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Oral Health Different Ages/Different Stages Birth to 12 years
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HealthyMouth HealthyYOU 39-2581G_MHP_0_12_BOOK_E.indd 1
39-2581G 39-6914C 3-18-2009 9:54 AM 0-12 ENG BOOK
100% of Final Size 5.5 in x 8.5 in 5 in x 8 in 5.5 in x 8.5 in 5.75 in x 8.75 in None None 5.5” x 8.5” None
Cossette MHP ORAL HEALTH BROCHURES 39-2581G_MHP_0_12_BOOK_E.indd 4C Cyan Magenta Yellow Black L. Dubcovsky R. Prashar
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K. Beach george lai / rekha.prashar
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100%
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TABLE OF CONTENTS 4
What Causes Cavities?
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When You Neglect Your Child’s Teeth
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Taking Care of Your Child’s Teeth • Brushing • Flossing • Fluoride
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Nutrition and Good Dental Snacking
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Good Dental Snacking and Drinks
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Injury Prevention and Mouthguards
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Dental Emergencies
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Eruption Chart (When Teeth Come In/Fall Out)
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Different Ages & Different Stages • 0 to 6 months • 6 to 24 months • 2 to 5 years • 6 to 12 years
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Dos and Don’ts for a Great Smile
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Good Oral Health Online Resources
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Why is Oral Health Important?
ORAL HEALTH • DIFFERENT AGES/DIFFERENT STAGES • BIRTH TO 12 YEARS
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IF A CHILD TELLS YOU THEIR TEETH HURT, WE CAN HELP.
The Children in Need of Treatment Program offers FREE dental services to babies, kids and teens, age 17 and under, who urgently need care. It provides: fillings, extractions and sedation • preventive dental care, including cleaning and fluoride • dental health support and information. Call or visit your local Public Health Unit today to find out if you are eligible. Because no child should ever have to suffer.
ORAL HEALTH • DIFFERENT AGES/DIFFERENT STAGES • BIRTH TO 12 YEARS
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Queen’s Printer for Ontario, 2009
FREE URGENT DENTAL CARE.
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WHY IS ORAL HEALTH IMPORTANT? In 2000, the Surgeon General in the United States wrote the first ever report on Oral Health in America. He said: “Oral health is integral to general health. You cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities. Oral diseases are progressive and cumulative and become more complex over time. They can affect our ability to eat, the foods we choose, how we look and the way we communicate. These diseases can affect economic productivity and compromise our ability to work at home, at school or on the job.” Healthy teeth and gums are important as your child grows to help them develop good speech, healthy eating habits and good social skills. • Cavities are the most common chronic disease of early childhood. • Oral diseases are infectious, often painful and expensive to treat. • Poor oral health has been linked to diabetes, heart disease and other long-term health problems in adults.
What Causes Cavities?
+
Bacteria (in plaq ue)
4
Sugar
=
Acid
=
Cavity
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The most common oral disease in children is tooth decay or cavities. They are caused by bacteria in the mouth. • Every day a sticky film called plaque forms on the teeth. • Plaque consists of bacteria and food debris that collects on your teeth day and night. • If plaque is not removed by brushing and flossing on a regular basis, it will cause cavities and lead to periodontal (gum) disease. Cavities occur when food and liquids containing sugar combine with the bacteria in plaque to produce acid. This acid attacks the teeth and can cause cavities. There’s no such thing as “Soft Teeth.” Many people believe that they suffer from cavities because they have “soft teeth.” While family history is important, most cavities develop because people eat too much sugar and do not thoroughly brush and floss their teeth.
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WHEN YOU NEGLECT YOUR CHILD’S TEETH... Children with poor oral health tend to struggle in school, may lack self-esteem and may have less success later in life. This could lead to undesirable outcomes such as: • Cavities and gum disease • Pain • Infection • Loss of teeth • Poor nutrition • Lack of sleep • Lower body weight • Prolonged infection and/or swelling • Difficulty learning and communicating • Poor self-esteem • Future serious dental problems • High cost of dental care
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ORAL HEALTH • DIFFERENT AGES/DIFFERENT STAGES • BIRTH TO 12 YEARS
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TAKING CARE OF YOUR CHILD’S TEETH Brush Your Child’s Teeth Every Day 2 FOR 2 IS WHAT YOU DO...
