Expecting Mothers

Oral Hygiene

• Many dental procedures are safe and effective during pregnancy (consult your dentist or primary care physician).
  Brush at least twice per day and floss nightly.
  
• Increased risk of gingivitis due to hormonal changes, therefore, rinse daily with an antibacterial, alcohol-free mouth rinse.
  
• If possible, address all active disease prior to the pregnancy.
  
• Needed treatment can be provided throughout pregnancy; however, the time period between the 14th and 20th week is ideal.
  
• Elective treatment can be deferred until after delivery.
  
• Regular 3-4 month visits with the dentist helps monitor the overall oral health.
  
• Toxins from periodontal disease have been shown to cross the placental barrier and reach your fetus, potentially causing both premature birth and birth defects. In fact, women with periodontal disease are seven times more likely to have a premature delivery than those with healthy gums.
  
• Fluoride can cross the placental barrier, but there is insufficient evidence to show any link with congenital disorders.

 

Expecting Mothers

Nutrition: Sugar alternatives

• Choose natural sweeteners in their raw forms, keeping in mind that they are still high on the glycemic index and can also contribute to tooth decay.
  
• Blackstrap molasses is exceptionally healthy and will add delicious maltiness to coffee and baked goods.
  
• Raw, organic honey with propolis is also considered an amazing health food and is an excellent sugar replacement.
  
• Stevia is another natural sugar alternative but has not been tested on pregnant women, so you may wish to err on the side of caution.
  
• Even sugar itself is loaded with nutrients if it is raw, organic and untouched.
  
• Xylitol is another natural sweetener that has been shown to interfere with cavity producing bacteria, with less of an effect on the glycemic index.

Infancy (0-11months)

Oral Hygiene

• Become familiar with the normal appearance of your infant’s gums and teeth so that problems can be identified if they occur.
  
• Once a month, check your infant’s gums and teeth, by lifting their lips to look for decay on the outside and inside surfaces of the teeth.
  
• If your infant has sore gums caused by tooth eruption, you can provide them with a clean, chilled teething ring, cool spoon, cold wet washcloth, or simply rub their gums with a clean finger.
  
• Obtain special oral health equipment, (e.g., a mouth prop), to brush your infant’s teeth.
  
• Clean your infant’s gums with a damp cloth or toothbrush and plain water after each feeding.
  
• Use a soft-bristled toothbrush with a small head, preferably one designed specifically for infants, with either water or a non-fluoridated toothpaste.
  
• Brush your infant’s teeth as soon as the first tooth erupts, usually around age 6 to 9 months, twice a day (after breakfast and before bed). Lift the lip to brush at the gum line and behind the teeth. Avoid giving your infant anything to eat or drink (except water) after brushing at night.
  
• For infants at increased risk for tooth decay, consult with a pediatric dentist or pediatrician about brushing their teeth with fluoridated toothpaste or alternative anti-cavity pastes.
  
• Make an appointment for your infant’s first oral examination within 6 months of the eruption of the first primary tooth, and no later than age 12 months, thereby establishing a dental home.
  
• For infants with special health care needs, your may need to have more frequent dental visits based on their risk or susceptibility to disease.
  
• The parent, especially the mother, should maintain good oral hygiene, using daily antibacterial rinses and regular dental visits.
• This minimizes the transfer of caries-causing bacteria from parent to infant and therefore reduces their risk of future caries.

Infancy (0-11months)

Nutrition

• Avoid testing the temperature of the bottle with your mouth, sharing utensils (e.g., spoons), or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
  
• Do not put your infant to sleep with a bottle or sippy cup
  
• Do not allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth leading to increased risk for tooth decay.
  
• Avoid at will breastfeeding, especially during the night time (once teeth erupt).
  
• Hold the infant while feeding. Avoid propping a bottle (that is, using pillows or any other object to hold a bottle in the infant’s mouth).
  
• Avoid adding cereal to the bottle. This causes sugary fluids to pool around the teeth. Promote the use of a spoon or fork, or, once the infant is able, encouraging self-feeding.
  
• Introduce a small cup when the infant can sit up without support.
  
• Gradually wean your infant from the bottle as they begin to eat more solid foods and drink from a cup. By age 12 to 14 months, most infants can drink from a cup.
  
