Why are cavities on the rise for younger children?

Thanks to better brushing habits, increased access to fluoride and regular trips to the dentist, Americans are getting fewer cavities than ever before. But as reported in a recent story in The New York Times, there is one segment of the population that isn’t doing so well when it comes to their teeth: preschoolers.

Cavity rates are on the rise for kids between the ages of 2 and 5, with just over 28 percent of them experiencing tooth decay. That means that nearly one in three toddlers has at least one cavity, which can cause mouth pain, gum disease and other health problems.

And like many medical conditions, if action isn’t taken early, tooth decay in toddlers can lead to life-long problems.

“Cavities at a young age is the single biggest risk factor for a lifetime of cavities,” says Man Wai Ng, DDS, MPH, dentist-in-chief at the Department of Dentistry at Boston Children’s Hospital. “Over the years, that can force the child to deal with pain, expensive dental work and more serious medical concerns like diabetes and heart problems.”  

Cavities are caused by plaque, a sticky film made up of bacteria, saliva and left over food particles. Plaque sticks to our teeth, and the bacteria that naturally live in our mouths love to eat it. But as the bacteria attacks the plaque, it also eats away at the outer layer of the tooth, causing decay that leads to cavities.

Man Wai Ng, DDS, MPH

But dentists have known the causes cavities for years. The real question is what’s behind the rise in cavities for preschoolers? No one can say for sure, but dentists suspect modern diets and permissive parenting styles have a lot to do with it.

Today’s kids drink more sugar-laden fruit juice and eat more sugary and starchy foods than in the past, both of which are big plaque producers. To combat all that cavity-causing food, kids need to brush more, but many toddlers aren’t likely to do that without mom or dad’s help.

To help children avoid a lifetime of poor dental health—and help parents escape battles over making sure teeth get brushed—Ng recommends getting children into good dental habits early. Here are some of her tips:

Brush children’s teeth as soon as they come in. Using children’s toothpaste with fluoride, start brushing a child’s budding teeth and gums the moment you notice them. Some parents worry that infants’ mouths are too sensitive for tooth brushing, but those fears are ungrounded. “If they’re old enough to grow a tooth, they’re old enough to have it brushed,” Ng says.

Brush your children’s teeth for them. Just because a child is old enough to put toothpaste on a brush and stick it in her mouth, doesn’t mean she can scrub well enough to get rid of plaque. Parents should be brushing kids’ teeth for them until they are about 6 years old to ensure that a thorough job is done. Ng recommends standing behind the child to brush, using your free hand to move the lips and cheeks out of the way when needed.

Use fluoride toothpaste.  Skip the training toothpaste.  It is safe and cost-effective to use a tiny smear of fluoride toothpaste for your infant and toddler, even if he or she cannot yet spit out.

Look out for “secret” cavity causers. Juices advertise themselves as being the healthy alternative to soda, but most juices are full of sugar and will hurt your child’s teeth just as badly. And while snacks like crackers and chips don’t have a lot of sugar in them, they leave tiny crumbs that cause plaque. Ng suggests limiting your child’s access to them, and brushing their teeth at least two times per day.

Even non-sugary snacks can cause plaque build up.

Avoid “grazing.” When kids have access to snacks food all the time, a feeding style known as grazing, which increases the amounts of time their teeth are in contact with sugars, starches and acids produced by oral bacteria. Some children may need to have constant access to food for medical reasons, but as rule grazing should by avoided whenever possible.

Skip the final rinse.  Once our teeth are brushed, most of us rinse the excess toothpaste from our mouths. All that water may make us feel cleaner, but toothpaste with fluoride in it actually works better if you leave it in after brushing. The more time the fluoride has to sit on the teeth, the better it works, so have your child skip the final rinse and give the fluoride enough time to do its work.

By focusing on preventive measures, instead having cavities filled after the decay has started, Ng says parents can save their children a lifetime of expensive—and sometimes painful—trips to the dentist. While there are many universal truths when it comes to taking care of young teeth, like brushing two to three times per day and limiting sugary foods, personalizing a child’s approach to dental hygiene works best.

“Traditionally there has been a ‘one-size-fits-all’ approach to talking to parents about how to take care of their children’s teeth, but we found that blanket advice isn’t always successful,” Ng says. “Recently we have started using a more customized approach to risk assessment and helping families learn how to avoid cavities. Thus far it’s worked quite well.”

Ng and her team have created a group of self-management goals for families that includes a list of tooth brushing/oral hygiene techniques they can adapt based on what would work best for their child.

“As a parent, I know that getting a child to eat better and brush more often can can be hard,” says Ng. “Our program isn’t about always forbidding sweets or constantly nagging them. Like a lot of things in medicine and parenting, it’s all about finding a healthy balance that works for everyone.”