Infant Oral Dental Care

A Complete Parent's Guide For Raising Children Free of Tooth Decay

Primary Teeth / Baby Teeth Importance

Parents always ask question that is : "Why should baby teeth be filled, since they will fall out in a short time anyway?"

Primary teeth also called "Baby Teeth." The first tooth usually lost until 6 years of age and some primary molars must function until 12 or 13 years of age before they are replaced! Primary teeth are necessary for proper chewing, proper speech, the proper development of the jaws and for esthetics. Care of the primary teeth is important not only for proper function, but also to avoid a number of unpleasant conditions that result from their neglect.


Neglect of primary teeth can result in severe pain and serious infection of the gums and jaws which can in turn seriously affect a child's general health.

Permanent Teeth:

Tooth decay is an infection which, if left unattended in primary teeth, can spread to adjacent permanent teeth which begin to erupt by 6 years of age. In addition, an infection of a primary tooth can cause significant damage to the developing permanent tooth which lies in the jaw directly beneath the primary tooth.


Children have a need and deserve to appear normal wherever possible, especially in the eyes of other children. Children who appear abnormal because of "missing" or "ugly" front teeth, often become the object of teasing and and ridicule by their peers.

Tooth Alignment:

Primary teeth serve to guide the erupting permanent teeth into their proper position. Each primary tooth reserves a space for the permanent tooth that will replace it. If a primary tooth is lost prematurely due to severe destruction or infection as a result of tooth decay, the space it reserves for the permanent tooth may be lost due to subsequent shifting of the adjacent teeth. This results in an inadequate amount of space for the permanent tooth - a major factor causing the need for orthodontic treatment.

Babies can get cavities before age two!

One of the major goals we have as parents is to do our best to assure that our children grow and develop properly and enjoy the best state of health possible. The health professions have virtually eliminated many once-dreaded diseases through effective immunization programs. Yet the prevention of such diseases as the common cold, the flu and the like still remains undiscovered. However, with our current knowledge and technology, the most common disease of childhood is entirely preventable. Yes, it is entirely possible to prevent the disease that affects most children in the world - DENTAL CARIES (tooth decay).

Although total prevention of dental caries is possible, it is not necessarily a simple one-step procedure nor can it be postponed for too long a time. Toddlers and even infants only 10-12 months old can suffer from tooth decay. Unfortunately, parents usually receive information on caries prevention during their child's first visit to the dentist, which traditionally occurs at 3 years of age. In order to prevent dental caries in young children, preventative measures must be undertaken during infancy, prior to 1 year of age. Preventative efforts must be continuous, consistent and should include the areas of infant tooth cleaning, infant feeding practices, diet management and fluoride therapy. When each of these areas are approached early and conscientiously, the prevention of dental caries is possible.

Parents should receive preventative information, advice and instructions early so that the decisions regarding oral cleanliness, diet and snacking habits which are generally made by parents during their child's first year of life can be made in the best interests of dental health.

When all aspects of prevention are begun during infancy, the pain and discomfort, inconvenience and expense of treatment associated with dental caries can be avoided. Having you child examined not later than 1 year of age by a dentist experienced in the examination and prevention of caries in infants and young children is the only way to effectively learn the best approach to preventing dental caries in your child.

Dental Development

Tooth Formation:

During the 4th month of pregnancy your baby's primary (baby) teeth begin to form. Their formation isn't complete until approximately 1 year of age. The development of your baby's permanent (adult) teeth began at birth and will continue to 12-13 years of age. Proper diet and nutrition are important from birth to 13 years of age for the development of strong, healthy teeth. Proper fluoride intake during the tooth forming years assures the greatest chance that your child's teeth will be as strong and healthy as possible.