• Postpone the introduction of high sugar containing drinks or foods during infancy. This reduces future cravings and reduces the risk for future tooth decay.
  
• For infants ages 6 months and older, serve age-appropriate healthy foods during planned meals and snack times.
• Avoid grazing throughout the day, especially during the evenings.
  
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. Frequent consumption of complex carbohydrate snacks, such as chips and pretzels, also increase caries risk.
  
• Avoid frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and toffee. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugars, and all types of sugars can promote tooth decay.

Early Childhood (1-4 Years)

Oral Hygiene

• If your child has not yet been to a dentist, make an appointment for their first dental visit, thereby establishing a dental home.
  
• For children with special health care needs, you may need to make more frequent dental visits. You may need to obtain special oral health equipment (e.g., a mouth prop) to brush the child’s teeth.
  
• For children under age 2, brush the teeth with plain water twice a day (after breakfast and before bed). For children at increased risk for tooth decay, consult with your pediatric dentist about brushing the teeth with a pea-sized amount (small smear) of fluoridated toothpaste or a xylitol-based toothpaste.
  
• For children ages 2 and above, brushing the teeth with no more than a pea-sized amount (small smear) of fluoridated toothpaste twice a day (after breakfast and before bed). Consult with your pediatric dentist about alternatives to fluoridated toothpastes.
  
• For effective plaque removal, make sure to help brush your child’s teeth. Because brushing requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
  
• Become familiar with the normal appearance of your child’s gums and teeth so that problems can be identified if they occur.
• Check your child’s gums and teeth about once a month.
  
• Professionally applied topical fluoride (varnishes, gels, foams) or calcium-phosphate pastes may be especially effective for children at higher risk for tooth decay.
  
• If your child experiences sore gums caused by tooth eruption, provide them with a clean chilled teething ring, cool spoon, cold wet washcloth, or simply rub their gums with a clean finger.

Early Childhood (1-4 Years)

Nutrition

• Avoid sharing utensils (e.g., spoons) or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of cavity-forming bacteria from the parent, especially the mother.
  
• Continue to encourage drinking from a cup. Weaning the child from the bottle by age 12 to 14 months.
  
• Do not put the child to sleep with a bottle or sippy cup.
  
• Do not allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase your child’s risk for tooth decay.
  
• Serve age-appropriate healthy foods during planned meals and snacks, while limiting grazing between meals.
  
• Appropriate snacks include fruits, vegetables, various nuts, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt).
  
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. Frequent consumption of complex carbohydrate snacks, such as chips and pretzels, also increase caries risk.
  
• Avoid frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and toffee. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugars, and all types of sugars can promote tooth decay.
  
• Encourage consumption of fruits as opposed to fruit juices.
  
• Serve the child juice in a cup, and limit your child’s consumption of juice to 4 to 6 oz per day.
  If the child drinks beverages between meals, encourage water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).

Elementary School Age (5-10 years)

Oral Hygiene

• Schedule a dental visit for your child according to the schedule recommended by your child’s pediatric dentist, based on the child’s individual needs or susceptibility to disease.
  
• For children with special health care needs, make more frequent dental visits based on the child’s individual needs or susceptibility to disease.
  
• Provide more assistance with brushing your child’s teeth, if needed, and obtaining special oral health equipment (e.g., a mouth prop) to complete the task.
  
• Ensure that your child brushes his or her teeth twice a day (after breakfast and before bed) with no more than a pea-sized amount (small smear) toothpaste (fluoridated or xylitol-based), and flosses nightly.
  
• Because effective plaque removal requires good fine motor control, young children cannot clean their teeth without parental support. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
  
• Become familiar with the normal appearance of your child’s gums and teeth so that you can identify problems if they occur.
• Check your child’s gums and teeth about once a month.
  
• Professionally applied topical fluoride (varnishes, gels, foams) or calcium-phosphate pastes may be especially effective for children at higher risk for tooth decay.
  
• Discuss with your pediatric dentist the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
  
• Expect your child’s first orthodontic evaluation between the ages of 7 and 8. Although many children do not require early orthodontic treatment, certain orthodontic problems are more easily addressed at an earlier age and more severe issues may be avoided.

