay:

Don't allow a child to fall asleep with a bottle containing milk, formula, fruit juices, or other sweet liquids. Never let a child walk with a bottle in her mouth.

Comfort a child who wants a bottle between regular feedings or during naps with a bottle filled with cool water.

Always make sure a child's pacifier is clean and never dip a pacifier in a sweet liquid.

Introduce children to a cup as they approach 1 year of age. Children should stop drinking from a bottle soon after their first birthday.

Notify the parent of any unusual red or swollen areas in a child's mouth or any dark spot on a child's tooth so that the parent can consult the child's dentist.

To prevent infections from spreading through germs found in saliva and blood on toothbrushes, see "Using and Handling Toothbrushes" in the chapter, "Following Protective Practices to Reduce Disease and Injury."

© January 1997

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