Interview of Dr. Eve Kimball on Early Childhood Caries
One of the docs we know at Medical Home, Dr. Kimball, recently went to a training about dental caries. Dental caries is a serious dental health condition that can have serious consequences for children. Dr. Kimball sees a lot of children with this issue in her practice and she is passionate about spreading the word that parents can make simple choices that will vastly improve their children's dental health. I eagerly took the opportunity to interview Dr. Kimball and pick her brain.
What is Early Childhood Caries?
Early Childhood Caries (ECC) is a syndrome characterized by severe tooth decay in infants or young children. ECC is actually a very common and transmissible bacterial infection. The first sign of ECC is half moon shaped white spots on the teeth. These need URGENT attention by a dentist. However, prevention is the best medicine. As soon as a first tooth erupts, it is susceptible to decay, so the child should be receiving dental care.
Why are children with special health care needs at increased risk for dental caries?
Many children with special health care needs have dry mouths. This is sometimes caused by medications and sometimes by conditions such as cerebral palsy. Having less saliva makes children more vulnerable to ECC. Also, many medications are high in sugar content, which contributes to tooth decay. It can also be very difficult for parents of children with special needs to clean their children’s teeth properly. Some children with special health care needs also have compromised immune systems. Another thing is that depending on the severity of the child’s condition, dental care can seem like a low priority, especially when there are other health crises demanding attention.
What is fluoride varnish?
Fluoride varnish is a preparation with 5% sodium fluoride in a resin that is painted onto the teeth. It permanently converts the hydroxy-appetite that is in the tooth enamel layer to fluoroappetite which is a harder substance and protects the teeth against decay. It is the SECOND best way to get fluoride to the teeth. The best way is to drink fluoridated water several times a day thus exposing the teeth to very small amounts of fluoride very frequently. Some pediatricians offer fluoride varnish treatments for children less than 3 years of age.
Are more pediatricians going to start offering fluoride varnish soon?
I hope so. Pediatricians see infants and toddlers many times before the dentist has an opportunity. Parents should ask their pediatrician about fluoride varnish. Any pediatrician or family practitioner can take the Oral Health Module at the AAP website, get a certificate, send the certificate to the state Medicaid folks and start offering fluoride varnish. Pediatricians can find the training online at www.aap.org/oralhealth/cme/.
When should parents start taking their child to the dentist?
You should take your child to the dentist at the age of 12 months if your doctor is not doing oral health evaluation and fluoride application. If your doctor is doing oral health evaluation and fluoride application, you can wait until age 3.
Do you have any advice for finding a dentist who will be able to accommodate a child with special needs?
Call your insurance company for names. Ask for a case manager to help you locate a dentist.
Aren’t baby teeth basically disposable? Why are we worrying about “practice teeth”?
Dental disease can lead to pain, infection, slow social development, sleep deprivation, poor weight gain, nutritional problems, missing teeth, attention deficit, and missed school days. Also, the habits that contributed to dental disease can be difficult to break in later years. ECC is a major health issue in our society. It is 5 times more prevalent than asthma and 40% of kindergarten children have dental caries!
Diluting juice is good for dental health, right?
Wrong, juice contains sugar no matter how dilute. Remember that decay occurs when sweet liquids containing fermentable carbohydrates are left clinging to the child’s teeth for long periods. Juice should only be offered at mealtimes in the container that the child is transitioning to (such as a cup). Children should not consume more than 4 ounces of juice per day.
Is tap water better for my child than bottled water?
Yes, if the tap water is fluoridated. It is BEST if it contains fluoride. Check with your local water department. If your local water is not fluoridated you may want to buy fluoridated bottled water.
What is fluorosis and how can I be sure my child won’t get fluorosis?
Fluorosis occurs when children receive too much fluoride. It is usually only a cosmetic problem. Yellowish pigment appears on the teeth but the teeth are actually more resistant to cavities! Fluoride varnish treatments are unlikely to contribute to fluorosis. To decrease the risk, supervise children’s tooth brushing to avoid excessive ingestion of tooth paste. Your doctor will probably also recommend stopping the use of fluoride tablets if your children are receiving varnish treatments.
What should I do at home to prevent dental caries?
Give tap water (hopefully fluoridated) as the preferred beverage between meal and bedtime. Brush your child's teeth with fluoridated toothpaste (a smear the size of the child's pinky fingernail on the toothbrush) twice daily, preferably after meals. Your pediatrician or dentist may suggest the use of xylitol gum (>50% xylitol content) three or four times per day for three months. Since parents with dental disease present a very high risk of passing the disease to their children, practice good dental hygiene for yourself and avoid sharing utensils, cleaning pacifiers with adult saliva, or other activities that could transmit dental caries. Also, while sippy cups are useful as a transitional device from bottle to cup, they should not be used for prolonged periods. Toddlers who carry sippy cups around and drink from them throughout the day are at higher risk for tooth decay as well as other problems. Offer only water in nighttime bottles or sippy cups. Get fluoride varnish 2-4 times per year.
