Infant Education

• First visit

  • A child’s first dental visit should be by age 1.

  • This initial assessment will evaluate review medical and dental history, understand cavity risks, provide education on infant oral health, complete an oral exam, complete an age-appropriate tooth and gum cleaning demonstration, and apply fluoride varnish if indicated.

• Toothbrushing

  • Should begin when 1st teeth erupt

  • oBrushing twice a day with biggest emphasis on quality brushing BEFORE bed and going to sleep with clean teeth. No nursing, food or drink after nighttime brush.

  • Brush with a soft-bristled infant toothbrush

• Toothpaste

  • The American Academy of Pediatric Dentistry recommends fluoride toothpaste for ALL AGES, regardless of if your child can spit or not. 

  • Rice sized amount for children LESS than 3 years old

  • Any brand containing fluoride with the American Dental Association (ADA) seal of approval is recommended such as Crest, Colgate, Toms with Fluoride

• Flossing

  • Brushing alone does not properly cleanse between the teeth, and floss should be used as soon as two teeth touch. Without flossing, your child is susceptible to “flossing cavities” between the teeth. Flossing also helps keep the gums, teeth, and bone healthy.

  • Flossing with floss picks is acceptable and can be the only possible way with younger children.

• Fluoride

  • The American Academy of Pediatric Dentistry (AAPD) recognizes drinking fluoridated water and brushing with fluoridated toothpaste twice daily are the most effective method in reducing dental caries prevalence in children.

  • For children under 6 years old, 5% NaF varnish in unit doses in the recommended professionally applied topical fluoride, which is what is applied here at Shiny Happy Smiles

• Early childhood caries

  • Risk factors

    • Baby bottle use after 12 months

    • Nighttime bottle feedings with juice

    • Repeated use of sippy or no spill cup of sugar added drinks

    • Frequent in between meal consumption of snacks and drinks

    • Frequent consumption of juice (juice should not be given in bottles or covered cups that fosters easy consumption)

      • 0 oz for <1

      • No more than 4-6 oz for children 1-6 years old

    • Newly erupted teeth, immature enamel may be at higher risk for caries

    • Enamel hypoplasia

• Bottle & Sippy Cups

  • No bottles in crib

    • Bottle feedings should be discontinued at 12 months and open cups or straw cups are recommended. Children ages 6+ months are ready to experiment with open cups with assistance.

    • Suggested cups: open cups or straw cup with low/no spill options such as Munchkin Weighted Straw Cup.

    • Sippy cups are NOT recommended as they create an unnatural pattern of swallowing.

• Pacifiers

  • Nonnutritive habits such as pacifier or digit sucking is normal! The habits just need to be stopped in an age-appropriate manner before changes in bite and facial development occur.

  • Ideally begin decreasing pacifier use by 9 months to sleep time only, and gone by age 1. However, the ultimate time for habit cessation is by 3 years old.

  • Cylindrical shaped pacifiers such as the Ninni or Philips AVENT soothie, recommended. The MAM is recommended against.

• Breastfeeding

  • The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO).

  • Children exposed to breastfeeding up to 12 months of age are at reduced risk of caries, but children that are breastfed more than 12 months are at increased risk for caries.

    • Confusing right?! Breastfeeding is amazing- and good job to momma and baby if you’ve been able to breastfeed! After age 1 with the introduction of carbohydrates, the two can act synergistically to create cavities. With breastfeeding after age 1, it is just even more important to ensure great oral hygiene with fluoridated toothpaste.

  • Children breastfed nocturnally or more frequently have increased caries risk.

• Formula

  • Most powdered infant formulas contain fluoride. The Centers for Disease Control and Prevention (CDC) recommends that if an infant is exclusively consuming infant formula reconstituted with fluoridated water, parents should use de-fluoridated bottle part of the time. De-fluoridated water includes nursery water, distilled water, deionized water, distilled water, or water purified with reverse osmosis. This will help reduce the risk of too much fluoride, which can lead to fluorosis, which causes the enamel to have permanent spots or streaks.

• Beverages

  • Juice

    • <1 year of age= no juice, do NOT introduce prior to age 1

    • 1-3 years= no more than 1/2 cup per day

      • Do not give at night and do not give in containers that foster easy consumption such as a bottle or sip cut

    • 4-5 years= no more than 1/2 to 2/3 cups per day

    • Fruit juices are an alternative to falling short of the recommended fruit intake goals, but whole fruit is always recommended.

    • 100% fruit juices should be a part of a meal or snack and not sipped throughout the day.

  • Milk

    • 1-2 years old

      • 2-3 cups of whole milk per day

    • 2-5 years old

      • No more than 2 cups of skim or 1% milk

  • Water

    • 6-12 months

      • 1/2 -1 cup per day

    • 2-3 years

      • 1-4 cups per day

    • 4-5 years

      • 1.5-5 cups per day

• Medications

  • Many medications have a high sucrose content to make palatable, so ensure medications are taken prior to toothbrushing.

  • Gummy vitamins can cause cavities because of sucrose content and sticky texture. They can also cause Vitamin A toxicity because gummy format is easy to over-consume.

  • The best way to get vitamins is through a healthy and well-balanced diet, the American Academy of Pediatrics does not recommend vitamins

• Teething

  • Teething can lead to intermittent localized discomfort in the area of erupting primary teeth, irritability, and excessive salivation; however, many children have no apparent difficulties.

  • Treatment of symptoms includes oral analgesics and chilled rings for the child to “gum”.

  • Avoidance of topical anesthetics and over the counter teething gels recommended.

• Frenum attachments (tethered oral tissues)

  • A frenectomy may be recommended to facilitate breast feeding and/or speech.

• Injury prevention

  • Caution with play objects, electrical cords (oral burns), and furniture

  • Always use age-appropriate car seats and play objects