Tooth Eruption:

Teeth usually erupt according to a common pattern and average dates. Considerable variability may exist however and should not be a cause for concern. The eruption of the first tooth occurs normally around 6 months of age. The eruption of the first few teeth is sometimes associated with symptoms and is referred to as "teething." Symptoms are sore gums, restlessness, irritability and disruption of eating and sleeping habits may be present, which may cause some disturbance in the digestive system resulting in loose stools. The claim that "teething" causes serious illness, persistent diarrhea, ear infections and the like is purely a myth. A sick child should be evaluated by a physician and not passed off as "just teething." Treatment for the symptoms consists of having the infant chew on something cold for its soothing effect such as refrigerated teething ring, etc. Your dentist should be able to provide you with further information is necessary.

Dental Caries (Tooth Decay)

Tooth Decay:

Dental caries (tooth decay) is a destructive process where the teeth are slowly dissolved by acids produced in the mouth by bacteria.


Dental plaque is a sticky film that coats the teeth and is loaded with millions of bacteria which can use sugar from our diets to produce acids that can dissolve teeth.

Sugar and Dental Health:

Sugar is transformed into acids by the dental plaque which then begins the decay process. Different forms of sugar are equally harmful in producing acids whether they are present naturally or added to foods. Honey, molasses, sucrose, dextrose (corn syrup), fructose and lactose are all forms of harmful sugars.

The Acid Attack

Each time sugar appears in the mouth, an acid attach occurs for at least 20 minutes. The amount (quantity) of sugar eaten is not a critical factor. Of more importance are how often sugar is eaten and how long the sugar remains in the mouth, since the acid attack will continue for at least 20 minutes after the sugar is removed from the mouth.

Diet and Dental Health

A well balanced diet that promotes good general health will also promote good oral health and is necessary for the development of strong, healthy teeth during the formative years (Birth to 12-13 years of age). Well balanced nutritious meals will reduce the chances of tooth decay.

1. Snacks eaten between meals should be nutritious foods, with little or no sugar.

2. It is important to reduce the frequency of sugar-food intake and avoid sugar-foods that remain in the mouth for long periods of time. (Lifesavers, sticky foods, etc.)

3. Sugar snacks, desserts, etc. should be eaten at mealtime when an acid attack is already occurring, thus reducing the frequency of between meal acid attacks.

4. Be aware of "Hidden Sugars" and be cautious of some "Health" foods. Many have a high sugar content in the form of "Natural" sugars such as honey, molasses, etc.

5. It is a wise dietary practice to read labels.

Dietary Habits

Dietary habits, likes and dislikes, are formed in infancy. The "sweetening" of baby food is unnecessary and will only serve to promote the development of a preference for sweet foods (sweet tooth). Sugar snacks and the like when introduced in infancy help to form a poor dietary habits which may promote dental disease as the child grows older.

Preventing Dental Disease (Tooth Protection)


One of the most effective ways for protecting a tooth from dental caries is the presence of fluoride during development which aids in forming the most acid resistant enamel possible. The best way to receive proper fluoride is through fluoridated water. If fluoride is unavailable in your drinking water (private well, etc.) the fluoride supplements can be prescribed by your dentist after the amount of natural fluoride in the drinking water has been determined.

Other forms of fluoride can be recommended for protection of teeth which are already present in your mouth. Your dentist can best advise you of the need and type of fluoride therapy recommended.


The biting surfaces of the back of the teeth form with many deep pits, grooves and fissures. Often it is impossible to remove the plaque from these crevices by tooth brushing and decay is ultimately the result. It is possible to place a protective plastic coating in these crevices and over the biting surface to prevent bacteria from growing in these areas thus preventing decay which otherwise can't be prevented. Your dentist can advise you which teeth are prone to decay and would benefit from the plastic "Sealant".

Oral Hygiene

One way to prevent dental disease is daily plaque removal. Not just "toothbrushing" or "flossing" but Tooth Cleaning which is total plaque removal. Plaque accumulates on the teeth immediately after they erupt. Therefore, the cleaning of an infant's teeth should begin as soon as the first tooth erupts. This should be accomplished in a comfortable place such as the couch, living room floor, etc. and NOT in the bathroom. The infants head should be placed in the parent's lap. The tooth or teeth may initially be wiped clean with a clean wash cloth or piece of gauze wrapped around a finger. A small soft bristled, moistened toothbrush may be used. Toothpaste, however, should be avoided because the foaming action and taste may be disagreeable to the infant. The teeth should be cleaned at least once daily, especially prior to bedtime. Frequently just before bedtime can be a difficult time due to a parent's fatigue and and infant's irritability. Therefore, a thorough cleaning following an infant's last meal of the day is recommended since it may be more suitable and pleasant for both the parents and the infant.

