Dental Health Tips for Parents: A dentist's take on how to raise a kid with a killer smile

This kid’s goin’ places.

Disclaimer: The information presented in this article is for educational purposes only and is NOT intended or implied as a substitute for professional medical advice, diagnosis, or treatment from your dentist, physician, or any other healthcare professional. You should NOT use the information presented here for diagnosing or treating any health problem or disease. Never disregard advice from your personal medical care provider(s) or delay contacting your dentist/other healthcare providers because of anything you read or heard here. Reading this article and/or utilizing any of the information presented in any way does NOT create a doctor-patient relationship between you and the article creator or with any of the healthcare professionals in any way affiliated with this article. You use this information at your own risk. You should contact your dentist/healthcare professionals before beginning any new treatment or practice to address a health problem or improve your health. The author is not responsible for information on external websites linked to from this article or for the information on external websites that link to this article.

Introduction: The Family as Foundational to the Health of Children

I’m not a dad. As not a dad, I can’t fully¹ relate to the struggle that is raising kids. However, I did not too long ago become an uncle for the first time. I’ll admit, I didn’t really have to do a whole lot to make that happen, but I got a glimpse of some parental impulses while holding my tiny little nephew. For instance, I’m terrified of dropping a baby. I sort of knew that already, but this confirmed it. That led to a spiral of other anxieties concerning the future of our new infant family member. Can you tell me if he’s going to grow up happy and healthy already? I’m very anxious about it. I don’t want him to be led to a life of addiction by a leftover prescription medication! How’s an uncle supposed to get any sleep thinking about that?

Ok, I’m going to try to snap out of it now. “Get a hold of yourself, Mike! You have an article to write for these fine people.”

Alright, what I’m saying is I can’t speak with first-hand authority on the subject of parenting. Still, outside looking in, looks like a pretty difficult endeavor. I want to try to help all you parental units out there to the extent that I can. It takes a village, right? Besides, I need you to raise good kids so I don’t encounter a bunch of stinkin’ punks out in the world. See, it’s selfish in the end, really.

Here are the big takeaway messages from this article:

1. Dental and/or oral health (the health of your teeth, gums, tongue, jaw muscles, jaw joint, etc.) is largely influenced by our daily habits. Most of the problems that affect your mouth and jaw joints are BEHAVIORAL diseases and injuries. That means that they are PREVENTABLE if you know the right habits to use in your life. You don’t have “bad teeth.”

2. Establishing the right HABITS for dental health EARLY IN LIFE is key.

3. Parents have the power to empower their children to experience a lifetime of dental health. PARENTS are by far MORE IMPORTANT than dental care providers in influencing their child toward a healthy mouth lifestyle.²

As parents, you want to gift your kids as many healthy habits as you can. Those habits will continue paying dividends long after they have left your care and protection.

This article will give you some of the tools you will need to set your child up for success. I’m going to say all sorts of things I wish I had the time to communicate to patients effectively when they come to see me in a dental office. The reality is, what I say here is so much more important than the repair work I do on patients’ teeth as a dentist, but time does not allow for such an in-depth discussion when I’m on the clock at work. I want as many people as possible to have access to this information so that they can be confident in taking care of their dental health.

Also, if you don’t think children getting cavities is a big deal, please read this World Health Organization implementation manual about the fight against early childhood caries (cavities in children age 6 and younger). An excerpt:

“Prevalence of [early childhood caries] is increasing rapidly in low- and middle-income countries, and dental caries is particularly frequent or severe among children living in deprived communities. In many countries, access to dental care is not equitable, leaving poor children and families underserved.”

Sounds grim. But wait, there’s hope! Read on:

“Fortunately, [early childhood caries] is preventable, with almost all risk factors modifiable…[early childhood caries] is influenced strongly by health behaviours and practices of children, families and caregivers…The importance of establishing good eating habits in childhood to minimize the risk of [early childhood caries] and obesity cannot be overestimated. Since eating patterns track from childhood to adulthood, establishing appropriate habits in the early years is a major target.”

Again, we see a key emphasis on EARLY PREVENTATIVE CARE:

“…most problems of [early childhood caries] occur before the child attends school and therefore cannot be impacted by [school based] programmes. [Early childhood caries] prevention and control interventions should be integrated into existing primary care such as child and maternal health programmes alongside vaccinations and general medical check-ups. This could lead to a continuing programme of interventions that provide reassurance to parents and caregivers and boost their knowledge of the need to attend health appointments.”

I think this line of thinking is headed in the right direction. Still, honestly, in the internet age, I don’t understand why we can’t educate people about how to successfully take care of themselves and their family right alongside the cat memes. Primary care inside a clinical office setting is all well and good, but you have to get people into that office setting first. That is no small task. For many, it is too expensive, or they face other barriers to accessing that care. We have to adapt and meet people where they are. People are at the cat memes. We need to go to the cat memes.

Is that insane for a dentist to propose that we try educating people about how to maximize their dental health at a low cost via online channels next to a bunch of GIFs and Tik Toks? Maybe. Even if you can’t address every problem online, I think you can educate patients a lot and make them more confident about seeking care in a dental office setting. There is so much counseling and coaching that can be accomplished online, and that saves on time and cost, leaving more resources that can be utilized for treatment that can only be addressed in person in a clinical setting.

I really hope what I’m saying is resonating with some of you, because as a dentist with plenty of first-hand experience seeing the consequences of not establishing mouth healthy habits at an early age, it hurts when I think about how unnecessary it is for people to suffer so much of the pain, anxiety, and loss of confidence that accompanies dental decay and deterioration. I don’t want what I’m writing to make anyone feel bad. I want this knowledge to make you feel stronger and empowered to protect and enhance your dental health. I want you to instill that same confidence in others you care about.

If we all put in a little bit of effort to NON-JUDGMENTALLY and EMPATHETICALLY³ share this information with others, I’m confident we can change the world and, who knows, maybe make a little tooth-shaped dent in the universe. It starts with the family as the foundation of our health, but we all have our roles to play in supporting parents to raise independent, confident, tooth-healthy little tykes. As parents, grandparents, aunts, uncles, family friends, the friendly neighborhood Spider-Man…you all have the power to make the next generation stronger.

Again, from the World Health Organization implementation manual for ending childhood dental caries:⁴

“The family represents the child’s primary source of learning about health and risk factors. Awareness of oral health and attentiveness to [early childhood caries] prevention among parents can be raised through health communication and by providing them with sound information about disease and intervention.”

Let’s start talking about how you can get your family on track toward healthy smiles for a lifetime.

I’m not a dad. As not a dad, I can’t fully relate to the struggle that is raising kids. But I’m going to give you unsolicited advice anyway. How much do you want to punch me right now?

Showing Your Child Mouth Healthy Habits

Let’s get one thing straight right off the bat: Baby teeth aren’t baby teeth. They’re TRAINING TEETH. What do I mean by that? Baby teeth matter. Just because they eventually fall out doesn’t mean you can treat them like crap. The habits a child learns with their baby teeth WILL carry over and affect what happens to their adult teeth. Habits get established early in life, and it is a lot more work to build new habits (BUT still very possible — don’t give up!) than it is to ride the momentum train of good habits built early in life.

I’ll give you an example from my own life. My parents made me play sports growing up. The rule was that I had to be doing a sport every season of the year. The rotation for me was soccer, basketball, baseball. I hated baseball. To stop playing baseball, I had to pick up swimming. I ended up swimming when I was in college. All those years of regular exercise built a habit. I no longer play any competitive sports, but I work out at least three times a week, and when I miss workouts, it bothers me. I enjoy exercising.

That might sound insane to some people. It probably would have sounded insane to dorky little 8 year old me who just wanted to play video games all day (I’m still a dork, btw). The fact is your body and mind adapt to the environment and activities they are exposed to. If you’re used to regular exercise, your body optimizes to that pattern. I feel resistance to any attempt to break that routine.

There is nothing special about me that makes me want to exercise regularly. It’s not a judgment on my personal virtue. It’s just a well-worn patterned behavior in my life. It’s a healthy habit. As parents, you want to gift your kids as many healthy habits as you can. Those habits will continue paying dividends long after they have left your care and protection.

You might be thinking, “But my dental health habits aren’t very good. How am I supposed to improve my kids’ habits if I don’t have good ones myself?” I’m here to help you with that too. Confession: I didn’t start flossing my teeth regularly until my final year of dental school. “Gasp! Egad! Say it ain’t so! Zoinks and jeepers, mister, that ain’t right!” It may not be right, but it’s the truth. Even dental students and dentists can be terribly flawed hypocritical human sacks of detritus. Nevertheless, as long as we’re still breathing, we always have the opportunity to turn it around. I know how hard it is to establish even simple, basic health habits. Don’t worry. You’re not a lost cause.

You might be thinking, “But my dental health habits aren’t very good. How am I supposed to improve my kids’ habits if I don’t have good ones myself?” I’m here to help you with that too.

I’ve created a whole series of articles and videos to help nudge you and your family toward dental health. You don’t have to change everything at once. Just pick some small things you learn to focus on. Once you master a little change, try taking on something slightly more challenging. We’re not creating a new dental you overnight. This is a lifelong process of enjoying dental health. There is no final goal or finish line you have to cross. We’re just aiming for incremental improvements to give you a fun little confidence boost here and there.