I'd like to give Dr. Kimball a big thanks for this important information. Do you, as a reader, have any additional questions? Please respond to this blog to post them. I will pass them on to Dr. Kimball.
-Debbie
What is Early Childhood Caries?
Early Childhood Caries (ECC) is a syndrome characterized by severe tooth decay in infants or young children. ECC is actually a very common and transmissible bacterial infection. The first sign of ECC is half moon shaped white spots on the teeth. These need URGENT attention by a dentist. However, prevention is the best medicine. As soon as a first tooth erupts, it is susceptible to decay, so the child should be receiving dental care.
Why are children with special health care needs at increased risk for dental caries?
Many children with special health care needs have dry mouths. This is sometimes caused by medications and sometimes by conditions such as cerebral palsy. Having less saliva makes children more vulnerable to ECC. Also, many medications are high in sugar content, which contributes to tooth decay. It can also be very difficult for parents of children with special needs to clean their children’s teeth properly. Some children with special health care needs also have compromised immune systems. Another thing is that depending on the severity of the child’s condition, dental care can seem like a low priority, especially when there are other health crises demanding attention.
What is fluoride varnish?
Fluoride varnish is a preparation with 5% sodium fluoride in a resin that is painted onto the teeth. It permanently converts the hydroxy-appetite that is in the tooth enamel layer to fluoroappetite which is a harder substance and protects the teeth against decay. It is the SECOND best way to get fluoride to the teeth. The best way is to drink fluoridated water several times a day thus exposing the teeth to very small amounts of fluoride very frequently. Some pediatricians offer fluoride varnish treatments for children less than 3 years of age.
Are more pediatricians going to start offering fluoride varnish soon?
I hope so. Pediatricians see infants and toddlers many times before the dentist has an opportunity. Parents should ask their pediatrician about fluoride varnish. Any pediatrician or family practitioner can take the Oral Health Module at the AAP website, get a certificate, send the certificate to the state Medicaid folks and start offering fluoride varnish. Pediatricians can find the training online at www.aap.org/oralhealth/cme/.
When should parents start taking their child to the dentist?
You should take your child to the dentist at the age of 12 months if your doctor is not doing oral health evaluation and fluoride application. If your doctor is doing oral health evaluation and fluoride application, you can wait until age 3.
Do you have any advice for finding a dentist who will be able to accommodate a child with special needs?
Call your insurance company for names. Ask for a case manager to help you locate a dentist.
Aren’t baby teeth basically disposable? Why are we worrying about “practice teeth”?
Dental disease can lead to pain, infection, slow social development, sleep deprivation, poor weight gain, nutritional problems, missing teeth, attention deficit, and missed school days. Also, the habits that contributed to dental disease can be difficult to break in later years. ECC is a major health issue in our society. It is 5 times more prevalent than asthma and 40% of kindergarten children have dental caries!
Diluting juice is good for dental health, right?
Wrong, juice contains sugar no matter how dilute. Remember that decay occurs when sweet liquids containing fermentable carbohydrates are left clinging to the child’s teeth for long periods. Juice should only be offered at mealtimes in the container that the child is transitioning to (such as a cup). Children should not consume more than 4 ounces of juice per day.
Is tap water better for my child than bottled water?
Yes, if the tap water is fluoridated. It is BEST if it contains fluoride. Check with your local water department. If your local water is not fluoridated you may want to buy fluoridated bottled water.
What is fluorosis and how can I be sure my child won’t get fluorosis?
Fluorosis occurs when children receive too much fluoride. It is usually only a cosmetic problem. Yellowish pigment appears on the teeth but the teeth are actually more resistant to cavities! Fluoride varnish treatments are unlikely to contribute to fluorosis. To decrease the risk, supervise children’s tooth brushing to avoid excessive ingestion of tooth paste. Your doctor will probably also recommend stopping the use of fluoride tablets if your children are receiving varnish treatments.
What should I do at home to prevent dental caries?
Give tap water (hopefully fluoridated) as the preferred beverage between meal and bedtime. Brush your child's teeth with fluoridated toothpaste (a smear the size of the child's pinky fingernail on the toothbrush) twice daily, preferably after meals. Your pediatrician or dentist may suggest the use of xylitol gum (>50% xylitol content) three or four times per day for three months. Since parents with dental disease present a very high risk of passing the disease to their children, practice good dental hygiene for yourself and avoid sharing utensils, cleaning pacifiers with adult saliva, or other activities that could transmit dental caries. Also, while sippy cups are useful as a transitional device from bottle to cup, they should not be used for prolonged periods. Toddlers who carry sippy cups around and drink from them throughout the day are at higher risk for tooth decay as well as other problems. Offer only water in nighttime bottles or sippy cups. Get fluoride varnish 2-4 times per year.
I'd like to give Dr. Kimball a big thanks for this important information. Do you, as a reader, have any additional questions? Please respond to this blog to post them. I will pass them on to Dr. Kimball.
-Debbie
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