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Tooth Decay in Children

This is why the majority of Canadian kids have cavities

Vanessa Alcott* has lost track of how many cavities her five-year-old daughter has in her tiny mouth. Eight? Nine? Over the past two years, Alcott and her husband (who, luckily, have dental coverage) have spent thousands of dollars on repeated drilling and filling, plus one extraction and three full caps that required anesthesia.

"After the third, she was bawling by the time the mask came off," says Alcott. "She's traumatized."

As for the cause of the tooth decay, Alcott says bluntly: "It's just neglectful parenting." With four kids, her family's daily tooth-brushing regimen is somewhat lax (though two of her children are cavity-free). "If I stood there and brushed every kid's teeth, it would take half an hour," she says.

And flossing? Forget about it. Bedtime snacks -- bestowed by dad, après tooth-brushing -- are a constant battle. "He used to give the kids Oreos," says Alcott with exasperation. She now insists on nothing but fruit but knows that's still not ideal.

Then there's the guilt -- even shame. Alcott dreads the inevitable lecture she gets from the dentist at each visit (not to mention hearing her little one sob after a filling). "Every time we come home from the dentist, I start cracking the whip," she says. "But it never lasts."

Alcott is not alone. Each year, 19,000 Canadian kids between the ages of one and five require dental surgery -- representing one-third of all day surgeries for kids in that age group, according to a study from the Canadian Institute for Health Information. And it's estimated that 57 percent of kids aged six to 11 have cavities. Among lower-income children, the rate of tooth decay is 2.5 times higher. In Aboriginal communities, where dental offices simply don't exist, tooth decay can be as high as 90 percent.

Overall, the numbers are way up. American studies have pegged the increase in early children tooth decay, at 15 to 18 percent over the past 20 years.

Dr. Peter Doig, president of the Canadian Dental Association, has been practising as a dentist in Manitoba for three decades. During his first 15 years, he saw a marked decline in pediatric dental caries (dentists' lingo for cavities).

"Unfortunately, about 15 years ago, we started to see a trend back toward more dental caries in children," he says. "It can cause pain, swelling and eventually impair a child's ability to eat," he says. "It can even lead to infections that can be life-threatening. I have seen that many, many times."

Doig says that the move to put fluoride in community water supplies accounted for the huge drop in childhood cavities in the early years of his practice. (The U.S. Centers for Disease Control calls fluoridation one of the top 10 public health programs of the past 100 years.) But many communities have since lobbied to have fluoride removed.

Today, only 45 percent of community water supplies in Canada are fluoridated, according to the Canadian Pediatric Society, which issued a call for action on early childhood caries in January. And fluoridation varies wildly across the country. In Ontario, 76 percent of water contains fluoride; in Newfoundland and Labrador, it's just 1.5 percent. Doig says the inevitable result of no fluoride is higher rates of dental decay.

But Doig points to diet as the major driver of the rise in dental decay. Cavities begin with a bacterial infection (yes, you can infect your kids with dental bacteria). Those bacteria use sugar and complex carbohydrates in your mouth to produce acid, which begins destroying the structure of your teeth. Once the bacteria get lodged inside your pearly whites, it becomes a progressive problem.

Over the past couple of decades, sugar consumption has risen, along with meal frequency. "When I was a child," says Doig, "you were taught to have three basic meals per day and not to snack." Now, kids are eating three or four times at school, with no chance to brush.

Considering that many typical school snacks and lunches are loaded with carbs -- bread, crackers, cookies, even milk -- it's a recipe for cavities. "If it's something sticky, you're providing a source for bacteria a long time after they eat that snack," says Doig.

To help combat dental decay, the Canadian Dental Association now encourages parents to visit the dentist before their child turns one (and yes, Doig does see babies with early signs of cavities). "If we can see the early signs, perhaps we can intervene before they get into more trouble by age two or three," says Doig.

It is also encouraging family physicians to educate parents on proper dental hygiene -- which could have a huge impact in Aboriginal communities and lower-income households, where kids are more likely to see a doctor than a dentist. To help spread the word, the CDA is developing a national action plan, bringing together dentists, oral surgeons, doctors, pharmacists, nurses, regulators, government agencies and industry to address the issue and come up with a blueprint.

There's plenty you can do at home to help keep your kids' teeth and gums healthy and cavity-free.

Here are seven tips from Dr. Doig:

1. Brush even before your kids have teeth
Since plaque can develop even in the absence of teeth, says Doig, you should start cleaning your baby's gums (using a soft piece of gauze) right away. Not only do you reduce the bacterial lode, but you also get them accustomed to the idea of tooth-brushing later on. As for older kids, Doig says they don't really have the manual dexterity (not to mention the patience) to do an effective job, which means parents should be doing it for them until they're seven or eight.

2. Use toothpaste containing fluoride
Even though your kids might already be benefiting from fluoride in your tap water, Doig recommends using a small amount of fluoride-containing toothpaste, even for toddlers. "If you use a very small amount -- we call it a smear of toothpaste -- they will get the benefit without ingesting the fluoride," he says.

3. Cut back on sugar consumption
"Diet is incredibly important," says Doig. Sugar hides in all sorts of foods: cereal, juice, bread, even milk. "The bacteria in a child's mouth can use sugar from milk just as they can use sugar in pop to create acid."

4. No bottles at bedtime
"We try to discourage parents from putting children to bed with bottles," says Doig, since it allows them to hold potentially sugary milk or juice in their mouths. "If a child can't sleep without a bottle, ensure it has just water."

5. Dump the sippy cup
"One of the trends we've seen over the last number of years is that when parents move children off bottle, they tend to move to a sippy cup," says Doig. "But that enables the child to hold the fluid in their mouth, so it creates a circumstance where they're exposing their teeth to a continual source of sugar." The CDA recommends using an open cup, which forces kids to swallow immediately.

6. Ditch sticky snacks
"Anything that has sugar in it and sticks to teeth is dangerous," says Doig. And since kids don't generally have a chance to brush their teeth at school, he recommends banishing sugary foods from their lunchboxes. On his hit list: bread, potato chips, fruit rollups and other dried fruit. "Fruit rollups are just as bad as giving them toffee to eat, from a dental decay perspective."

His best snack suggestion: cheese. "We used to call cheese the dentally perfect food -- it's almost entirely fat and protein. Even though it will stick to your teeth, it will not feed the bacteria." But watch the labels: Some cheese snacks might contain added sugar.

7. Brush those gums
"Bacteria in the mouth don't just stick to teeth; they also reside within your mouth," says Doig. That means it's important to keep your child's entire mouth clean, including tongue and gums.

8. Get thee to a dentist
The Canadian Dental Association recommends taking your child to the dentist by age one. If there are early signs of dental decay, you and your provider can come up with a plan to reverse it and it will help prepare your little one for a long and, hopefully, stress-free, relationship with the dentist.

*Not her real name.