Why are we suddenly talking about improving you? “I thought this was about fixing my dumb kids. How come I have to be different? I think I’m pretty dope as is, thank you very much.” I hear you. You are pretty dope as is. But the fact remains that even when you’re a dope person, your teeth may not be the most dope. I’m a dentist, so I tend to focus on getting people to the point that they have dope teeth. We have to focus on getting you dope teeth first so that your dope health habits can rub off on your dumb kids. Then, maybe someday, those dummies can be dope, too, just like you and me. Make sense?

So cute! So cutesy wootsey! I can’t stand it. I just can’t.

Healthy Habit #1 — Healthy Eating Patterns

When it comes to protecting your teeth, THE WAY you eat and drink matters just as much (and possibly more than) what you eat and drink.⁵ It’s all about the amount of time that foods and drinks stick to and coat your teeth. If a food is sticky and clings to the teeth, that’s bad. Any drinks that contain carbohydrates/sugar are a problem because all water-based drinks will coat and cling to your teeth.

The goal then becomes keeping sticky/clingy foods and drinks off your teeth most of the day. How to accomplish that? You need to be disciplined about when you eat. Snacking and sipping are a lot harsher on your teeth than eating a discrete meal in a 20–30 minute time frame and then not eating or drinking anything other than water for several hours. If you do have a snack in between meals, rinse thoroughly with water afterwards to get as much of the food off of your teeth right away as possible.

You can train your kids to drink water throughout the day by offering them water, and only water, in between meals. Water is fundamental to life. We die pretty quickly when we don’t have enough of it. You may as well get your kids used to plain old H₂0. It’s been a reliable staple for the human race for a long time. Your kids don’t need a “sports” drink when exercising. Water will do the trick.

I drank a lot of Kool-aid as a kid and lived to tell the tale, but I would not recommend doing what I did. I was actually allowed to mix the Kool-aid up myself. Don’t put children in charge of how much sugar they add to things. I used to dump multiple flavored sugar packets into the pitcher and then add additional extra sugar. This was normal for me. It was a terrible habit, but I didn’t know any better at the time. Why am I talking about Kool-aid? Because most “sports” drinks are the same thing: rebranded sugar water. It’s not good for you.

Most people are aware that candy and soda are bad for your teeth, but lots of people don’t realize the damage that can be caused by products that contain enriched wheat flour. Think crackers, pretzels, and cereal. These foods can stick to the teeth for LONG periods of time. Flour is a carbohydrate that breaks down into sugar in our mouths. The bacteria in our mouths turn the sugar into acid, and the acid breaks down our teeth. Donald Glover’s parents knew what was up with sugary cereals. They were ahead of the game. Be like Donald Glover’s parents.

If you want a really thorough guide on what to eat to keep your teeth healthy, go to this website and print out the tooth snack guide. Print it out. Put it on your kitchen fridge. Stick a second one on your desk at work. Stick one on the fridge in the office lunchroom and help out your coworkers. As far as your teeth are concerned, eat and drink everything in the blue column whenever you want. Be a little more judicious eating things in the yellow column. Only eat things in the orange column once a day and make certain not to snack or sip on them. Teach your children to do the same.

Another way to think about it is that anything you eat or drink will be on your teeth for an average of 20 minutes after you finish eating and drinking. You can reduce that amount of time by thoroughly and vigorously swishing with water after eating and drinking (something that isn’t water). You don’t want to have cavity-causing foods and drinks in contact with your teeth for more than 20–40 minutes on any given day. That’s 20 minutes to eat/drink and another 20 minutes for water and your saliva to clean that food/drink off your teeth.

Also, this is not permission to hold soda in your mouth for 20–40 minutes a day. You will destroy your teeth VERY FAST if you do something insane like that. What are you, nuts? When I say “in contact with the teeth,” I mean incidental contact from eating and drinking, not a continuous bath in sugar acid. Why do I bring this up? Some people have habits of holding drinks in pools in their mouths or sucking on lemons or other citrus fruits. That wrecks your teeth.

This is also why the only thing you want to put in sippy cups for kids is water. When kids drink out of a sippy cup, the liquid comes in direct contact with their front teeth. It clings to and coats the teeth. A sippy cup also very much encourages a habit that is not good for your teeth, namely, sipping. Lots of parents just don’t know any better. It’s not uncommon to hear about parents giving their kids soda or juice in sippy cups regularly throughout the day. Those are the kids who wind up having to have major dental treatment under general anesthesia in a hospital setting. It’s expensive. It’s not fun. It’s preventable.

Water goes in the sippy cup. If anything else winds up in that cup, it should only be accessible to your child through you and for a short period of time each day. As soon as they are coordinated enough to drink from a regular cup, upgrade your kiddos to the big leagues. It might cost you a spill here or there, but that’s way less of a hassle than a trip to the hospital to fix a mouth full of decayed teeth.

When I’m at work, and I identify that a child has decay on their teeth, it’s not unusual for me to hear parents say something like: “See, you’re eating all that candy. That’s why you have a cavity!” That may be true. But who buys the candy to keep in the house? Yes, we absolutely have to teach children to take responsibility for themselves and their care, but what are the environments that we’re placing them in from a food perspective, and is that setting them up for success? Are you as a parent setting up a healthy environment?

I didn’t like it that my mom made me eat turkey “bacon” instead of real bacon as a kid. But I have healthier eating habits because of it. Now, based on modern evidence, you can argue that real bacon isn’t actually that bad for you in moderation, but the point is my mom was making a concerted effort to make my range of choices healthier based on the best evidence she had. I promise you: sugary foods and drinks lead to cavities. Cavities are preventable, along with all kinds of other problems, if we stop giving our kids sugary foods and drinks.

For additional advice on healthy eating for your children and whole family, check out this website from the Academy of Nutrition and Dietetics, eatright.org.

It’s not unusual for me to hear parents say something like: “See, you’re eating all that candy. That’s why you have a cavity!” That may be true. But who buys the candy to keep in the house? Yes, we absolutely have to teach children to take responsibility for themselves and their care, but what are the environments that we’re placing them in from a food perspective, and is that setting them up for success? Are you as a parent setting up a healthy environment?

Healthy Habit #2 — Cleaning the Teeth

You know brushing and flossing are important. That doesn’t mean you ever do it. As I mentioned earlier, I didn’t start flossing every day until I was about to graduate from dental school. I get it; why bother doing this weird, tedious thing that makes your mouth bleed when it hasn’t caused you any problems yet?

The messed up thing about problems with your teeth and gums is that A CRAP TON of damage can happen before you ever feel any pain or discomfort. Teeth often don’t hurt until cavities are really deep and you are getting close to needing a root canal. Gums rarely hurt unless you get severe gum disease that leads to a large infection under a tooth.

We don’t have a great early warning system when it comes to mouth health problems. Basically, your house can have termites, and you don’t find out until one of the walls finally collapses. I’m not sure if that’s how termites work, but I’m sticking with the analogy because it feels right. Come at me, termite people.

The good news is, you don’t need an exterminator to handle mouth termites. See, our mouths are full of bacteria. We can’t change that. It’s normal. Some bacteria in our mouth and the rest of our digestive system are good for us. You have to take the good with the bad. How to manage the bad?

Mouth bacteria only become a problem when they cling to the teeth and form a gang. The bacteria can team up once they are on your teeth. Then they can plot really dastardly stuff, like turning sugar into acid to destroy your teeth and inciting an intense response from your body’s immune system that ends up beating the hell out of your gum tissue and bone that you need to support your teeth.

To stop these bacterial gangs from doing their dirty work, all you have to do is brush and floss each day. Can it truly be so simple? Yes.

I made a video to show you how to floss properly. I wrote an article about flossing. I made a video about how to brush properly. Here is an excellent article about brushing not written by me. It takes about 24 hours for the bacteria gang to build up on the teeth, so if you brush and floss thoroughly at least once each day, you’ll successfully break up the gang before they can wreck your mouth neighborhood. If you only brush and floss once a day, make sure it always happens at night before you go to bed. You got this.

How does this translate to your kids? You need to help them with brushing and flossing until they are old enough to do it themselves.

When they are infants and just drinking milk, it’s sufficient to clean their teeth off after feeding with a dampened cloth. Once they switch to solid food, you can switch to a small soft bristle toothbrush.

It should only take about 20 seconds for you to brush their wickle little teefers at this age effectively. Try to make brushing a fun activity for them. Sing. Dance. Be silly as hell and extra positive and encouraging. Make it bonding time you’ll cherish together forever. When you’re pooping your pants dying in a nursing home, you all can laugh about the songs you used to sing while brushing together.

If you follow the advice I’m spitting online, you can even keep your teeth and avoid having to get dentures in that nursing home. Maybe if your kids end up loving you enough and aren’t disgusted by your smile in old age, they’ll be willing to let you live with them instead of sticking you in adult daycare. Once you’ve lost the ability to tie your shoes and brush, they can do you a solid and buy you some sick velcro sneaks as well as sing to you while they brush your teeth since your hand-eye coordination isn’t what it used to be.