Elementary School Age (5-10 years)

Nutrition

• Serve healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks.
  
• Limit eating (grazing) in between meals.
  
• Serve foods containing sugar at mealtimes only (not between meals), and limiting the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), increases the risk for tooth decay.
  
• Frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay.
  
• Look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
  
• Encourage your child to eat fruit rather than drink fruit juice.
  
• If your child drinks beverages between meals, encourage the child to drink water rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
  
• If the school has vending machines, encourage your child to choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).

Adolescence (11-21)

Oral Hygiene

• Schedule a dental visit according to the schedule recommended by your pediatric dentist, based on your child’s individual needs and susceptibility to disease.
  
• If your child has special health care needs, make appointments for more frequent dental visits based on their individual needs and susceptibility to disease
  
• Brush your teeth twice a day (after breakfast and before bed) with fluoridated or xylitol-based toothpastes, rinse, and flossing daily.
  
• Become familiar with the normal appearance of your gums and teeth so that you can identify problems if they occur.
  
• Discuss with your pediatric dentist whether you need to apply fluoride topically (via varnishes, gels, foams), which reminerlizes the outer layer of the tooth (enamel).
  
• Cavity-fighting topical gels or varnishes (i.e., fluoride, calcium phosphate) may be especially effective for adolescents at high risk for tooth decay because they have a history of decay, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
  
• Discuss with your pediatric dentist whether you need to dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
  
• Discuss with pediatric dentist any orthodontic concerns you may have.

Adolescence (11-21)

Nutrition

• Consume healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks.
  
• Limit eating (grazing) in between meals.
  
• Serve foods containing sugar at mealtimes only (not between meals), and limiting the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), increases the risk for tooth decay.
  
• Frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay.
  
• Look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay
  
• Choose fruit rather than fruit juice. Drinking water between meals rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
  
• If the school has vending machines, choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).

Fluoride

Basic Facts

• Fluorine, from which fluoride is derived, is the 13th most abundant element and is released into the environment naturally in both water and air.
  
• The promotion of fluoride to prevent tooth decay began in Europe in the 1800s
  
• Fluoride is the only chemical added to drinking water for the purpose of medication (to prevent tooth decay). All other treatment chemicals are added to treat the water (to improve the water's quality and safety - which fluoride does not do). This is one of the reasons why most of Europe has rejected fluoridation.
  
• Contrary to previous belief, fluoride has minimal benefit when swallowed. When water fluoridation began in the 1940s and '50s, dentists believed that fluoride needed to be swallowed in order to be most effective.
  
• Fluoridated water is no longer recommended for babies. In November of 2006, the American Dental Association (ADA) advised that parents should avoid giving babies fluoridated water.
  
• More recent studies of shown that topically applied fluorides are more effective at reducing caries risk and safer.
  

Irvine City Fluoridation

• In 1995, the California legislature passed AB 733, which requires fluoridation of all water systems serving 10,000 customers or more, when funding is made available.
  
• In November 2007, the Metropolitan Water District of Southern California (MWD) began adding fluoride to the drinking water it provides IRWD and other Southern California water agencies after being requested to do so by the health agencies in all counties it serves. Irvine Ranch Water District receives approximately 35% of its total water supply from MWD.
  
• MWD adjusts the natural fluoride level, which ranges from 0.1 to 0.4 parts per million, to 0.7 to 0.8 parts per million. Fluoride levels in drinking water are limited under California state regulation to a maximum of 2.0 parts per million.
  
• Naturally occurring fluoride levels in the groundwater from IRWD's Dyer Road Wellfield average 0.42 parts per million. Customers who receive a mixture of water from MWD and this groundwater receive water with an annual average fluoride concentration of approximately 0.6 parts per million. Therefore, Irvine Ranch Water District currently has no plans to add fluoride to its well water.
  

Water Fluoridation Information

• In the second half of the 20th century, a steep decline in tooth decay occurred among children in the United States. Proponents of water fluoridation have long claimed that this reduction in tooth decay is primarily the result of adding fluoride to water.
  
