Antibiotics and Cavities

A large-scale 2009 study investigated whether a child’s taking of antibiotics before the age of 2 had anything to do with the development of tooth decay (dental caries) later on. The researchers found a definite association between taking antibiotics at age 0 to 12 months or 13 to 18 months and the later development of early childhood caries.

From such results, one could surmise that the antibiotics themselves are a direct cause of caries that appears months or years after they have been taken.

However, other, possibly more logical, possibilities may exist. Perhaps, if a child is often sick (he is, after all, taking antibiotics), parents may provide extra “treats”—quite possibly sugary treats—to make the child feel “better.” And we are all aware that sugar has been proven to cause tooth decay.

Importantly, children taking antibiotics during the first year of life often take antibiotics in subsequent years. Since such children were presumably deemed ill more often than children who didn’t take antibiotics, they would be more likely to have taken more over-the-counter medications, like cough syrups and acetaminophen. These preparations often contain sugar, contributing to caries just as a sugary snack might.

The infections themselves that the antibiotics were prescribed to treat could also eventually contribute to early childhood caries. In fact, some infections have been linked to developmental enamel defects, a possible springboard to tooth decay.

While more research about the antibiotics–early childhood tooth decay link is needed, we recommend that if your child has taken antibiotics before the age of 18 months, be extra-vigilant about dental visits and oral hygiene in the next few years to help prevent problems and to treat those that do develop as early as possible.

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Teething and Fever—What’s the Connection?

While babies usually cut their first teeth at between four and seven months of ages, some children do not get their first teeth until their first birthday or later. Crankiness, drooling and fever have long been considered traditional signs that a child is teething. But is fever connected to teething?

Recently, researchers observed a group of infants aged five to fifteen months, recording the babies’ body temperature and symptoms during the period when children typically get their baby teeth. They tracked such classic signs of teething as fever, sleep disturbance, rash, irritability, drooling, diarrhea, runny nose and loss of appetite during four time periods: the day a tooth erupted, the day before a tooth erupted, the day after a tooth erupted and all other days.

Surprisingly, on the day a tooth erupted, the children’s temperatures rose by only a few tenths of a degree. Other symptoms, including irritability, drooling, diarrhea and runny nose, appeared the day the tooth erupted but not before, meaning that it was impossible to predict when a new tooth would emerge just by reading the so-called signs.

“I've seen a lot of parents that will come in with children with fevers of 101 degrees or higher, and first thing they say is, ‘It might just be teething,’” noted Dr. Roya Samuels, a pediatrician at Cohen Children’s Medical Center in New Hyde Park, New York. “Teething has never been proven to be related to high-grade temperatures.”

Some babies feel the pain of teething intensely while others seem to shrug it off. To alleviate crankiness, you can give your baby a chilled (not frozen) rubber teething ring or let her chew on a clean, wet washcloth that has been cooled in the freezer for thirty minutes. If your child is having great difficulty sleeping, your pediatrician may recommend giving her acetaminophen.

An infant’s fever should not be shrugged off as “just teething.” Any fever over 100.4 degrees should be checked out by the baby’s pediatrician. It may be related to another condition and should be treated accordingly.

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Flossing 101

How old should your child be before you encourage him to floss? Four, perhaps? After the first permanent teeth begin to erupt? As adolescence begins?

Actually, the American Academy of Pediatric Dentistry recommends flossing “as soon as there are two adjacent tooth surfaces that cannot be reached by a toothbrush”—or simply put, when two teeth touch—usually during toddlerhood.

Plaque, the film formed by bacteria attaching themselves to the tooth’s smooth surface, knows no lower age limit. At first, the plaque will be soft enough to be removed by a fingernail or toothbrush, but it begins to harden within 48 hours and at 10 days becomes tartar, a hard substance that is difficult to remove at home. Unremoved plaque between teeth raises the risk of inflamed, swollen gums and gums that pull away from the teeth (gingivitis). In severe cases, untreated gingivitis can even affect the jawbone.

At age two, though, your child certainly won’t be thinking about the lifelong consequences of not flossing. All she needs to know is that it is something to do once a day, preferably at night, and that Mom or Dad will help until she is old enough to do it on her own.

Rather than use string floss, you may find it easier to manipulate a floss pick in your child’s small mouth. However, use whatever works best for you and your child. Once your child reaches an age when he has the appropriate manual dexterity, probably by age 10 or 11, he can begin to floss his teeth himself.

The teen years are a time when flossing becomes especially important. Teens who don’t eat as well as they should and get too little sleep will find their resistance to infection lowered—including gum infection. Girls, whose hormones make them more susceptible to gum sensitivity and disease anyway, may find that their gums hurt and even bleed in the days before their period begins. While flossing might be uncomfortable at those times, its importance doesn’t diminish.

Taking a few days off from flossing, for whatever reason, only allows the plaque to accumulate and harden, meaning even greater discomfort when flossing resumes. Starting your child on a schedule of regular flossing, even as early as toddlerhood and continuing through adolescence and beyond, can ensure a healthy mouth for a lifetime.

