Prevent Dental Disease in Infants
The prevention of dental disease begins in infancy. While newborns do not have teeth, the development of bacterial implantation is believed to begin before teeth develop. The transmission of bacteria from the parent’s mouth to the infant can occur early. It is this bacterium that causes decay.
Bacteria are transferred to the baby by sharing eating utensils or cups with the child or by innocently “cleaning” a dropped nipple or pacifier by mouth with your own saliva. Parents, siblings, grandparents, other children or other caregivers can be responsible for exposing the child to decay causing bacteria. The bacteria will grow when the conditions in the mouth feed it. That is why it is important to begin good oral hygiene practices at birth.
The children’s dental conditions tend to be similar to their parents’ and may place them at high risk for getting cavities. You can determine your child’s risk of dental disease by evaluating your own condition. Your risk is higher if you have had a cavity within the last three years, eat frequent snacks, drink juice or sugary soft drinks and do not brush after every meal and floss or if you fail to visit the dentist regularly. Once the risk level has been determined, it is possible to change it through excellent prevention techniques and habits. With careful daily cleaning of gums and brushing of teeth, it is possible to reduce the disease-causing bacteria that are harmful to the gums and teeth of the child. Reduce “sweet” foods and juices and make regular visits to the dentist for detection and treatment will improve the overall oral health.
How to clean an infant’s mouth
Uses a soft wet cloth wrapped around your finger and gently wipe the gums on the outside next to the cheek and around the inside of the mouth and tongue. Clean all the spaces including the open area in the cleft.
Special care for infants born with clefts
It is important to prevent bacterial growth in infants who are born with cleft lip and palate and who have appliance therapy before surgery. Bacterial can grow on and behind the appliance or in the space where the cleft is. It is important to clean the mouth and the appliance several times a day. Take the appliance out and wash it with soap and water, brush it and rinse the appliance before placing it back in the mouth.
Special dental issues for children with clefts
Often, teeth may grow in the roof of the mouth or gums near the cleft. Sometimes they grow sideways. These teeth are may be extra teeth or teeth that have been displaced by the cleft. Your dentist can determine if the teeth need to be removed or can be saved to move into a more favorable position. These misplaced teeth are not generally painful but may irritate the tongue or be annoying when chewing. They also need special attention during brushing to avoid decay. We recommend you discuss these misplaced teeth with the cleft team before agreeing to extraction.
Oral Hygiene
Once the teeth develop, it is important to continue the healthy habits that you have used with your infant. Fluoridated water and fluoridated tooth paste help prevent dental disease. Use a “smear” of paste for children under two years and after that use a “pea” sized amount on the tooth brush. Use a soft toothbrush that is made for your child’s age. Brush twice a day. Do not rely on the child to do it alone. Watch the child brush and finish the job by getting the hard to reach places (especially in the cleft). Rinse the mouth after eating or drinking. Remember sugars will develop even from milk. Only put water in bedtime bottles or sippy cups. Begin regular check-ups starting as soon as the first teeth erupt or at age one. Establish a “Dental Home” where care and advice will assure you that the child is developing properly and control of dental disease happens. Dentist visits every 3-6 months is important, depending on the risk level, to keep a healthy child and a healthy mouth.
When cavities develop
Often decay begins with white spots. Later decay appears as brown or black spots on the teeth. Once they develop, it is important to see a dentist right away. The smaller the cavity the easier it is to treat. If the gums begin to look a brighter red, it is a sign that brushing is not occurring regularly and the child is at risk for cavities as well as gum infection. The child may be nervous at an early age but reassurance and proper dentist selection will make it easier.
Treating decay in primary (“baby”) teeth is important because once the decay begins, it can destroy the teeth causing an infection that may be really painful. The result is swelling and inability to eat perhaps accompanied by fever. Severe decay can lead to infection that can spreads to other areas of the body. We do not want to pull primary teeth if we can avoid it. This would cause difficulty eating and allow the remaining teeth to shift and cause problems for permanent teeth eruption. It is easier to prevent these conditions by daily brushing the child’s teeth (even though they might not like it!), using dental floss to clean between the teeth when they develop close together and then regular visits to your dental professional for early disease detection. When a tooth must be pulled, your dentist will discuss whether other therapy is needed to protect the space for permanent teeth.
As children grow, it is important to continue to practice good dental care. It is also important to monitor how straight the teeth are and if they are in the right place. Most children who are born with clefts will need orthodontic care. The gap caused by the cleft in the gum line needs to be filled in before the permanent teeth come in. This is done surgically with a bone graft between 7-9 years of age. Later it will be necessary to straighten the teeth, move them into the correct position, and provide a good biting relationship between the upper and lower teeth.
The final treatments may occur in early to late adolescence as the remaining permanent teeth come in and final surgeries are accomplished. At that point, it remains for the patient to continue regular visits and maintain oral hygiene for a successful result.