Did you know that it was mandated that we have to put every patient’s name on their dentures because patients in nursing homes were getting their dentures mixed up with each other? Does that sound like fun? Do you want to be putting your friends’ teeth in your mouth accidentally? Doubt it. Follow my advice. You may inevitably face a future where you regularly and uncontrollably poop your dipe in the middle of the day, but at least keep yourself and your kids out of dentures.

Most kids will have spaces between many of their baby teeth. Once their teeth start to touch each other (usually the back teeth first), you need to start helping them floss. When their mouths are little, you’ll have the easiest time using floss picks as opposed to reaching your fingers in with string floss. When you floss their teeth, just be sure to gently scrape against the sides of each tooth up and down underneath the gums. It doesn’t take long. Be sure to do this each night.

You need to help them with brushing and flossing until they are old enough to do it themselves.

As your child grows and wants independence, it is fine to start passing these duties on to them. Most kids won’t have the dexterity to do these jobs well until age 6 or 7. A good coordination landmark is when they are able to tie their own shoes. Until you are confident that they are consistently doing a good job, you should double-check their work for them and tidy up as needed. Might not be a bad idea to invest in a penlight so you can see in their mouth well.

After they/you brush and floss at night, there should not be any more eating or drinking of anything except water. We don’t produce as much saliva while sleeping at night, which means that anything stuck on the teeth or down in the gums tends to stay there all night long. This also means you should never leave a bottle of milk with baby at night. There is sugar in that liquid, and sipping on that in an uncontrolled way without cleaning the teeth off after feeding could really damage the teeth. If you go to bed with clean teeth, you’ll wake up with clean teeth. If you go to bed with dirty teeth, you’ll wake up with dirty teeth. Your breath will likely stank stank as well.

Avoiding eating and drinking too close to bedtime is also very healthy because it helps prevent acid reflux at night. If your stomach has to produce acid to digest food and you are lying down, you can tend to have little aerosol droplets of acid work their way up onto your teeth at night. Gravity! This stomach acid getting up on the teeth results in a very distinctive pattern of acid erosion on the back teeth and the back sides of the front teeth that I see in patients all the time.

Most patients are unaware of it. It’s another thing that happens to the teeth that doesn’t hurt. However, if it gets bad enough over time, it can severely affect the look of your teeth, making them look older, yellower, and more brittle. The teeth are also more likely to crack, and because the height of the back teeth is wearing down over time, your jaw shifts up, which can lead to your cheeks/corners of your lips sagging. You know how patient’s faces look collapsed when they take out their dentures? Acid erosion can cause a less severe version of the same thing over time. The good news is, once again, this process is completely preventable. Ideally, you want to avoid having anything other than water to eat or drink for 2–3 hours before you go to sleep. That’s also helpful if you’re a fan of intermittent fasting as a healthy habit.

Bonus Habit #3 — Fortifying the Teeth

This is the least important habit of the three, but it is still quite helpful for many patients. Somehow, this one has also managed to become very controversial for some. If that’s you, I’m ok with you skipping this habit IF AND ONLY IF you are religiously and dogmatically devoted to strictly following habits #1 and #2.

What is habit #3? Fluoride. You can watch this video I made about fluoride if you want to deep dive into the topic. You can think of fluoride as vitamins for the teeth. Fluoride gets absorbed by the teeth and makes them more resistant to breakdown from acid.

Your teeth can be exposed to fluoride from four different basic sources:

1. Fluoride toothpaste

2. Fluoride mouthwash

3. Professionally applied in-office fluoride treatments

4. Fluoridated water

Starting at age 2, you can add a RICE-sized (think about how small a grain of rice is) dab of fluoride toothpaste on the brush for your child. Tell them to spit thoroughly and have them rinse with water and spit after you brush with them.

Starting at age 3, that rice-sized grain of paste can be upgraded to a PEA-sized (again, think about how small a pea is) dab of fluoride toothpaste.

You DO NOT need a giant glob of toothpaste similar to what you see on the packaging for your teeth to get the benefits of toothpaste. I’m a grown man, and I still only ever use a smear of toothpaste that is maybe equivalent to the size of a pea when I’m brushing. Save your toothpaste. It takes a long time for the stuff to “expire” (which doesn’t mean it’s unsafe; it’s just that some ingredients can degrade, and the flavor/consistency can change). Save your money. You can still keep your pearly whites pearly and white while pinching some pennies here and there.

What about mouthwash? If you’ve had trouble with cavities in the past or have a lot of gum recession, a fluoride mouthwash can be a nice adjunct to brushing and flossing. Children should not be given fluoride mouthwash until they can swish and spit without reflexively swallowing any of it. I wouldn’t give my kids (if I had any) mouthwash until at least age 7, and I would keep an eye on them while they are using it. Mouthwash is toxic if swallowed.

If you regularly take your child to a dentist, they will likely talk to you about professionally applied fluoride treatments. The benefit here is that the fluoride is more concentrated, so your teeth absorb more of it at this one application. Especially if your child has a history of tooth decay, I would recommend getting these treatments regularly (every 3–6 months, depending on the severity of your child’s decay history).

If you live in a community with fluoridated water, I would say that that is a very fortunate thing overall for you and your children. Fluoridated water has saved a lot of people from developing cavities over the course of the past 75 or so years. While it is healthy for us to reevaluate regularly the amount of fluoride in the water supply based on updated evidence, I think we made the right call as a society by pursuing some level of water fluoridation. I promise I’m not getting paid off by Big Fluoride to say that. If you don’t know what I mean by that, you can read this other article I wrote to catch up.

That’s about it as far as daily habits at home to keep your teeth and your family’s teeth healthy. 1, 2, 3. Eat with a healthy daily pattern that includes swishing with water after all meals/drinks. Clean your teeth thoroughly at least once a day. Slap a little fluoride on there for good measure. 1, 2, 3. Pretty simple. Not complicated. Doesn’t mean it’s easy to do, but it is simple. It will take effort, but now you at least know what needs to be done. If you get your child doing these things early, they will grow up to be a dental rock star.

Doesn’t mean it’s easy to do, but it is simple. It will take effort, but now you at least know what needs to be done. If you get your child doing these things early, they will grow up to be a dental rock star.

Raising a Child Who Doesn’t Fear the Dentist

Mel Brooks vibes.

Oh, you thought this article was finished already? Ha, ha, ha. Nah, bra. It’s just getting warmed up. The whole reason I started writing and making videos online was to keep as many people as possible from developing problems with their teeth. That being said, I’m a realist who understands I’m not about to cure the world of all dental disease overnight. Sometimes you’re still going to need help in person from healthcare professionals.

That being the case, one of my other goals in writing and speaking online is to coach patients through having healthy relationships with their healthcare providers — relationships that result in pleasant experiences obtaining appropriate care. That’s easier said than done. I’ve come to understand firsthand the incredible challenges that can be encountered trying to provide high-quality care to various patients. I have learned about these challenges through my personal shortcomings over the years, as well as those of others I’ve seen working within our healthcare system.

In the end, so many of these challenges come down to the relationships between patients and providers. If there is trust on both sides, generally, everything works out well in the end, even with a bump here or there along the way. If the relationship is purely transactional, with minimal trust and even fear and anxiety pervading interactions…oh boy, strap in and put on a helmet because this isn’t going to be fun for anyone involved. Get ready to cry and slam your head into a wall in frustration. Don’t forget the helmet. That’s important for the slamming your head into a wall part.

I was in no way prepared for how scared patients would be of me when I became a dentist. I have had anxiety issues myself just about my whole life (didn’t properly understand that that was what was going on with me until I was well into my 20’s). Having anxiety problems as a young dentist encountering patients with severe dental anxiety was not a great combo. I’m way better at my job now, especially in handling situations when patients break down crying or lash out angrily at you seemingly out of nowhere, but it was a rough start for me. I didn’t know what was happening. It wasn’t really addressed in my training. I had to do a lot of independent research and seek out learning resources to prepare myself to help these patients well.

Why am I bringing this up in an article about parents training and influencing their children to have healthy mouths? I don’t want you to pass on your dental anxiety to your kids. I see parents doing this all the time. It’s ok that you’re scared of the dentist. I’m not questioning that you’ve had bad experiences. You have every right to be upset about that. The emotions you feel and the intense fight or flight response that gets triggered every time you step foot in a dental office is real and outside your control. You deserve to work with professionals who understand that and will treat you with patience and kindness.

Still, we have to be very careful about what we say and do in front of our kids. They are always watching and learning. If you tell them that the dental office is a scary place with big needles and loud drills, how psyched to have a filling taken care of do you think they will be? If you tell them how much teeth hurt, are you sure that is going to stop them from eating the wrong foods, or is it just going to scare them away from dental offices for years so that when they finally show up, they have a bungus load of cavities that need to be taken care of? Then they dread the appointment for a month, and their anxiety level skyrockets, and they end up canceling their appointment, and then they don’t come back until they have a toothache that’s so painful they can’t sleep or function?

This is not a story I’m making up. This is an everyday occurrence. This happens ALL THE TIME. High dental fear has a prevalence of about 14%. These are not small numbers. You can help change this.