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Seven Ways to Protect Your Child’s Teeth

Protecting your child’s teeth from an early age is the best way to minimize tooth- and mouth-related problems as your child grows. Use this seven-step plan to develop an oral hygiene strategy that works for you and your child:

1. See the dentist early. Ideally, your goal should be to take your child to see a dentist by her first birthday.

2. Start brushing with the first tooth. Although many parents may not feel a need to brush a baby’s first teeth, keeping even the earliest teeth clean and healthy is critical to good oral health later on.

3. Reconsider the bedtime bottle. Letting a child take a bottle of juice, formula or milk to bed is an invitation for decay development. If your child must have a bottle, the American Academy of Pediatrics (AAP) advises filling it only with water.

4. Use sippy cups wisely. Sugary beverages + prolonged use of sippy cups = tooth decay. The AAP also recommends giving children no more than four ounces of 100% fruit juice per day and restricting sugary beverages to mealtimes only. Many pediatricians and pediatric dentists advise giving juice only as a treat.

5. Say “bye-bye” to the binky. Pacifiers may be appropriate for infants and until a child turns two, but after that, the pacifier should be avoided to avoid misalignment of the teeth and jaw, which can promote tooth decay and be costly to correct.

6. Keep an eye on medicines. Many pediatric medicines contain sugar and can promote the growth of bacteria, and prolonged use of antibiotics may cause a fungal infection called thrush. Children using medications to treat chronic conditions are at greater risk for tooth decay, so be sure to discuss these risks with your pediatrician or pediatric dentist.

7. Stay firm. Although children may complain about brushing and flossing, you’re not doing them any favors by allowing them to avoid good oral care. Get them involved by letting them choose, with your guidance, their own toothpaste or toothbrush, and reward efforts with stickers or other small tokens to keep them motivated.

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The Surprising Ear-Nose-Tooth Connection

The link in children between dental malocclusion—condition in which upper and lower teeth are not correctly aligned—and the common middle-ear infection (otitis media) remains unclear. A child with ear infections appears to be more likely to have a posterior crossbite (a kind of malocclusion), but no significant connection between any kind of malocclusion and ear infection has been determined.

However, a child who has dental malocclusion—or its beginnings—and a tendency to develop ear infections may actually have an underlying problem that causes both: mouth breathing. Just as the name suggests, mouth breathing occurs when the nasal passages experience chronic blockage, and because the child can’t breathe well out of his nose, he breathes primarily through his mouth.

So, what can cause chronically blocked nasal passages? Seasonal allergies, surely. Another major cause is swollen tonsils and/or adenoids.

The change from nasal to mouth breathing often results in chronic middle ear infections, sinusitis, upper airway infections and sleep disturbances such as apnea and snoring. And mouth breathing has been shown to affect the growing face, causing not only the teeth and jaw to be mismatched but, over time, significant abnormal facial development that can affect a child emotionally and socially, especially if it occurs during the critical growing years.

If a child sleeps poorly, he may well act tired, behave poorly and have difficulty concentrating, especially at school—all of which can lead to a (mis)diagnosis of ADHD. In many such children, when the enlarged tonsils and/or adenoids are removed, “behavior, attentiveness, energy level, academic performance, and growth and development” all improve, according to Yosh Jefferson, DMD, in an article he wrote for the journal General Dentistry in 2010.

Once mouth breathing is resolved, dental malocclusions and craniofacial issues can then be addressed—leading to a happy, if often initially unexpected, ending.

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Dental Injuries and ADHD

The causes of dental trauma—injuries to the teeth and mouth area—traditionally have been classified by a child’s oral developmental stage. Injuries to a child’s baby teeth tend to occur from falls and accidents related to the fact that the child is still learning to walk and run, and hasn’t yet fully developed his senses of balance and space. During the time period when baby teeth are being replaced with permanent teeth (transitional dentition), accidents are more likely to result from outdoor activities such as running and bicycling. But falls are still a major factor during this period, with some studies suggesting that falls account for up to 40% of all dental injuries in the transitional dentition.

Attention deficit/hyperactivity disorders (ADHD) is a neurodevelopmental disorder that may become apparent before age 7. Children with ADHD often demonstrate poor impulse control, hyperactivity and inattentiveness. Since accidents and falls are the most frequent cause of dental trauma in children, it seems logical that children suffering from ADHD could be more prone to dental trauma than are their peers.

A recent study conducted at Nationwide Children’s Hospital in Columbus, Ohio, compared a group of children each of whom a history of recent dental trauma with a group of children without dental trauma. The children’s parents completed the ADHD Rating Scale IV, a form that evaluates children for ADHD and its two component parts: (1) inattention and (2) hyperactivity and impulsiveness.

Interestingly, based on the rating scale, both groups of children averaged similar scores for ADHD and for inattention. However, the group of children with dental trauma scored significantly higher for hyperactivity and impulsiveness.

Children with ADHD are more at risk than other children for cavities and are more likely to grind their teeth. And these children’s behavioral issues can make visits to the dentist more difficult for the child and the parent. Parents of children with ADHD should make sure their children use seat belts, bike helmets and mouth guards to help minimize the chances of dental trauma. And they should foster an early and trusting relationship between their child and his dentist.

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