Announcer: Welcome to the First Things First podcast, with information and insight for parents of young children about child development, early learning, and health. First Things First partners with families and communities across Arizona to support the healthy development of young children from birth to age five. Learn more at FirstThingsFirst.org.
Anita: Well, my name is Anita. I’m a mother of two boys. I have five year old Evan and an almost two year old Elliot, and I’m here with pediatric dentist Dr. Jeanette MacLean from Affiliated Children’s Dental Specialists in Glendale here to discuss the importance of oral health in children age’s birth to five. Dr. MacLean is a diplomat at the American Board of Pediatric Dentistry, as well as a member organization the American Dental Association, the Arizona Dental Association, and the Academy of Pediatric Dentistry. Welcome, Dr. MacLean. Thank you for joining me here today.
Jeanette MacLean: Thank you so much for having me. Great to be here. And I should also mention that I am a mother as well.
I have a son and a daughter. My son just turned seven, and my daughter is about to turn five. So I want to say that I’m coming from a place of understanding to the moms out there, because I fight the good fight right along with you.
Anita: It’s good to hear, because I know as a mother of two smaller children, I’m right now going through that fight –
Jeanette MacLean: Yeah.
Anita: – and I have so many questions I would like from an expert, but from a mother as well. So my first question would be probably the biggest question I hear from other mothers is if our children’s teeth are going to fall out, why do we need to brush and maintain them prior to that happening?
Jeanette MacLean: That is an excellent question, and it’s a question I get asked very frequently. And my best response to that is it’s important to realize that the oral health of your children’s baby teeth directly impacts the health of their adult teeth, so they are important.
And it’s important to take care of them. So beginning early is a huge factor. We recommend having their first dental visit by their first birthday. And the reason for that is really prevention. Our goal is to prevent the kids from having cavities, and what a lot of parents don’t realize is that a third of kids in our state, in Arizona, have cavities by the age of three, which is really kind of shocking, and about half by kindergarten. So it is important to start early with brushing and even flossing your baby’s teeth.
Anita: Got it. Before the children start getting teeth, before they actually start developing the teeth, what do you recommend as far as oral care for them?
Jeanette MacLean: You know, it really starts with the moms, even in pregnancy, or even before you get pregnant. You want to have your oral health to be good, right? Because remember that cavities, it’s actually a bacterial disease, and we transfer that bacteria to our children.
So if mom has a mouthful of cavities, obviously, you’re going to kiss your baby, right? You’re going to love on your baby. But we do pass that bacteria to the child. So it’s really important for moms to know that, and remember to take good care of their own teeth, get the decay under control, make sure they’re brushing and flossing. Gingivitis has been linked with preterm labor. You know, your teeth, your gums, are vitally important to your unborn infant.
Now when they’re newborn and they don’t even have teeth yet, I even recommend getting in there, looking at their gums. I have seen babies born with teeth. I mean, it’s very rare. But typically, they get their first teeth on average about six months old. But even before then, you can get in there and wipe out the gums or massage the gums. There’s little finger brushes you can use, just to get them used to you being in their mouth, and then they tend to be a little more receptive once that tooth finally comes in and you do get in there and brush.
Anita: What are the tips you have for brushing and flossing? I know with my oldest son, I had a hard time nailing him down to actually let me put the toothbrush in his mouth. What do you recommend?
Jeanette MacLean: That’s the other great question we have, and trust me, I have the same issue with my children. Ironically, when they were infants and they first got their teeth and I did start brushing their teeth as soon as they started coming in, they were fine with it. They kind of liked it, because they’re teething, and I had a cute little banana rubbery brush that they loved to gnaw on, and they really enjoyed it. But you know how when they start to get a little older and more into that toddler phase, and they start to get a little more independent and opinionated, but yet they can’t really communicate effectively, so then they start to do the tantrums for brushing.
So honestly, both of my kids, right around the age of one is when it turned from being pleasant brushing their teeth to a fight. But I still brush their teeth. So the frustrating thing is a lot of parents, when they get that resistance, they don’t want to push it.