• We recommend that you brush your child’s teeth for two minutes twice a day. • Bedtime is the most important time to brush to prevent cavities. • Use a manual or power toothbrush with soft bristles. • Use a toothpaste that contains fluoride and is recommended by the Canadian Dental Association. • Move the brush in a small circular motion over the teeth and gums. • Brush all the outside, inside and chewing surfaces of the teeth. • Gently brush the tongue to remove any germs and to make your child’s mouth feel fresh.
Floss Your Child’s Teeth Every Day
• Take a piece of floss about 45cm (18 inches) long and wrap it around the middle finger of each hand until you have no more than 2.5cm (1 inch) in length between them. • With the thumb and index finger of each hand, guide the floss gently and carefully between each tooth using a back-and-forth motion, until the floss reaches the gum line. • Curve the floss into a C-shape around each tooth and slip it under the gum line. • Slide it up and down the side of the tooth. • Move the floss to the side of the next tooth and repeat. • Remove the floss and repeat the above steps for each tooth.
Let your child practice these new skills, but remember, as the adult, you are the one to do the job effectively!
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• We recommend flossing at least once a day to clean between the teeth and under the gums.
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Use Fluoride Every Day Fluoride is a naturally occurring substance that helps prevent cavities by strengthening the enamel, or outer layer, of the tooth. There are four main sources of fluoride: most tap water, many toothpastes, mouth rinses and professionally applied fluoride at the dental office. Fluoride is also found in many foods.
Tap Water • Over the past 60 years, it has been a major factor in the decline of tooth decay. • Fluoridation of community water supplies benefits everyone equally and is cost-effective, as it saves money on dental treatment needs. • The fluoridation of drinking water supplies is a decision made by municipalities. Health Canada has recently accepted an optimum recommendation of 0.7 mg/L, which is within Ontario’s recommended range of 0.5 to 0.8 mg/L. T:8.5”
Fluoridated Toothpaste • Health Canada recommends that children use no more than a pea-sized amount of toothpaste and are taught to not swallow the toothpaste. Children aged six and under should be supervised while brushing. Children under three should have their teeth brushed by an adult, without toothpaste, unless deemed high risk.
Professionally Applied Topical Fluoride • Your dental professional may suggest that your child could benefit from a topical fluoride treatment at their checkup appointment, or suggest a fluoride rinse or supplement.
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NUTRITION AND GOOD DENTAL SNACKING Give your child nutritious meals and snacks to help develop strong bodies and healthy teeth that will last a lifetime.
Be a good role model. Healthy eating and active living are important for your children to reach their full potential. • Choosing a variety of different foods from each of the four food groups, as recommended in the new Eating Well with Canada’s Food Guide, will help your children achieve proper energy levels, growth and overall health. • Start the day in a healthy way! Eating a nutritious breakfast is a great start to your child’s day. Try cereals that are low in sugar, whole grain breads, fresh fruit, yogurt, milk, cheese and eggs.
Healthy Lunches and Snacks for School
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• Involve your child in planning lunches and snacks. • Do not let lunch and snacks get boring. • Offer your child a selection of nutritious foods and let them choose their favourites. • Think like a kid. Stick to foods you know your child will like. Introduce new foods at home, instead of in the lunch bag.
What Should Kids be Eating? • Fruit and vegetables, including the following: carrots, celery, cucumbers, peppers, broccoli, apples, oranges, bananas, kiwi, watermelon, pineapple, strawberries, blueberries, cherries. • Grains: bread, bagels, pitas, unsweetened cereals, pasta, rice, crackers. • Milk and alternatives: yogurt, cheese, milk. • Meat and alternatives: fish, chicken, turkey, beef, ham, beans and lentils, pumpkin seeds, nuts and sunflower seeds.