It’s ok for you to be scared of the dentist. It’s ok to need nitrous oxide, oral sedation, IV sedation, or even general anesthesia for dental work. You have to do what is best for you. However, all of those things get a little to a lot more expensive. Wouldn’t it be nice if your child associated going to the dentist with comfort? Is that even possible? Yes, it is.

Part of this will require some scouting on your part. You should scope out a potential new dental office yourself before you bring your kids there. Make sure you are comfortable with the staff and the doctor. That’s important. As a general rule, until you’re confident that you will have a comfortable dental appointment, I would avoid bringing your kids to your dental appointments. Again, you just don’t want your anxiety rubbing off on them.

Sometimes I see parents bring kids into the office first before scheduling their appointment. I wouldn’t go that route. I get it. You’re scared. The kids are the guinea pigs to see if I’m a jerk or not. I wouldn’t use your kids as the guinea pigs. Check it out for yourself first (obviously, if it’s a pediatric dental office, you won’t be able to schedule an appointment, but you can still read reviews and ask around with other parents).

I’ll be the first to admit that I’m not fantastic at working with kids as a dentist. I work with plenty of kids, and most of the time, it goes just fine, but I’m still not great at it. At one point, I thought I might even want to be a pediatric dentist because of how much I enjoyed coaching kids in swimming. That seems laughably naive now. Taking care of kids in a healthcare environment is nothing like coaching them in a sport. Research has also shown that dentists with kids of their own are often better at working with children to provide care.

Why am I telling you this? Well, often, when I suggest to a parent that I refer their child to a pediatric dentist for treatment because I have concerns about my ability to manage them successfully, the parent gets upset with me. They don’t like hearing that they need to go to another office for treatment. I always try to make the best call based on my experience so that their child will have a positive care experience. I promise that the extra time and money at a specialist office is worth it if the result is that your child continues to have a positive view of dental care and grows into an adult who has a healthy relationship with dental care providers.

Once you find an office and dental care staff you like, always talk about dental visits positively. Even if you had an anxious dental visit and it stressed you out, don’t share that with your kids. Don’t vent to them about it. Don’t say, “You better take care of your teeth, or else you’ll end up hurting like me.” It’s better to frame everything in positive terms when teaching them to care for their teeth.

Don’t hide dental visits from your kids. Let them know of any upcoming appointments, and try to be excited about it for them. Tell them how nice the people are at the office, or remind them of staff members they like if they have been to the office before.

If your kids have questions (as they almost always do), do your best to answer them. I wouldn’t let them read any of my articles or watch any of my videos as I can get a little PG-13 (or worse) sometimes, but you can pass the useful info along through your filter. Never miss an opportunity to gently remind them of the benefits of a healthy mouth in terms they might be attracted to. For example: a charming/alluring smile, fresh breath, white teeth, ability to chew (something we often take for granted), the ability to speak confidently, etc.

Ideally, you want to avoid bribing your kids to go to the dentist. Don’t tell them they get ice cream after they survive a dental visit. If you associate an appointment with getting a reward, you’re subtly admitting that there is something “bad” about dental appointments. Try to avoid that association in your kids’ minds. Even I break this rule when kids get fussy at appointments because we offer them toys, but it’s a goal to aim for.

Also, I know I’m writing an article all about how you don’t actually need to go to a dental office in order to have healthy teeth. However, it is still a good idea to take your child to a dental office early in life for one simple reason: acclimation. You want the dental office to be a familiar environment for your child. We typically fear the unknown. If your child grows up habituated to some weirdos scraping and looking at their teeth every 6 months, they won’t view a trip for a chipped tooth when they’re older as a big anxiety-inducing nightmare.

Am I being a hypocrite right now? Maybe a little. Look, I’m devoted to the idea, supported by lots of valid science, that you technically can keep your teeth and gums perfectly healthy throughout your lifetime without any in-person assistance from dental care providers like myself. That’s why I started all this online stuff. I’m trying to reach the massive numbers of people who have slipped through the cracks of our dental care system. It’s why I write things that are a little quirky and off the wall. It’s why I release a fair bit of my zany insanity on my YouTube channel. I’m trying to grab some of the attention you’re giving to Wolf Blitzer over on CNN or to all those gorgeous young ladies twerking on the Tikking Toks. Did I also mention I’m available on the Tikking Toks?

That being said, you don’t want a dental office to be a foreign environment for your kiddo when they happen to need a little help. That’s why regular dental visits as a child are important. The American Association of Pediatric Dentists recommends that every child see a dentist starting at age one. You may have heard from your dentist that they start seeing patients at age three. If your child is going to have problems with baby bottle decay, that’s too late. It’s also a missed opportunity to start familiarizing them with the dental office and staff.

If you want to be a super-parent who raises a reader, you can even start reading your kids some dental storybooks to make the dentist seem more fun and familiar. Did I just link to Pinterest? Yes, I did.

Find a pediatric dental office. Introduce your baby. Set them up for a lifetime of dental health. Once your kid is a dental rockstar adult taking care of their teeth at home and comfortable working with dental care professionals, they can consider spacing out the visits to longer than 6 months apart.

This next part is going to upset some parents (if I haven’t already upset you), but it needs to be said. It is best if you DON’T accompany your kids into the dental treatment room. Most pediatric dental offices are good about enforcing this. I don’t do a good job of putting my foot down about it with parents when I’m at work, and it causes more problems than it helps.

If kids get scared or worried, they naturally reach out to mom and dad as their security blanket. If they know they can grab you and that will stop whatever has them anxious, then that is what they are going to do. As hard as it is, sometimes we just have to face our fears and take care of business. That’s the way life works. Dental offices are no different.

The kids I see who struggle the most often have “helicopter” parents who hover over the dental chair, asking questions during treatment and repeatedly checking in to make sure their child is ok. I understand those impulses. You want to make sure they are fine. However, this behavior undermines the trust between the child and the care provider. If mom or dad has a worried look on their face and keeps asking questions in a worried tone, it doesn’t take long for your mini-me to start thinking something is wrong, and they need to get out of this situation.

If you don’t trust the dentist, your child won’t trust the dentist. That means you need to find a dentist who you trust to treat your child while you are not present in the room. I’ve seen children brought to tears by the incessant worrying of their parents in a dental operatory.⁶ It puts me in a strange position. I usually don’t say anything because it’s rather taboo to offer anyone parenting advice, especially face to face, and especially when I don’t have kids of my own. I’m just letting you know that the kids who handle dental appointments like pros typically don’t have a parent in the room holding their hand. It forces them to grow up a little bit, and most kids rise to the occasion if you give them a chance.

Hopefully, I haven’t offended any of you too much. I’m just trying to offer my best, honest advice. The good news is that if you hate everything I’m saying, you don’t have to see me as your dentist. There are lots of other dentists with different dispositions and skillsets out there for you to choose from. I want to help you figure out who the right dentist for you and your family is. You won’t hurt my feelings if you hate my stinkin’ guts.

Having dental work done is weird. It’s never going to be normal to have someone reach inside your mouth and fiddle around. I’ve been reaching into people’s mouths for almost a decade now, and it’s still weird for me. I don’t like it when we accidentally make eye contact. Gives me the heebie-jeebies.

Still, until the robots take over, we’re going to have to keep having people reach in our mouths and look around and perform little microsurgeries. Until everyone suddenly becomes flush with tons of extra cash, we’re also going to have to keep doing those microsurgeries while people are awake. I don’t expect anyone to enjoy that. However, I don’t think we have to panic about it. If we make a solid effort to build trust and respect, much of the anxiety and fear will go away. Raise yourself some self-assured, knowledgeable kids who know how to express themselves confidently and thoroughly to a dentist. Teach them that dental care is valuable and worth the preventative care investment to avoid costly and difficult repairs down the line. Help change the dental fear zeitgeist.

Oh, you thought this article was finished already? Ha, ha, ha. Nah, bra. It’s just getting warmed up.

What to Ask About and Expect at Dental Visits Depending on Your Child’s Age

If you are still reading this article (Bless you child! You are clearly a parent on a mission to raise a kick-ass kid. Keep up the good work!), I would think I have convinced you of the importance of making dental health a priority in life. I think you are well on your way toward healthy teeth and gums for you and your family, and that is no small thing! This next section is going to discuss in broad terms what you should be looking for and discussing with your dental care team at various ages for your children. I thought it would be helpful for you to have an outline of the dental milestones most of us go through as we grow and develop. Again, I just want to build your confidence in the discussions you have with your dental care providers. I want to help you strengthen those relationships and improve trust and understanding so that you can make informed decisions about what is best for you and your family.

Age 0–5 (Your Child Only Has Baby Teeth)

Age 0 to 5? Isn’t zero a little young to be bringing a child to the dentist? Yes. That would be a little early. Technically, this should be age 1–5. You want to bring your child to a dentist starting at age 1. However, stuff happens with your baby before age 1 that still affects their oral health, and I want you to know a little bit about that stuff. Year 0 still matters when it comes to dental health, and year 0 is in your hands.