As more teeth erupt, the teeth may begin to contact one another. When this occurs, plaque can only be removed from between the teeth by flossing. Flossing aids are available and your dentist can recommend a proper flossing technique.

For further information regarding tooth cleaning technique, positioning and recommendations for infants and young children, please feel free to contact Dr. Merritt's office for more information.

Nursing Caries

Nursing caries is a type of severe dental destruction seen in infants and young children which primarily effects the upper front teeth in the beginning, but which an effect the rest of the teeth in later stages.

The cause is improper feeding habits during infancy and early childhood. The most common feeding practices responsible are:

1. Putting the child to bed with a nighttime or naptime bottle.

2. Allowing the child to have a bottle as a pacifier. Although sweetened beverages (Kool Aid, Soda Pop, Sugar Water, Etc.) have been labeled as "culprits", milk and formula can be just as damaging since they ALL contain sugar which the bacterial plaque can transform into acids.

The above practices are as potentially damaging as constantly snacking on sugar foods!

The same type of destruction can be seen in breast fed children once the teeth have erupted and results from frequent and prolonged feedings as well as sleeping with the child who "feeds" all night. Breast milk has more sugar (lactose) than either formula or cow's milk!


To avoid nursing caries, the following recommendations are offered:

Bottle Feeding

Avoid bedtime and naptime bottles. (If already doing so, use only water).

Avoid using a bottle as a pacifier.

Bottles should be used for feeding only.

Use only formula in the bottle, all other liquids should come from a cup.

Discontinue the bottle by 12 months of age.

Breast Feeding

Avoid frequent feedings once the teeth have erupted.

Avoid prolonged feedings.

Avoid all-night feedings (sleeping with child).

Oral Habits

Thumb Sucking

Sucking is a natural and normal desire and need for the infant. Satisfaction is considerable during the first year of life during sucking and shouldn't be discouraged. Controversy exists concerning whether a thumb or pacifier is best, but the decision is up to the parents, or in many cases, the infant. Should a pacifier be selected it should meet the following requirements:

Solid, one-piece construction or with inseparable parts.

Large plastic shield to prevent aspiration.

Shield should have 2 ventilating holes.

Non-toxic material


A thumbsucking habit should not be of concern prior to 4-5 years of age. Often peer pressure from other children will result in termination of the habit. The child should never be punished, scored, ridiculed or belittled by the parents in attempt to stop the habit. A positive approach is always best. The habit becomes a concern when the permanent teeth erupt or a severe deformity develops. Dr. Merritt can offer suggestions to help terminate a damaging thumbsucking habit.

Dental Injuries

Falls, bumps and bruises are a normal part of he growing-up process of infants and young children. Quite often, between 12-18 months of age as the infant learns to walk, unsteadiness leads to injuries of the mouth and teeth when the infant falls against furniture, stairs, sidewalks and the like. The resulting dental injury may be a minor laceration, a laceration combined with a fractured tooth, or a tooth which is pushed up into the gum. Any injury causing bleeding that doesn't stop readily or that results in tooth fractures or teeth being intruded should be evaluated by our office.

We can provide the following information related to the injury:

The extent of damaged caused by the injury (there may be more than meets the eye).

The possible outcomes that can be expected as a result of the injury.

A description of signs and symptoms that signal unfavorable reactions resulting from injury that parents should look for.

What treatment should be accomplished if any.

Frequently all that is required is close observation. However, this can only be determined by examining the injury itself. Occasionally some immediate treatment may be required. Whenever there is an injury to the mouth of an infant or young child that is severe enough to cause parental concern, it is wise to have it evaluated promptly.