Note: Be aware of allergy restrictions in schools and daycares. Need Help Planning Healthy Meals and Snacks? You can speak to a Registered Dietitian personally by calling EatRight Ontario toll-free at 1-877-510-510-2, Monday, Wednesday and Friday – 9 a.m. to 5 p.m., with extended hours on Tuesday and Thursday evenings until 9 p.m. The EatRight Ontario Call Centre provides trustworthy nutrition information free of charge to all residents in the province and has the capacity to answer questions in more than 110 languages.
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GOOD DENTAL SNACKING AND DRINKS • Snacks that are nutritious, sugar-free, and do not stick to your child’s teeth are the best dental snacks. • Research shows that eating cheese may help prevent tooth decay. • Kids should drink milk, water and a limited amount of 100% fruit juice. • Children should not be given energy drinks.
Liquid Sugars
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• Soft drinks or pop are mainly water, sugar and caffeine. One can of pop (355 ml) contains 50 mls (10 teaspoons) of sugar! Drinking too much pop has been linked with tooth decay and obesity. • Sport drinks were developed to help you recover from strenuous exercise. They should not be used as regular thirst quenchers, because they are high in sugar, calories and chemicals. • “Fruit drinks” differ from 100% fruit juice. Think of these drinks as pop without the bubbles. • Read your labels! Sugar comes in many disguises – dextrose, glucose, fructose, lactose, maltose, corn syrup, maple sugar and honey. • Milk is a great drink that is loaded with vitamins and minerals. The calcium and vitamin D in milk will build strong teeth and bones in growing children. Visit ontario.ca/eatright to access helpful meal plans, recipes and nutrition information. You can also use the “Ask A Dietitian” feature and receive answers to your questions online, courtesy of an EatRight Ontario Registered Dietitian.
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IF YOUR TEETH HURT, WE CAN HELP.
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The Children in Need of Treatment Program provides FREE dental services to teens, age 17 and under, who urgently need care, and includes: emergency extractions, fillings and sedation • preventive dental care, including cleaning and fluoride • dental health support and information. If you have tooth pain, bleeding gums, cavities or a mouth injury, call or visit your local Public Health Unit to see if you are eligible.
Queen’s Printer for Ontario, 2009
FREE URGENT DENTAL CARE.
ORAL HEALTH • DIFFERENT AGES/DIFFERENT STAGES • BIRTH TO 12 YEARS
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INJURY PREVENTION AND MOUTHGUARDS Once your baby is on the move… • Prevent tooth injury by using safety gates and putting corner guards on furniture. • DO NOT allow them to walk or run with anything in their mouth.
Once your child is on the move… • Many children begin sports early. Your child may require a mouthguard for a number of activities. Some organizations have a mandatory mouthguard policy. • Wearing a mouthguard is an important part of any athlete’s uniform. It will help to protect the teeth, lips, and cheeks. It may prevent concussions and jaw fractures.
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DENTAL EMERGENCIES Your child is growing and changing every day – crawling, walking and running. Along with these new milestones, bruises, bumps and accidents can occur. The following is a guide to help you deal with a dental emergency.
Toothache • If swelling occurs, place a cold compress on the face next to the sore tooth. • DO NOT use heat, as this can increase swelling and pain. • DO NOT place aspirin, other pain relievers or numbing gels on gum tissue around the sore tooth. • Take the child to the dentist immediately.
Knocked-Out Permanent (Adult) Tooth
Broken or Bumped Tooth • Place a cold compress on the face next to the injured tooth. • Take the child to the dentist immediately.
Bitten Tongue or Lip • If swelling persists, apply a cold compress. • If bleeding persists or the bite is severe, take the child to the dentist or seek urgent care.
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• CHECK to see if your child has any serious injuries. • If it is a baby tooth, do not try to replace (a child under five years will probably not have adult teeth). • DO NOT clean the tooth. • If it is a permanent (adult) tooth, try to replace the tooth in the socket. • If you cannot replace the tooth in the socket, put the tooth in a glass of milk immediately. • See a dentist as soon as possible. If the tooth loss occurs at night or on the weekend, try calling your dentist’s office (many after-hour messages provide resources for emergency services). Otherwise, seek urgent care immediately (even if you cannot find the tooth).