Breastfeeding

I realize I’m a dude, and you’re probably thinking, “What is this dentist dude talking about breastfeeding for? What a weirdo creep! That’s between me and my real doctor.” Look, I very well may be a weirdo creep, and I may not be a real doctor, but there is still some relevant dental information you should have regarding breastfeeding.

If you want to get that info from someone who isn’t me, check out this resource, and this resource, and this resource. When I link to outside resources, it doesn’t mean I necessarily agree with or endorse everything that they recommend or say, but I also don’t want you to 100% rely on me for your dental health information. I don’t know everything.

Current studies have shown some contradictory evidence as to whether breastfeeding can contribute to tooth decay in infants. One review showed that breastfeeding decreased tooth decay up to age 1, and another study showed that it could increase tooth decay after age 1. That’s pretty weird. The catch is that the studies from the second scientific review did not properly control/analyze the data to understand if the children who developed decay were also being exposed to other sugary foods/drinks like juice. So, not actually a great study that you can draw definitive conclusions from. The most recent scientific review concluded that breastfeeding does not increase the risk of tooth decay. That doesn’t stop sensationalist headlines from making it into the news.

The good news is that we already know that tooth decay can only happen if carbs/sugars contact the teeth for long periods of time. If we are cleaning baby’s teeth off with a damp cloth or wet mini soft-bristle toothbrush after every feeding, then the bacteria don’t have time to turn the lactose in breast milk into acid that can break down the teeth. This is especially important at night. Keep a cloth at the ready in your baby’s bedroom so that you can quickly dampen it and wipe off their teeth after feeding.

There is also some evidence that breastfeeding can positively influence the development of your child’s jawbones and muscles, as well as potentially reduce the incidence of SIDS. SIDS is still a little bit of a medical mystery, but the theory as to why breastfeeding may help reduce it has to do with how breastfeeding strengthens the jaw muscles to promote healthy growth and encourages nasal breathing.

More good news here: you don’t have to exclusively breastfeed to get these benefits. If your husband takes a turn feeding baby formula at night so you can get some shut-eye, you can still help your child’s jaw and muscle development by breastfeeding a portion of the time during the day.

Breastfeeding is a very personal decision, and different solutions will be right for different parents. Even if you only breastfeed selectively, that can still be very helpful for your child’s development and overall health. Also, realize that you should also be cleaning your child’s teeth off after feeding them any kind of formula from a bottle.

Wizard child casting bow tie spells, or, maybe just a kid with a toothache. I’m not sure.

Teething

Your baby will start getting teeth around 6 months of age. Some babies are born with a couple of teeth already present; some take a little longer to get teeth. Whenever your baby starts teething is fine. It’s not going to make a huge difference one way or the other.⁷

If you want detailed information on how to handle teething, check out these helpful resources:

One — American Dental Association

Two

Three

Four — American Academy of Pediatrics

When your baby is teething, you may notice they become fussier, don’t sleep as well, drool more, reject food, and put their hands in their mouth more.

Here are the basics:

1. Do NOT use numbing gels on your child. These can cause a rare but life-threatening reaction called methemoglobinemia.

2. Gently rubbing the gums with a cool, clean piece of gauze or allowing your baby to suck on a sugar-free popsicle may be soothing.

3. If you get a teething ring, make sure it is made from solid rubber, is not filled with liquid, and does not have any small parts that could come loose and pose a choking hazard.

Baby Bottle Tooth Decay

Remember from the healthy habits list above: the most important factor in whether or not cavities develop on teeth is the amount of time any carbohydrates or sugar are in contact with the teeth. Baby bottles can be a problem because they encourage sipping behavior, and the liquid comes into direct, prolonged contact with the front teeth.

Signs of early baby bottle tooth decay can include white or brown spots on the front teeth. Black spots can mean the decay is deeper in the tooth.

To avoid baby bottle tooth decay:

• Make sure you aren’t putting anything other than breast milk, formula, or water in your baby’s bottle.

• Do NOT give them juice in a baby bottle. Do NOT give them soda or “sports” drinks.⁸

• Do NOT put your baby to bed with a bottle as they could fall asleep with it in their mouth. That could be a continual source of sugar throughout the night that could wreak havoc on their teeth.

• Wipe off your baby’s teeth after feedings.

• Consider having your baby drink some water after drinking formula/milk to rinse the teeth off.

• Sippy cups can pose very similar tooth decay problems as baby bottles because of the slow drinking pattern that easily coats the front teeth in liquid. Consider encouraging your child to start drinking from an open-top cup starting as early as 6 months of age. Life is all about learning through continual failure. It’s ok if your kiddo spills some water on the way to becoming a confident cup drinker. Be positive and encouraging of their efforts.

• And again, do NOT put juice, soda, or “sports” drinks in a sippy cup for your child.

For more on this topic, check out these helpful resources:

One — American Dental Association

Two

Three

Pacifiers and Thumb Sucking

Pacifiers can be very helpful in calming down your baby. There is also some evidence that they may reduce the incidence of SIDS. Lots of kids have a hard time breaking a thumb or finger-sucking habit. When do these behaviors become a problem?

You want to start weaning your child off a pacifier and leading them away from thumb sucking by at least age 2. It may take a while to break the habit fully. If you can eliminate thumb sucking by age 3, your child should be at minimal risk for growth and development issues.

Why does pacifier use and thumb sucking cause problems? The position of our teeth is influenced by the force of the pacifier or thumb sitting between the teeth, as well as the force of the cheeks sucking in on the sides and pressing on the teeth.

I can often tell when a child has used a pacifier or sucked their thumb heavily as they have been growing. They will develop what is called an anterior open bite where the front teeth don’t come together when they close their jaw. Often a posterior crossbite will also develop in which the upper and lower teeth contact each other in a reversed position. These altered bite relationships can be less than ideal for chewing food, speaking, and maintaining a confident smile.

If you give your child a pacifier:

• If you’re breastfeeding, don’t introduce it until your baby is 3 to 4 weeks old and you have established a consistent nursing routine

• Wash it before first use

• Clean it regularly

• Check frequently for cracks, discoloration, or tears in the pacifier’s rubber and discard if damaged

• Do not tie pacifiers around your infant’s neck

When it is time to get rid of your child’s pacifier, this could be an opportunity to introduce the Tooth Fairy. A little cash reward under the pillow might go a long way.

As far as breaking a thumb-sucking habit, that’s a little different. You wouldn’t want to put that under your child’s pillow for the Tooth Fairy to lop off. Humans need our opposable thumbs. I wouldn’t be capable of performing much dental work without my thumbs. They aren’t quite as disposable as those good for nuthin’ wisdom teeth, right?

For great tips on helping your child kick the thumbsucking habit, read here and here. Is it lazy writing of me to just be directing you to outside sources? Yea, maybe. They did a nice job, though. Why reinvent the wheel? This article is plenty long as is.

I will say that the second WebMD article I linked was a bit enlightening for me. It brought up some things that run counter to what I was taught as a dental student. As dental surgeons, we have traditionally been trained to intervene in some way for patients. There was a heavy emphasis in my training on surgical procedures to “fix” patients.

As I’ve practiced in the real world, I’ve come to see that approach as highly inadequate. My care philosophy is focused on preventative medicine and keeping patients healthy as much as possible, rather than intervening with some dental gadget or gizmo. We still need the gadgets and gizmos when things have already gone wrong, but I don’t think they are ideal treatments.

How does this relate to thumb sucking? I was taught to discuss techniques with parents such as placing foul-tasting coatings on the thumb to discourage sucking, having the patient wear mittens or socks at night to block the thumb, or having a dentist place a crib appliance in the mouth to make thumb sucking impossible. I actually talked to a patient who had one of these tongue cribs as a child, and she recalls how “awful it was” and “how much she hated it.” It wouldn’t have been her chosen way to quit thumbsucking.

As that WebMD article discusses, there is an approach to quitting you can take that relies on positive psychological reinforcement instead of forceful restraint or shaming. This approach resonates when I think about how I try to help patients quit smoking to save their teeth and gums. It’s about empowering patients to make choices that are good for them. It’s not about me imposing my will and scolding you into changing.

That’s part of why I like the dynamic of writing and talking online. You don’t have to listen to me. I’m not going to pester you if you don’t. I just want the information to be available when you’re ready. My message is that a healthier you is always available to you, and it is not as complicated to understand or achieve as our culture may have taught you. Is that a lofty message to tie into thumbsucking? Maybe, but I’m rolling with it.

If you feel up to reading a thorough scientific article on this topic that will include a fair bit of dental jargon, check this out and read the first section under “Recommendations” titled “Oral Habits.”

For some more accessible extra info on pacifiers and thumbsucking, check out the following resources:

One — Mayo Clinic

Two — American Dental Association

Three

Full body armor.

Facial/Dental Trauma

Children fall down a lot. They get hit in the face. They put things in their mouths that they shouldn’t. C’est la vie.

I’m not going to tell you to box your children up so they can’t explore the world. If you haven’t seen Finding Nemo, check it out. You have to let your kid leave the sea anemone, even if they have an underdeveloped fin. They can still make it in the world if you let them push themselves. That may mean a busted tooth here and there. That’s ok. At least they’re turning into brave little explorers.