Because they’re maybe worried that the kid will be upset with them. They’re also not pushing it because, you know, I’m a working mom myself. I’m tired after a long day at work. The last thing I want to do is go home and have to fight with my kids about brushing. But I do realize, of all the kids I see who have cavities, I have to do it, even if I’m tired, and they’re fighting me. So we still brush anyway, and it’s important to show them that this is something that’s non-negotiable.
Anita: Now I had a dentist recommend putting my son in my lap and practicing brushing his teeth laying down in my lap.
Jeanette MacLean: I recommend that, too, actually. That can be really effective. So some parents are – have it lucky, and their kids will actually be cooperative for brushing, so that’s amazing. But the kids who do put up a fight, there are other ways that I will suggest to get around it. One thing that sometimes work is, for example, at the bedtime bath, like if you have a little toddler seat or something to sit them in, often, the distraction –
of being in the tub and playing with toys, or like the relaxing feeling of being in the water, sometimes for me, would allow me to get in there and brush their teeth. Another thing, too, like say if it was just me by myself at night, and having to brush their teeth, when I would swaddle them in the little towel after getting them out of the bath, I’d lay them down on the changing table, and that way, their head was supported, and I could get in and brush their teeth without their hands coming up and grabbing at things. So I was better able to clean their teeth effectively, and not have to worry about them squirming around. So sometimes that helps.
And then another way, too, and this is how we examine the kids’ teeth when they come into our office, and let’s say they’re like a squirmy little toddler, we’ll actually lay them on the laps of myself and the parent, whether it’s mom or dad. We call it the knee to knee position. And the child’s would be rested in the lap, and you’re able to see better, and they’re more supported, so you’re less likely to hurt them, too, if their head is supported while you’re brushing.
Anita: Is there anything to look for when you’re in there, as a parent, as far as discoloration, or – I know we can’t see cavities ourselves, but is there anything that we should be aware of at that age range?
Jeanette MacLean: Sure. That’s part of the good thing about wanting to bring your kids in sooner, is I as a dentist know what to look for as far as risk factors for cavities. So some of those things would be crowding of the teeth. So ideally, kids’ baby teeth should have all those cute little gaps between them, because they’re less likely to get cavities, because the food isn’t getting stuck, whereas some kids, their teeth are really tight together, and the food gets packed in between the teeth. Another factor, too, are the shape, the anatomy of their molars. Some kids have these really nice, smooth, flat molars, and nothing gets stuck in them, whereas other kids are sort of dealt the bad card, where they have really deep fissured grooves in their molars, so everything gets packed and stuck in them.
Like they could look at a fruit snack and get a cavity. So the anatomy and the layout of your teeth are big factors. Some kids are actually born with congenital enamel defects, like they could have a discolored spot on their tooth that it’s not acquired from lack of brushing or eating too much candy or whatever, but it literally grew in like that. And sometimes the parents don’t notice that, because it’s hard to see in their mouth. It’s like there’s a light bulb in there, right?
Jeanette MacLean: So laying them back, you have a better view, and then of course coming to the dentist, we have our lights and what not, and we can look for those risk factors and point them out to you so that you know at home where to focus your attention, so that you can do a better job in preventing any problems.
Anita: When should you take your child to their first dentist appointment?
Jeanette MacLean: Well, what I recommend, and the recommendation of the American Academy of Pediatric Dentists, and also the American Academy of Pediatrics, which are the pediatricians, we recommend the first visit no later than the first birthday, or within six months of their first tooth erupting.
Anita: And how would you prepare your child, if you have a nervous child, for that visit?