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ERUPTION CHART 20 Primary (Baby) Teeth
Upper Teeth
This chart is a guideline only; children grow at their own pace.
Lower Teeth
Upper Teeth
When teeth “fall out”
7-12 mos.
6-8 yrs.
9-13 mos.
7-8 yrs.
16-22 mos.
10-12 yrs.
13-19 mos.
9-11 yrs.
25-33 mos.
10-12 yrs.
20-31 mos.
10-12 yrs.
12-18 mos.
9-11 yrs.
16-23 mos.
9-12 yrs.
7-16 mos.
7-8 yrs.
6-10 mos.
6-8 yrs.
When teeth “come in”
When teeth “fall out”
7-8 yrs.
N
8-9 yrs.
E
11-12 yrs.
V
10-11 yrs.
E
10-12 yrs.
R
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32 Permanent (Adult) Teeth
When teeth “come in”
6-7 yrs. 12-13 yrs.
Eruption (year)
Lower Teeth
17-21 yrs.
This is a guideline only; your child’s teeth may “come in” and “fall out” at different times.
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DIFFERENT AGES AND DIFFERENT STAGES Birth to Six Months As early as six weeks into pregnancy, your baby’s first teeth are beginning to grow. Looking after oral health and eating nutritious foods is very important for both mom and baby. Research has linked gum disease in pregnant women to an increased risk of premature low birth weight babies. It is essential to maintain regular dental visits during your pregnancy. Smoking and/or drinking alcohol while pregnant can have many serious side effects on an unborn child, including a condition called cleft lip and palate, which may require several operations to correct.
Early Childhood Tooth Decay • Tooth decay can occur in very young children up to four years of age. • This decay results when liquids that contain sugar are left in the baby’s mouth for a long time, and the teeth are not cleaned. T:8.5”
• These liquids include: breast milk, formulas, cow’s milk, fruit juice, sweetened tea, soft drinks and many others. • Early cavities start on the top front teeth. Look for any chalky white or brown spots at the front and back of the teeth.
How To Prevent It! • Lift your baby’s upper lip monthly and check the front and back of their front teeth for any of these spots. • Never dip a pacifier in sugar, honey or other sweets. • When your baby is able to sit up alone, give him/her a cup to drink from. • Babies do not have decay causing bacteria at birth. To avoid giving your baby these bacteria, DO NOT share utensils or pacifiers with your baby. Be sure to clean forks, spoons, bottle nipples and pacifiers if you have put them into your mouth for any reason such as testing food temperature or placing a pacifier in your mouth to clean. • Most liquid medications are available in sugar-free form. If not available, clean your baby’s mouth after giving the medication. • Your baby’s bottle should not be used as a pacifier.
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Teething Teething is a natural process of baby’s first teeth working their way through the gums.
Common Signs of Teething • Drooling, irritability, sore and swollen gums, loss of appetite, rashes and showing a need to chew on things. • High fever, severe diarrhea and vomiting are NOT common symptoms of teething. If these occur, take your child to their doctor.
Helping You and Your Baby Through Teething • Offer a teething ring that contains only water, cooled in the refrigerator. • Offer a clean, damp, cooled washcloth for your baby to chew on. • Massage your baby’s gums with your clean finger or a baby washcloth. T:8.5”
DO NOT... • Use teething gels or ointments, as they contain medicines that may harm your baby. • Give teething biscuits to your baby, as they contain sugar and could also be a choking hazard.
Cleaning Your Baby’s Mouth • It is important to begin the habit of cleaning your baby’s mouth, before the teeth come in. • Choose a convenient time to clean your baby’s mouth each day. Bath time is ideal, because your baby is happy and relaxed. • Wipe the inside of your baby’s mouth with a clean washcloth or a finger brush. • Regular mouth care makes your baby’s mouth feel fresh and develops good habits.