As a dentist, I do have to warn you to keep your toddlers the hell away from electrical cords. They can’t tell the difference between that and a toy, and if they chew through it, the result can be a horrific injury that doesn’t heal well and leaves lifelong scarring and facial disfigurement. Be aware of your surroundings. Make sure baby doesn’t have access to any electrical cords to gnaw on when you’re not looking.

What if baby decides to take a nose dive while trying to pull an ollie on their board at age 3 or 4 and busts a tooth? If you knock out a baby tooth, you leave it out. This shouldn’t cause any trouble with the permanent teeth when they come in. The roots on baby teeth aren’t long enough to successfully replant them in the mouth.

What if your kid beefs it pulling that same ollie attempt at age 7 or older and busts out a permanent tooth? First, take a half-second to consider why they weren’t wearing a mouthguard. Right after that, spring into action.

If they only chipped the tooth, try to find the tooth right away and get to a dentist so they can bond the fragment back in place. The dentist will also check to ensure the rest of the root and bone around the tooth are in position.

If they knocked the whole tooth out, find it, and clean it in milk or, better yet, some saline solution designed for teeth. Make sure you only handle the tooth by touching the crown portion (the part that you would recognize as a tooth shape). Don’t touch the root. Do not rinse the tooth off with normal water. It needs to be the right balance of saltwater. Why?

There are lots of cells on the outside of the root of the tooth. If you remember osmosis from biology class, water will flow through a semipermeable membrane (like a cell wall) until the salt concentration is balanced on both sides of that membrane. If you put water that doesn’t have any salt in it on that tooth, that water will flow into our naturally saltier cells to the point that it stretches the cell walls so much that they burst. Now we have killed the cells on the outside of the tooth root, and it won’t heal back into the tooth socket how we want it to when we place the tooth back in position.

If you feel confident enough to reposition and place the tooth back in position after you have cleaned it in milk or a saline solution, go for it. The faster those cells are in their home environment, the better. If you’re not comfortable placing it yourself, you have about 1–2 hours to get to a dentist who can place it before those cells die. Keep the tooth in the liquid on your way to the dentist.

Either way, you’ll still want to see a dentist to have them check your positioning and possibly place a flexible splint to reinforce the tooth position for a couple of weeks. A root canal will also be in the future for that tooth, but if you can keep the cells on the outside of the root healthy by following this protocol, the tooth should still move with the rest of your child’s teeth as he or she grows. Another healthy smile survives a skateboard catastrophe. Wear a mouthguard next time.

Don’t be afraid to be picky with finding the dental office that is right for your kids. You want to set them up for a lifetime of dental health, and introducing them to dentistry with an expert who can make the experience enjoyable is of critical importance.

Finding the Right Dental Office

If you talk to many general dentists, you will hear them say that they typically start seeing children at age 3. We don’t really get much, if any, experience working with children younger than that in dental school. Some of us, including myself, aren’t exactly stellar at working with very young children. As I’ve made clear in this article, if you wait until age 3 for a dentist to see your child, they could have tooth decay issues that are a BIG problem already and require expensive treatment in a hospital setting.

What to do? If you can find a general dentist who is comfortable seeing your child starting at age 1, that’s awesome. I still do see children that young. I still see 2-year-olds. I do my best, but it isn’t my every day, so I don’t claim to be an expert. Who are the experts in seeing children starting at age 1? Pediatric dentists.

Also, if you’re concerned about cost, realize that there are pediatric dentists who take Medicaid insurance that your child could be covered by.

I can say that based on my personal experience of always seeing a pediatric dentist since I was a young child, I have never had a fear of the dentist. It was always a simple and pleasant experience for me. I always felt safe and comfortable. The dentist was a place I went to watch Pixar movies and get balloon animals. There was nothing scary about it.

Don’t be afraid to be picky with finding the dental office that is right for your kids. You want to set them up for a lifetime of dental health, and introducing them to dentistry with an expert who can make the experience enjoyable is of critical importance.

Age 6–11/12 (Your Child Has a Mix of Baby Teeth and Adult Teeth)

Age 1 up to age 6 at a dental office is all about learning. We want mom and dad to learn the habits at home to take care of their little tyke. We want your little tyke to learn to be comfortable and relaxed in a dental office around dental care professionals. If those goals are accomplished, then age 6–12 in a dental office should also be relatively uneventful. Realize that as your child is gaining independence, they will have more opportunities to make food and drink choices for themselves. Keep modeling healthy choices and be positive and encouraging when they do the same. Positive reinforcement is always more powerful over the long run than shaming or scolding.

Your dentist will continue evaluating your child's growth and development to make sure there is going to be room for all the teeth and to ensure speech, chewing function, breathing, and smile esthetics are all tracking well. Sometimes a little help may be needed from an orthodontist to influence growth and make extra room.

From a cavity prevention standpoint, your dentist may recommend sealants when the permanent molars start coming in around age 6. Why are sealants helpful? The back molars tend to have more grooves and pits on their surfaces. These are places that food and bacteria can pack and get stuck. Much of the time, these little indentations in the teeth cannot be thoroughly cleaned even by attentive young toothbrushers.

A sealant is like weatherproofing a wooden deck. It keeps the bacteria and food out of these grooves so they can’t cause problems deeper in the tooth. Sealants create a smooth, shallow surface on the top of the tooth that is easy to brush clean.

Sealants are an easy procedure to use to introduce your child to dental treatment as well. They don’t require any numbing. It’s an opportunity to both protect the teeth and show your child that working with a dentist on an actual procedure doesn’t need to be scary.

I have encountered many parents concerned about the chemical composition of dental sealants and don’t want to have them placed because of this. First off, dental sealants are made out of the same materials we use to place white dental fillings, so if you don’t have sealants placed and your child gets a cavity, they will end up with a larger amount of the same material in the tooth.

Secondly, dental sealants are safe. The primary concern is with BPA levels. Studies have shown that any BPA exposure from sealants is minimal and transitory. Much as with the phobia some patients have regarding dental x-rays, it’s not enough exposure to cause any problems, and it’s far less exposure than plenty of other regular daily activities. If you still have concerns about dental sealants, I suggest you read this highly informative page from the American Dental Association on the topic.

Thirdly, sealants really do offer extra protection to teeth in a unique way. Interestingly, without sealants in place, fluoride can actually make it harder for a dentist to tell when there is decay on a back tooth. What’s up with that?

Fluoride is normally great for teeth. It gets absorbed by the teeth and makes them more resistant to acid breakdown. The issue with back molars and their grooves is that they serve as an Achilles heel fluoride can’t protect. Sort of like that weird vent that let the rebels blow up the Death Star. Those little grooves let bacteria and food have a party and provide access for acid into the middle of the tooth, fluoride or no fluoride. Then, because the fluoride keeps the rest of the tooth looking healthy on the surface, the decay on the inside of the tooth actually ends up getting bigger before your dentist notices that it’s there. Whoops!

Solution? Keep using fluoride as indicated with your child’s toothpaste and with fluoride varnish treatments at your dentist, but get your kids back teeth sealed when they come in for extra protection. In a weird twist of dental poetic justice,⁹ fluoride also actually stops sealants and fillings from bonding to teeth, so if you have sealants placed on the teeth, it needs to happen before that appointment’s fluoride treatment.

Let’s see…what else is going on from age 6-ish to 12-ish? If your child is starting to play sports, that is also a great opportunity to talk to your dentist about mouth guard options as well. Since your child will be growing and losing/gaining teeth, you’ll likely need to get a new guard each year. Not everyone may be able to afford a professionally made mouth guard every year, but luckily there are good options available online.

Speaking of gaining and losing teeth, this is the time period when your dentist will be assessing if your child has room for all of his or her permanent teeth. Permanent teeth are larger than baby teeth, so sometimes there can be crowding issues. As previously discussed, breastfeeding and avoiding prolonged pacifier use or thumbsucking can help influence growth and development so that the permanent teeth have enough room to come in straight. Is there anything else that can be done if your child is having tooth spacing or alignment issues?

Around age 6, when the first permanent molars come in, your child can see an orthodontist for something called a palatal expander. What does that do? It fits on the roof of the mouth and helps expand the bone of the upper jaw. This expands the whole dental arch, so you have more space for teeth to come into position.

Why do some patients need palatal expanders? That could be another very lengthy article. One well-supported theory has to do with the influence of nasal breathing. “Huh?” Yep. Short version: breathing through your nose regularly is healthier than breathing through your mouth for all kinds of reasons. One of those reasons is that when you breathe through your nose, your tongue compresses to the roof of your mouth. The compression of the tongue to the roof of the mouth puts pressure on the teeth to move out to the sides. Bone follows the teeth. The arch expands naturally without an artificial expander. By contrast, if you breathe through your mouth all the time while growing, the tongue drops to the floor of the mouth for air to pass over the top of it, and you end up with a narrower arch on the roof of your mouth. A narrow arch means less room for the permanent teeth and more crowding.