Jeanette MacLean: Well, with an infant, they really don’t know what to expect, so if you are having that first visit by the first birthday, there’s not a whole lot of preparation, although what I suggest and what I did for my own kids is a great thing is maybe getting a book that – like there’s Dora Goes to the Dentist, or Pep the Pig Goes to the Dentist, or Elmo. So you can look at that picture book, and they can familiarize themselves with the chair, in the mirror, and just, you know, less is more. Sometimes as parents, we’re so nervous, and the kids will – it’s like they smell our fear, and they feed off of that negative energy. So you don’t want to try and over-prepare them, because they think, ooh, well, what’s coming, because really, that first visit, especially an infant exam, it’s quick, and it’s easy, really., And I’ll prepare the parents, because sometimes they’re not knowing what to expect.
This is really about education and prevention, and we’re going to look at their teeth, look for any problem areas, like I mentioned earlier. We’re going to brush their teeth with the toothbrush, so they can see how to effectively clean their child’s teeth, give any tips and pointers on diet, eating habits, what not, if there’s any other habits, like finger sucking or pacifiers. So it’s really informative, and the parents have that opportunity to ask all the questions that they like. And that – you know, we’ll lay them across our lap, so they’ll feel secure. They can hold onto Mommy’s hands.
We also take a picture of the parent and the baby. We try to make it fun. We don’t want kids to be afraid to come to see us. I would be perfectly content to just clean teeth all day. You know? I don’t want your kids to get cavities. I’m happy to see them for prevention. So think of it as an opportunity to raise a child cavity-free.
Anita: Now what is the advantage of going to a pediatric dentist, versus taking it to your regular dentist?
Jeanette MacLean: Well, a pediatric dentist is a specialist, just like you have a pediatrician versus you have family medicine or internal medicine. So it’s someone who has additional training beyond dental school. It’s typically two to three years, in addition to the dental school education in pediatrics. So we learn about behavior management, dealing with a nervous child, children with special needs, and so forth.
But, you know, it is important to realize that there are more children than there are pediatric dentists, so it’s okay to see a general dentist as well. I think what’s important is is that dentist comfortable treating your child. So there are some general dentists who will tell you, gosh, I don’t see kids until five. That doesn’t mean you shouldn’t go till five, but maybe they’re just not comfortable yet. So in that situation, you might be best off at a pediatric dentist who’s very comfortable seeing the one year olds, like myself. So there’s definitely an advantage to that.
But let’s say you have a ten year old who’s well-behaved. They don’t have to see a pediatric dentist, if they can go to your family dentist. That would be wonderful. But let’s say if they have special needs, or anxiety, let’s say they have treatment that needs to get done. Having it done in a pediatric dental office is a wonderful setting, because it can help relax them. We’re special trained to deal with the anxious child, and turn the negative into a positive, and have them have a positive experience at the dentist.
Anita: And you guys have the toys and the movies and the prizes, too.
Jeanette MacLean: This is true. Right.
Anita: That’s a benefit for us, at least, when we go.
Jeanette MacLean: Yep. I’m all about bribery and rewards.
Anita: Yes. Now speaking of rewards, going back to teeth brushing, my son, I get him to brush his teeth by giving him the toothpaste with Lighting McQueen on it. That’s his go to. Is there a toothpaste your recommend or not recommend us using?
Jeanette MacLean: Well, I recommend anything with fluoride. I mean, there’s a particular brand that I like.
But honestly, whatever flavor or brand that your child wants to use, that’s the brand to use. Again, you want it to have fluoride, so they get that added benefit of not only cleaning the plaque off, but delivering the fluoride ion or vitamin, if you will, for their enamel, to help really protect against cavities. So –
Anita: Do they need the electric toothbrushes now? I know my dentist wants me to use one. Do children need that level of technology for their teeth brushing?
Jeanette MacLean: I think that there’s benefits to it. Now if you have a one year old, is it necessary to use say a SoniCare on them? No. You can use a finger brush. I’m a big fan of Oral B Stages makes a wonderful infant brush that’s actually what we distribute to the parents and the babies. There’s lots of different ones. The main thing is to get the appropriate size for the age of your child.