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6 TO 24 MONTHS Between the ages of six and 24 months, there will be many changes in your baby’s mouth. The first tooth will appear around six months of age. A total of 20 baby teeth will come in. Give your child the gift of healthy teeth for life with daily brushing, nutritious meals and snacks.
Lift the Lip • Babies can get cavities as soon as teeth erupt. • Once a month, lift your child’s upper lip and look for chalky white or brown spots on the front and back of their upper front teeth. • If you notice any spots or anything unusual, take your child to their dentist.
Thumb Sucking • Sucking is a natural urge which comforts and relaxes. • Thumb sucking usually stops by four or five years of age. T:8.5”
• If this habit continues after the permanent teeth have erupted, it could affect the positioning of your child’s teeth or jaws. • You should seek the advice of a dental professional if you have any concerns.
Pacifiers are Safe to Use • Pacifiers satisfy your baby’s natural need to suck. • It is easier to stop pacifier use than thumb sucking. • Choose a pacifier that is the right size for your child’s mouth. • Use an approved pacifier that meets safety standards. • Wash with soap and water before first use and on a regular basis. • NEVER clean a pacifier in your own mouth. This could spread bacteria. • Check often for signs of wear and replace the pacifier if it is sticky, cracked or torn. • DO NOT attach a string to a pacifier – use a proper clip. • DO NOT dip a pacifier in sugar, honey or anything sweet, as this could cause cavities. • Use of a pacifier should be stopped as soon as possible, as it may affect the positioning of your child’s teeth.
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First Dental Visit • Take your child to the dentist for a quick checkup by their first birthday. • Start dental visits early, so your child will learn the importance ance of good oral health care and feel comfortable visiting the dental tal office. • Your dental professional will then advise you about future visits.
Bottle Feeding • A bottle should be used ONLY to give a nutritious meal. • DO NOT let your child use the bottle as a pacifier. • Wean your child from the bottle by 12 to 14 months of age. ge.
Introducing Your Child to a Cup • Start giving your child a cup at approximately six months of age or when your child is able to sit up. • Frequent drinking or sipping on milk, juice or anything sweetened with sugar could cause cavities. • DO NOT substitute a bottle with a sippy cup. T:8.5”
Cleaning Your Child’s Mouth • Daily cleaning of your child’s mouth is important. • Wipe the inside of your child’s mouth with a clean washcloth or a finger brush. • When a few baby teeth have appeared, you can start using a small soft toothbrush to clean them. • Use WATER ONLY on the toothbrush until your child can spit out. • Brush in a circular motion. • Brush twice a day and especially after the baby’s nighttime feeding.
Snacking • Healthy snacking plays an important role in oral health. • Encourage healthy choices such as cheese, soft cooked or canned vegetables, fruit and yogurt. • If your child needs a drink between meals, water is best.
Be aware of foods that could cause choking: • Grapes, berries or raisins
• Nuts
• Potato chips and popcorn
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2 TO 5 YEARS Healthy baby teeth are extremely important for eating, smiling, talking and keeping the space for adult teeth. Regular dental checkups are important to maintain good oral health.
Home Care
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We recommend that you brush your child’s teeth for two minutes twice a day using a manual or power toothbrush with soft bristles. 1. Brush your child’s teeth for two minutes twice a day. 2. Bedtime is the most important time to brush to prevent cavities. 3. Unless your child is high risk, you should begin to use a fluoride toothpaste once your child is three years of age, and can spit the toothpaste out. 4. Health Canada recommends that children use no more than a pea-sized amount of toothpaste and brush under adult supervision until the age of six. 5. Daily flossing of your child’s teeth is important. 6. DO NOT let your child swallow or eat the toothpaste.
Regular Dental Visits Start regular visits between two-and-a-half and three years of age, or as advised by your dental professional.
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6 TO 12 YEARS Your child will experience many changes during these years. Their baby teeth will fall out and their adult teeth will appear. Adult teeth are usually larger and more yellow in colour than baby teeth. This is sometimes called the “ugly duckling stage” because their teeth can sometimes be crowded and may not look ideal. Remember, their jaw is still growing!