I guess I technically should have talked about encouraging nasal breathing for your child in the age 0–5 section. Sorry, I’m not perfect. This is your reward for continuing to read this book. There are other orthodontic issues your dentist will screen for at these ages as well. Everyone’s treatment philosophy on when to intervene will vary slightly here and there and depends on the particular patient. The bottom line is that if you take your child to a dentist for regular evaluation during this transition period from baby teeth to adult teeth (which is usually complete by around age 12 or 13), they will often catch issues that can be resolved with a simple intervention at the younger age. Even if your child still wants treatment with braces or clear aligners, they will need them for a shorter period of time.

This is when your kid starts hanging out with a bunch of other punks you don’t like. They get your kid smoking and drinking. Now your kid’s got a tongue piercing, and it’s acting like a wrecking ball knocking into the back of the bottom teeth and causing gum recession that can cause them to loosen up and shift out of position over time. Smoking, drinking, tongue piercings, HPV…when will it end?

Don’t bother children when they are skateboarding.

Teens (Your Child Has Only Adult Teeth)

This is the time when all our hard work goes out the window. You diligently modeled healthy habits for your child throughout the first twelve years of their life. You didn’t keep junk food that’s bad for your teeth around the house. You took them to the dentist for regular check-ups, and they passed with flying colors. That was the hard part, right? What could possibly go wrong?

Everything.

This is when your kid starts hanging out with a bunch of other punks you don’t like. They get your kid smoking and drinking. Now your kid’s got a tongue piercing, and it’s acting like a wrecking ball knocking into the back of the bottom teeth and causing gum recession that can cause them to loosen up and shift out of position over time. Smoking, drinking, tongue piercings, HPV…when will it end? Then, you thought you could trust your dentist to take care of your kid, but you’re reading stories about opioid addictions starting after wisdom tooth extractions. What gives man? Why do teenagers suck so much? We put a lot of work into these ungrateful little ding dongs. This is how they repay us? And dentists too! Why do dentists suck again all of the sudden? I thought they were on our side?

Let’s pump the brakes a little bit. As much hell as teenagers put the rest of society through, they’re having a rough time themselves. Sure, they don’t have a job. That doesn’t mean they don’t have a lot to deal with in life. They have no idea who they are yet. They are fumbling through life, trying to transition from a time when everything was decided for them to a time when they have to figure out how to make healthy decisions for themselves. That’s not easy.

They’re gonna eff it up. Repeatedly. I’m in my thirties, and I still eff it up repeatedly. Don’t judge them too harshly. We’re all bumbling, fumbling idiots in our own way. We all have our deficiencies. Just do your best to support them when they make good decisions and to gently correct them when they make not-so-good ones. In the end, they’re the ones in the driver’s seat at this point. You have to let the little birdies learn to fly by trial and error. Some of the birdies crash and burn during the test flights. That’s just part of life we can’t avoid. We have to let them try anyway.

How tired are you of this parenting advice from someone who isn’t a parent? Have I enraged everyone sufficiently yet?

Here’s a shortlist of the dental problems teens and young adults are more likely to face:

• Increased decay rate from poor eating and drinking habits as they have more independence outside the home to make wild choices like drinking rowdy, exciting dirt bike fuel like Monster energy drinks and Redbull, etc.

• Increased gum disease from hormonal changes and lack of a flossing habit

• Increased gum disease from initiating a smoking habit

• Severe tooth erosion from vomiting that can accompany eating disorders (Bulimia nervosa). It’s hard for women out there on Instagram and Tik Tok. We gotta cool it with these filters. I only had a little bit of body dysmorphia as an adolescent, but it was enough for me to repeatedly rip a mole off of my face because I thought it was unattractive. The mole is still there. I eventually made peace with it. I still think about my hairline more than a healthy amount, though. A fellow comic told me I had a big forehead once. Still stings. You know what else stings? Vomit. If you are struggling with an eating disorder and throw up a lot, be sure to rinse your mouth out thoroughly with baking soda mixed with water afterward. Rinse real well and spit to get that stomach acid off your teeth fast.

• Deciding whether or not to remove wisdom teeth

• Experimenting with prescription pills and getting addicted to opioids starting a chain of behavior that leads to overdose at a young age. Not their fault. Don’t judge. Their brains aren’t developed yet, and this disease kills lots of “full-brained” adults too.

If you and your kids make it through the teen years with all the teeth healthy and intact, it should be relatively smooth sailing from there. Keep the habits in place, and you should have a lifetime of dental health ahead of you. There is no reason you can’t go to the grave with a full set of beautiful, healthy teeth in your head. Wasn’t this article supposed to be about parenting tips? Now this guy’s talking about graves all of the sudden?” Yea, because if you put the right habits in place and keep them in place, you can have a beautiful smile for life. Most of the work happens outside a dental office without the help of a dentist. You don’t have to pay weirdos like me to have a healthy smile from cradle to grave. Weirdos like me are available for when you or your kids go off the rails and do something that isn’t so healthy, but you don’t actually need us. If this article hasn’t fully convinced you of that, check out my YouTube channel. Maybe I’m more convincing when you can have a solid look at my stupid face.

I’m in my thirties, and I still eff up repeatedly. Don’t judge them too harshly. We’re all bumbling, fumbling idiots in our own way. We all have our deficiencies. Just do your best to support them when they make good decisions and to gently correct them when they make not-so-good ones. In the end, they’re the ones in the driver’s seat at this point. You have to let the little birdies learn to fly by trial and error. Some of the birdies crash and burn during the test flights. That’s just part of life we can’t avoid. We have to let them try anyway.

Summary:

I don’t even know what I’m talking about anymore. This was a marathon, and I don’t think I trained for it properly. I hope what I just wrote above this was understandable and helpful enough. Let’s try to land this albatross.

To review: Dental decay, and lots of other dental problems, are VERY common. They affect TONS OF PEOPLE. Most people have a perception that these problems are both inevitable and expensive to fix. The reality is, most of these problems can be prevented from ever occurring if you know what to do. Many of them can be prevented with the right behaviors at home.

The dental profession as a whole recognizes this in the studies and policy statements that we publish through various organizations. However, we have not been able to figure out how to get this information out to the public effectively. Not only do I have to find a way to inform you. I have to find ways for you to implement and adapt that information in your daily life. It’s not very helpful for me to mention the importance of flossing at a dental office visit if you don’t take the idea to heart.

I don’t expect any miracles from writing this article either. I know it’s an uphill battle. I know it’s going to take a lot of experimentation and failure for me to find tactics that are actually helpful. I simply felt the need to start trying something different because I have to say I get pretty depressing results much of the time in my clinical work as a dentist.

Maybe I just suck at my job, but part of me thinks that a dental office just isn’t a great place to try to teach people about dental health. Most patients are too on edge and rushed to absorb information. Hardly anyone is ever in the mood to have a conversation with me. That’s, of course, if I even have the time to spend to have an in-depth conversation when I’m busy at work doing procedures. How long would it take me to convey all the information in this article to a single patient in a dental office? An hour? Two hours? That’s just not practical.

My next best option? Make the information more widely available and accessible. Try to make it at least moderately engaging and interesting to read. If I make a YouTube video, try to make it even entertaining.

I also want this information to reach the people who need it most. The growing tooth decay rates around the world are alarming. This is also a huge problem here in the United States. This is an issue for a faltering middle class who is struggling with health expenses. I know how hard it is to deliver affordable interventional healthcare. It’s not easy. It’s expensive and difficult.

Consider these staggering facts:

“Treatment of [early childhood caries] is expensive to families and society in general, with 20% of children, mostly from lower SES families, accounting for more than 80% of cases. Treatment must often occur under general anesthesia in an operating room. In 2012, more than 25% of Medicaid dollars spent treating caries in children under 6 years of age were spent on the 2% of patients who required this mode of treatment. 50–80% of children undergoing treatment in the operating room have new cavities within 2 years.”

- Compendium of Continuing Education In Dentistry, February 2019

and…

“In 2015, 57% of children on Medicaid did not receive preventive oral health services. Medicaid patients ages 1 to 5 accounted for 45% of total dental costs, even though this age group represented only 5% of the insured population.”

- Decisions in Dentistry February 2019

And before you go blaming the difficulty of treating this problem on a lack of “universal health care,” realize that countries with those healthcare models face the same problems:

“Extraction of infected carious teeth is often the only option — a traumatic experience for both child and family. If facilities exist, these extractions are often carried out under general anaesthesia in a safe environment, but this is expensive. It is of considerable concern that in several high-income countries, dental extractions are among the most common reasons for hospital admission in infants and children. In 2016–2017, a total of 30 238 children aged 0–9 years were admitted to hospital for extraction of decayed teeth in England (population 53 million). This figure excludes extractions under general anaesthetic in young children carried out by community dental services and private hospitals. Tooth extraction was the most common reason for hospital admission for children aged five to nine years. The average cost of admitting a child aged 5 years or under for tooth extraction is £800–900. Similarly high numbers of hospital admissions for dental extractions in young children have been reported in Australia, the United States of America, Israel and New Zealand.”

- Quoted from the World Health Organization implementation manual for ending childhood dental caries

The sort of harsh reality I’m trying to get across here is that health care workers, charities, and the government CANNOT provide health. They can help some, but unhealthy daily habits woefully outmatch them in trying to make people healthy. No outside force can make an autonomous human being healthy. You need that free, autonomous human being to be making healthy choices for themselves, and then all the supportive health workers and infrastructure fill in the gaps and patch the holes when things go unexpectedly wrong. That’s the only way we get healthier as a group. Individual effort supplemented by professional expertise and assistance.