A mistake that is often made is sometimes the brush head is too large, and you have to remember how tiny their little mouths are. And if you get something too bulky, you’ll often miss areas like the gum line or the molars, because the brush is so big that it’s getting hung up on things. So that’s one disclaimer I have against some of the battery operated spin brushes. If you look at them, they’re pretty big. They’re almost double the size of a little infant brush. So just make sure you’re getting the appropriate age range, and look at the size of the brush, because remember, some kids have great big mouths with all that space, and then some kids have teeny-tiny little mouths, and the teeth are all tight together. So you want to get the appropriate size, and that way, when you brush, it’s going to be more effective.
Anita: Any tips for getting floss into their little mouths as well?
Jeanette MacLean: I love floss sticks, so that’s what we use on my son. That way, you don’t have to get your big old fingers in their mouth, because that can be very awkward. So floss sticks are great.
We mentioned earlier about laying them back so their head is reclined in your lap. So I suggest doing this on the bed, or you can sit on the couch. But if their head is rested upon your lap, they’re more supported, so then when you floss – you know how sometimes if you jam the floss in there, you can actually hurt them, and then they’re not going to want you doing it anymore, right? So you want to be gentle, and being able to see, and having their head supported is really helpful, and not accidentally hurting them, so you can see what you’re doing and be more effective when you’re flossing.
Anita: What if you do cause bleeding? Are there any tips to handling that with the child?
Jeanette MacLean: From flossing, you mean, or brushing –
Jeanette MacLean: You know, you bring up a good point, because sometimes parents will say, well, gosh, when I brush, their gums bleed, so I don’t want to do it. And that’s a natural instinct. It’s like they’re worried that maybe they’re hurting something. But think of it this way. Healthy gums and teeth don’t bleed. Okay? So if you’re seeing blood, there’s a problem.
So often, honestly, it’s that they’re not getting brushed correctly or as frequently as you should be doing. So plaque and bacteria is being left behind, and what that creates is inflammation of your gums. I think we all know the term gingivitis, which is inflammation of the gums, and you might be surprised to know that little kids get that, too, because it’s the same gum tissue, same bacteria. And if it’s left behind and not brushed away, it can create inflammation, and then in turn bleeding. So maybe if you haven’t brushed at all yet, and now – good for you, now you’re starting. Maybe you’ll see a little bleeding initially, but don’t let that concern you in the fact that you want to clean the teeth. And if you clean effectively, within a week or two of that, you’re not going to see bleeding anymore.
And same thing with flossing. Maybe the first couple of times you floss, maybe you might see a little spot of blood, but it’s just showing you that there’s irritants and bacteria in there that you’re cleaning out, and once you do it regularly, the gums get firmer and healthier, and they’re not going to bleed.
Anita: What about fluoride to reduce that as well?
Jeanette MacLean: Mm-hmm.
Anita: I’ve heard of that, rinsing –
Jeanette MacLean: Fluoride treatments?
Anita: Fluoride treatments.
Jeanette MacLean: Right. I’m a big believer in fluoride. I actually took fluoride supplements as a child growing up in Massachusetts. We’re fortunate in our – at least in this – the City of Phoenix, and in Maricopa County, to have fluoride in the drinking water. The problem is, a lot of kids aren’t drinking the city water. A lot of us now drink bottled water, and most of the bottled waters have no fluoride, so often, they’re not getting enough. So it is beneficial, whether it be at WIC or your pediatrician or at the dentist’s office, we’re offering fluoride treatment, which is a topical treatment for your enamel.
So you basically can think of it like a vitamin for their teeth, where when you get these treatments, whether it be a foam or a gel or for kids six and under we recommend what’s called varnish, which maybe you didn’t have as a kiddo, because it’s more of a newer version of doing the fluoride.
But it’s a way to treat the enamel so it becomes more resistant to the damaging effects of sugars and acids and what – bacteria that cause cavities. So I definitely recommend it.
Anita: How often do you recommend getting it?