Wiggly Teeth... your child will lose their baby teeth... it is a milestone in their lives! • The first baby tooth to be lost is usually a lower front tooth at around six years of age. • Don’t be surprised when only the top of the tooth (the crown) falls out. The roots have disappeared.
• Encourage your child to keep the area clean even when the tooth is wiggly. • SOMETIMES the new tooth will come in before the baby tooth has fallen out. DO NOT WORRY! The baby tooth normally falls out within a few weeks and the adult tooth will usually slip into the space. • Children should be encouraged to wiggle the baby tooth until it falls out (it is not usually necessary for your dentist to remove baby teeth). • BE HAPPY for your child. It is a normal and healthy part of growing up.
Permanent (Adult) Teeth • The first adult tooth to appear is usually a lower front tooth at around six years of age. • The first adult molar to come in is called the “six-year molar.” It comes in behind the last baby molars and does not replace a baby tooth.
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• Adult teeth will continue to erupt into their teenage years. Some children may experience discomfort.
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Orthodontics (Braces) • During your child’s growing years, through different stages, the appearance of their teeth will continue to change. • Some children will need to see an Orthodontist to straighten crooked teeth and correct teeth and jaws that do not fit together correctly. • Ask their dentist for a recommendation.
Brushing/Flossing • Your child will continue to need your help with brushing until eight or nine years of age. • Flossing is a more difficult task, and they will need your help until the child can floss effectively on their own.
Injury Prevention • REMEMBER: Mouthguards can prevent injuries during this very active time in your child’s life, BUT ONLY IF THEY WEAR ONE!
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DOs AND DON’Ts FOR A GREAT SMILE Do... • Lift the lip. Once a month, check your baby’s teeth for white or brown spots and anything unusual. Take your child to their dentist if you have a concern. • Brush your child’s teeth for two minutes twice a day. • Brush at bedtime. It’s the most important time to brush to help prevent cavities. • Floss their teeth every day. Parents need to assist younger children. • Visit the dentist regularly. Babies should have their first visit by their first birthday, with continued visits as recommended by their dental professional. • Make healthy eating and snacking a priority. Be a good role model. • Ensure your child wears a mouthguard while playing sports.
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Don’t... • Put your child to bed with a bottle or sippy cup. Use only plain water if you must give your baby a bottle in bed. • Put sugary liquids such as pop, fruit drinks and sweetened milk in a bottle or sippy cup. • Share germs. Cavities are caused by bacteria (germs). These germs are passed to babies through saliva. Avoid sharing of toothbrushes and spoons; DO NOT place baby’s pacifier in your mouth. • Expose your child to second-hand smoke. Be a good role model. DO NOT smoke or use spit/chewing tobacco in your child’s presence.
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GOOD ORAL HEALTH ONLINE RESOURCES Ontario Association for Public Health Dentistry oaphd.on.ca Canadian Dental Association cda-adc.ca Canadian Dental Hygienist Association cdha.ca EatRight Ontario ontario.ca/eatright Healthy Ontario HealthyOntario.com Eating Well with Canada Food Guide healthcanada.gc.ca T:8.5”
Health Canada Hc-sc.gc.ca U.S. Centers for Disease Control and Prevention cdc.gov About Kids Health Canada aboutkidshealth.ca
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IMPORTANT NUMBERS Family Dentist: Name: Number: Family Doctor: Name: Number: 1-866-797-0000
Poison Control:
1-800-268-9017
ServiceOntario INFOline
1-866-532-3161
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Telehealth Ontario Info Line:
Hours of operation: 8:30 a.m. – 5:00 p.m., Monday to Friday
EatRight Ontario
1-877-510-510-2
Hours of operation: Monday, Wednesday and Friday – 9 a.m. to 5 p.m., with extended hours on Tuesday and Thursday evenings until 9 p.m.
Special thanks to the Durham Region Health Department and the Oral Health Division for permission to reprint previously published materials. We appreciate their collaboration, which made this publication possible.
MARCH 2009
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