As I said at the beginning of this article, parents and families are foundational to health. You have to figure out how to get yourself healthy, and then you have to pass that wisdom on to those you care about as best you can. I want to help empower you and your family to be competent and confident in your ability to take care of yourselves.

I studied economics a bit back when I was in college (what a ringing endorsement of my economic acumen, eh?). That background has had a hefty influence on how I view solutions to the problems I’ve encountered working as a dentist. If you like how I approach things and want more inspiration, I highly recommend reading Richard Thaler and Cass Sunstein’s excellent work, Nudge. I consider myself a libertarian paternalist. I want you to have the freedom to make decisions for yourself, but I’m going to gently nudge you toward decisions that I think would be healthiest for you. You can’t force people to behave in any particular way, and you can’t insulate people completely from the consequences of their actions. That’s life. C’est la vie.

Being a libertarian paternalist is not the same as being a libertarian or an anarchist. I’m not advocating we throw the elderly on the street here. There are obviously circumstances where people cannot take care of themselves. I’m not heartless. But to the extent we are able, we have to work and struggle to grow strong and care for ourselves. We cannot lie to ourselves about our own power to be agents of our own health. We have to be honest when we are not living up to our potential. Individual honesty and striving for excellence leads to group prosperity. We can be stronger together even when fighting for our individual growth.

Maybe I just suck at my job, but part of me thinks that a dental office just isn’t a great place to try to teach people about dental health. Most patients are too on edge and rushed to absorb information. Hardly anyone is ever in the mood to have a conversation with me. Of course, that’s if I even have the time to spend on an in-depth conversation when I’m busy at work doing procedures. How long would it take me to convey all the information in this article to a single patient in a dental office? An hour? Two hours? That’s just not practical.

Preparing people for this independence and responsibility starts in childhood. Again, I’m not a parent. I have no idea how hard it is to raise a child. I’m sure there would be days and nights I’d be desperate to give them candy to shut them up. But that’s not the solution. When you haven’t slept well, you’re stressed out, you just had a long day at a job you hate, your kid is wearing you down, and your brain is screaming at you to give up; I totally get that you can barely remember to brush your teeth, let alone get those meddling kids to brush theirs. Regardless, as adults, we have to set the example. We have to be strong for our kids.

I’m sure plenty of people think I’m crazy getting as worked up as I do about not giving children sugar, but to me, it’s a health crisis in this country. The best thing for our kids and the best thing for parents, the best thing for our society, is preventative care. Stopping the cavities before they start.

I want your kids’ teeth to be healthy. I want your teeth to be healthy. I don’t want to have to work on your teeth because they’re falling apart. I love it when patients are healthy. That’s awesome. That means you get to live your life happy and healthy. You don’t come into my office upset and in pain with a toothache. I don’t want you to have a toothache. That just makes you get less sleep and makes it harder to remember to have your kid brush their teeth.

If your tooth hurts, you’re not smiling as much, which makes the world just a little bit sadder. That’s not any fun. Smiling is contagious. Laughing is good. I want your family to be smiling and laughing so much that they don’t need any more sugar in their life! I want to give you the tools to keep your family healthy, but you have to stay strong and follow through. Your kids need you.

Ok, I’ll shut up now.

Thanks for reading.

Chris Hemsworth vibes.

Footnotes:

¹ Let’s be real: I can’t relate at all. I don’t even have a dog. I’m a millennial without a dog. So yea, you could say I’m a few steps removed from being a responsible parent. I’m going to cross my fingers that this footnote hasn’t crushed my credibility with all the parents out there scrolling to the bottom of this lengthy article to read it right off the bat.

² It’s not even close. No doctor can ever influence the health of a person the way their family can. The family is influencing the behavior of everyone in the family day in and day out. Doctors see you occasionally, and often only when you’re anxious/stressed and not thinking all that clearly.

³ Empathy is NOT sympathy. It is NOT pity. No one wants to be pitied. People are all strong. People are all capable. Don’t underestimate anyone. Empathy has nothing to do with feeling sorry for anyone. You don’t have to take on their emotional pain and mirror it (a lesson I have struggled to learn as a healthcare professional).

The golden rule is to treat others as you want to be treated. I like the improved version: treat others as you would want to be treated if you were them. This takes into account the fact that everyone is different and unique. It recognizes everyone’s individual autonomy and rights to self-determination instead of being paternalistically scolded into a certain type of behavior.

For more on this topic of empathetically empowering patients to optimize their individual health with a personalized action plan, I strongly recommend the book Nudge by Richard Thaler and Cass Sunstein. Libertarian paternalism is the perfect balance for compassionate and individualized health care. What’s libertarian paternalism? Read the book.

⁴ If you haven’t picked up on it yet, “caries” is a fancy word for tooth decay.

⁵ This does not hold true for how foods and drinks affect the rest of your body. This is not nutrition advice for overall health. It is only relevant for protecting your teeth. If you’re looking for a starting point for overall nutrition advice, I’d highly recommend Dr. Mark Hyman’s excellent book, Food: What the Heck Should I Eat? Also, if you’re not ready to buy a book, spend some time on eatright.org first.

⁶ As an illustrative example, I saw a 13-year-old who cried very intensely and loudly when I gave a small injection to numb a tooth. Not to brag, but I frequently get compliments from patients about how my “shots don’t hurt” and “that wasn’t bad at all,” or I hear them say, “Did you already do it? I didn’t feel anything.” I take my time in applying a local anesthetic gel to the tissue. I carefully dry the tissue beforehand and cover it with gauze so that the anesthetic can be absorbed by the tissue without being diluted by saliva. I let this gel sit for at least two full minutes. When I inject anesthetic, I slowly shake the patient’s cheek or lip as a distraction technique.

I’m not perfect, but I’m above 90% for doing the type of injection I was doing for this 13-year-old without the patient feeling a thing. Occasionally, I’ll get a patient who winces for a second here and there. People also have different pain thresholds and tolerances. Some of this has a genetic basis in how each of our nervous systems develops and is structured. But all my care in trying to deliver a painless injection gets completely undermined if the parent is telling the patient things like “I know it hurts.” and “I know it’s terrible.” If you’re a kid and your parent is repeating that in your ear the whole time your treatment is supposed to be happening, exactly how in the world are you supposed to be able to relax?

This poor girl was sobbing uncontrollably before the needle ever came anywhere close to her gums. That sobbing intensified, and her whole body tensed up when she knew it was time for the shot. There was no change in her crying when the needle went in or when I slowly delivered the anesthetic. I doubt she even felt it. That didn’t alleviate her panic. Again, these are the patients I would prefer to be seen by a pediatric dentist for sedation, but that isn’t always an option financially.

The dental fear and anxiety stoking from the parent was assuredly a strong contributing factor to this young girl’s phobia. I listened to that parent like a broken record recount over and over again how awful dental appointments are and how much she knew her child was suffering right now. Again, I understand the impulse to validate your child’s feelings. I’m not trying to be dismissive or crude, but there comes a point where validation of emotions turns a corner toward reinforcing unhealthy anxieties and fears. This parent was setting constant negative expectations for the child.

If you want to be extra nurturing and sympathetic to your child AFTER the dental appointment, that’s fine. You can reward them with some positive praise for toughing it out or being brave. But in the moment, you have to keep a stiff upper lip and encourage them to do the same. If you genuinely believe the dental appointment will be too traumatic for your child physically or mentally, even with nitrous oxide and a dental team you trust, then you need to consider IV sedation with a pediatric dentist.

⁷ Your nipples may have a very different opinion about that, but your baby will be fine. I’ll say a prayer for your nips. If that offends you, I’m sorry. This was low-hanging fruit for me comedically, and you gotta remember that at the end of the day, I’m just another dumb dude over here. Besides, you’re reading the footnotes. That’s a lot of effort to go through and then muster outrage over it. It’s like you and less than five other people on the planet who read this footnote. Just chuckle, shake your head, call me an idiot, and move on.

⁸ You might think I’m crazy for telling you not to put soda in a baby bottle. Isn’t that obvious? The reality is that not all parents or young moms have this information. What seems obvious to someone with basic dental health education isn’t always so obvious to someone else. I consider it my responsibility as a dentist to help educate the public to the best of my ability, especially those people who do not have regular interactions with dental professionals. Those are the individuals most vulnerable to experiencing poor dental health.

You may be thinking I’m writing in the wrong place if I’m trying to reach young parents who may not have access to adequate healthcare. Maybe that’s true. I’ll be experimenting with Tik Tok, Instagram, Facebook, Quora, and Reddit in the future. We’ll see what works best.

⁹ I’m not at all confident that this introductory phrase makes any sense at all, but I have to be honest, I’m getting a little bored writing this. That’s not a good sign. I better try to spice things up a little bit. If I’m bored writing it, how is anyone going to bother reading it? They probably aren’t. If nothing else, this is just training for me to collect my thoughts for future Tik Tokking.