• When the Centers for Disease Control (CDC) nominated water fluoridation as one of the top 10 public health achievements of the 20th century, it published a graph (see Figure 1), which showed the reduction of cavities in US children coupled with the increase in water systems that have been fluoridated since the 1960's. The CDC referred to the graph with the statement:"as a result [of water fluoridation], dental caries declined precipitously during the second half of the 20th century."
  
• However, what the CDC failed to mention is that similar declines in tooth decay have occurred in virtually every western country, most of which do not fluoridate water (see Figure 2).

World Health Organization Data (2004) -
Figure 2. Tooth Decay Trends (12 year olds) in Fluoridated vs. Unfluoridated Countries: )

Sealants

The application of a sealant (light-cured resin) is applied to the surface of a tooth, most commonly the permanent molars, in order to seal the grooves and pits on the biting surfaces of the teeth. This resin layer acts as a physical barrier and reduces the risk of cavity formation in the sealed surfaces by 85%. Since the material sets immediately after the application of a special curing light, the patient is able to drink and eat right after the procedure. Sealants can last for years, and their retention depends on the occlusion, diet, saliva and strength of the resin used. It is important to note that the sealant only protects the biting surfaces, not the sides of the teeth. These areas are still susceptible to cavity formation, and therefore, one must still practice good oral hygiene techniques.

Xylitol

• What is Xylitol? Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, including various berries, corn husks, oats, and mushrooms. It can be extracted from corn fiber, birch, raspberries, plums, and corn. Xylitol is roughly as sweet as sucrose with only two-thirds the food energy.
  
• One teaspoon (5 gm) of xylitol contains 9.6 calories, as compared to one teaspoon of sugar, which has 15 calories. Xylitol has virtually no aftertaste and has a lower impact on a person’s blood sugar, compared to that of regular sugar. It also has a very low glycemic index of 13 (glucose has a GI of 100 for reference).
  
• Xylitol is not fermented by cariogenic plaque bacteria and, thus, does not lower the pH of plaque. Because plaque pH does not decrease, enamel demineralization is prevented, and plaque bacteria do not proliferate.
  
• Xylitol reduces the accumulation of plaque on the tooth surface.
  
• Since plaque pH does not drop when xylitol-sweetened gum is chewed, remineralization is enhanced.
  
• Regular chewing of xylitol-sweetened gum has specific inhibiting effects on the growth of mutans streptococci in the mouth. This suggests that there may be permanent reductions in oral mutans streptococci levels from this practice.
  
• Chewing any gum stimulates the flow of saliva, which enhances the buffering effect in plaque. This property is not unique to xylitol-sweetened gum, the chewing effect by itself is seen as beneficial.
  
• Chewing xylitol gum by mothers during pregnancy and first two years of a child’s life has been shown in multiple studies to reduce the population of cavity forming bacteria and therefore reduce the risk of cavity formation.

Professional Dental Cleaning

• Early detection and treatment of systemic diseases with oral manifestations (i.e., oral cancer)
  
• Early detection of carious teeth (cavities) in order to treat as minimally as possible, avoiding nerve involvement or infection
  
• Reduce risk of cardiovascular disease secondary to poor gum health, specifically periodontitis.
  
• Early detection of dental eruption problems allows for timely orthodontic intervention that can prevent more severe orthodontic issues and more invasive treatment
  
• Oral hygiene and nutritional counseling keep the patient informed of the steps required to maintain good oral health and informs the parent of any new products or studies that may influence what the patient does at home.
  
• With younger children, regular visits to the pediatric dentist helps reduce their anxiety and better prepares them for any possible dental treatment in the future.

Space Maintenance

Space Maintenance is a preventative measure used to avoid unwanted tooth movement due to early loss of a primary (baby) tooth or improper eruption of a permanent tooth. The most critical area for space maintenance occurs in the back molar regions, especially when a first or second primary molar is prematurely lost at a young age. The premature loss of the anterior primary teeth (incisors) rarely poses a space issue but may affect the eruption pattern and timing of the permanent teeth.
There are two major categories of space maintainers, removable and fixed. Removable space maintainers are rarely used due to the high risk of loss and lack of wear. There are several types of fixed space maintainers, some localized to a single side of the mouth, while others span both the right and left sides of each arch. Dr. Y will inform you and your child if he or she require a space maintainer, and if so, which type.