Jeanette MacLean: Well, I recommend using fluoride in your toothpaste daily, so for kids under the age of three, or as soon as they get teeth, I recommend using a tiny little smear of fluoride toothpaste. I’m talking like a grain of rice size, because as you know, as I know, what do they do as soon as they get that toothpaste?
Jeanette MacLean: They eat it, right?
Anita: They suck on it and – yes.
Jeanette MacLean: Exactly. So what I recommend is you get that teeny-tiny little speck, push it down into the bristles of their toothbrush, so it’s likely to not immediately be eaten, and think of it like dosing out a vitamin, where you have a therapeutic amount, and you don’t want to go overboard and do – like when you see those toothpaste commercials, they make that big, fat ribbon of toothpaste.
Jeanette MacLean: That is way more than anybody needs. It’s too much. You can have too much of a good thing, right? So dose it appropriately. So three and under, the little grain of rice or smear. Three and up, you do a pea-sized amount, so again, just a little tiny drop. And then around the age of six, plus or minus – it depends on the child – that’s typically the age where they learn to spit out toothpaste, or even mouthwash.
So for example, with my own son, now that he – well, he just turned seven, but at six, I started him using a fluoride mouthwash at night. He got his permanent teeth really young. He was four and a half, believe it –
Anita: Oh, wow.
Jeanette MacLean: Yeah, we see kids who are really young getting permanent teeth, and then you see some kids that are really late. You know, there’s some kiddos that are in second grade and they’re just barely losing their first baby teeth. But I do recommend if they have – especially if they have permanent teeth at six, or when they can spit out a fluoride mouthwash, that’s also another great way to help protect your enamel and help reduce the number of cavities that your kids get.
Anita: How often should we take our children to the dentist after that first visit?
Jeanette MacLean: Well, a good rule of thumb is just like you and I, is every six months. It can vary, because some kids might be more high risk and benefit from going more frequently. So let’s say, for example, some of our kiddos in braces. Some of them, if they’re struggling with their hygiene, we’ll actually clean their teeth four times a year. But in general, you’re looking at twice a year or every six months. And that’s also a good timeline for the fluoride treatments.
Anita: Good advice. And my son has not – my oldest has not yet lost any teeth, and –
Jeanette MacLean: How old is he again? Five?
Anita: He is five. Yes.
Jeanette MacLean: So that’s not – the normal – like the main common age is six.
Jeanette MacLean: But that is just an average. And then the range that we see, like I mentioned, my son was four and a half, and then we’ll see up to eight. So there’s that big span. And it’s always so sad, because often, they’re in kindergarten or first grade, and they literally have these sticker charts, and they make such a big deal about, oh, the tooth fairy came.
And so and so lost this many teeth, and they lost this many teeth. So sometimes the kids come in, and they’re like, I’m so sad, I haven’t lost a tooth yet. When am I going to lose a tooth? And I try to tell them, like, hey, if everyone lost their tooth on the same day, it wouldn’t be as special, and don’t worry, and I reassure them. Like if we have x-rays, I’ll show them, like here’s your teeth right here. We try to guesstimate like how long it’s going to be. But that’s just a variation of normal. We have our fast teethers and our slow teethers, and –
Anita: And I think my last question, and my most important one, do you know the rate for the tooth fairy? This is a big topic amongst parents, and we all want to know.
Jeanette MacLean: Oh, that’s hilarious. Well, let me tell you, the rate varies.
Anita: I wish as parents we could come to consensus, because this is a very hard topic.
Jeanette MacLean: Yes.
Anita: Well, thank you, Dr. MacLean, for joining me here today. You’ve really answered a lot of my questions, and it’s great to sit face to face with an actual pediatric dentist, and be able to ask those questions that I’m sure other parents have for their doctors.
Jeanette MacLean: You’re so welcome. It was a lot of fun.
Anita: Thank you.
Jeanette MacLean: You’re welcome.
Announcer: Thanks for listening to the First Things First podcast. For more information, tips, and resources to help you support the healthy development of your baby, toddler, or preschooler, visit us online at FirstThingsFirst.org.
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