Last Updated: April 14, 2018
Tooth decay is the single most common chronic childhood disease in the United States. Over 40% of children are affected by tooth decay by the time they reach kindergarten, and 53% of children 6 to 8 years of age have experience with cavities (untreated cavities, filled teeth, or missing teeth as a result of a cavity).
While tooth decay and gum disease have substantial oral health repercussions in their own right, they’re also linked to even more serious chronic illnesses such as heart disease, diabetes, and respiratory diseases.
The good news is that tooth decay is generally preventable for those who practice good oral hygiene, limit sugary drinks and snacks, and make regular trips to the dentist for checkups and cleanings.
From birth through the teenage years, this guide takes a comprehensive look at the risks, challenges, and positive steps to take through each stage of your child’s development. Additionally, we will discuss the difficulties and offer helpful guidance and resources for two of the most at risk demographics: low-income families and families with children who have special health care needs.
Table of Contents
- Oral Health During Pregnancy
- Oral Health for Infants and Young Children
- Oral Health for Children and Teens
- Oral Health for Children with Disabilities
- Affording Dental Care
- Additional Resources
Oral Health During Pregnancy
Due to hormone shifts and diet changes, pregnant women face a higher risk of oral health problems including gum disease and tooth decay. Along with taking steps to prevent oral health problems, it’s important for pregnant women to get any cavities treated right away, as strong evidence points to mothers as a primary source of the bacteria that causes tooth decay in infants and toddlers.
In addition to problems after birth, poor oral health can have consequences for the pregnancy itself. Gum disease has been linked to preterm birth, low birth weight babies, low birth weight babies being born prematurely, and the development of preeclampsia (a pregnancy complication that can lead to serious or even fatal outcomes).
Gingivitis and Gum Disease
According to the Illinois Department of Health, gingivitis occurs to some degree in 60 to 75% of all pregnant women. One reason for this is that they tend to have a more severe reaction to the plaque bacteria due to increased levels of the hormone, progesterone.
While it’s common and can be managed with good dental hygiene, when left untreated it can affect the tissue that holds the teeth in place, even resulting in tooth loss if the problem becomes severe.
The main symptoms of gingivitis are red, swollen gums and bleeding, If you start to notice a greater degree of sensitivity in your gums or bleeding during brushing, pay extra attention to your oral health habits. Brushing twice a day and flossing is always a good practice, but it’s especially important when you are experiencing symptoms of gingivitis.
In addition to normal oral health habits, it’s helpful to brush and rinse your mouth after every meal and snack. Be sure to contact your dentist as he or she may recommend extra professional cleanings as well.
Cavities and Tooth Erosion
Pregnant women have a higher risk of developing cavities due to several main factors such as increased acidity in the mouth for those with frequent vomiting and dry mouth due to hormonal changes for some. On top of that, more frequent snacking on less healthy foods because of cravings increases the risk of tooth decay, and some pregnant women find it harder to stay consistent with oral hygiene due to a heightened gag reflex causing nausea and vomiting when trying to brush their teeth.
Symptoms of cavities include:
- A toothache
- Tooth sensitivity
- Mild to sharp pain when eating or drinking something sweet, hot, or cold
- Visible holes or pits in a tooth
- Brown, black or white staining on any surface of a tooth
- Pain when biting down
Tooth decay is treatable and preventable if you are consistent and proactive.
If you suspect that you may have a cavity, schedule an appointment with your dentist as soon as possible to prevent further decay. As mentioned earlier, the bacteria that cause tooth decay are often transmitted from a child’s mother, so it’s important to take care of the problem sooner rather than later.
While pregnant women are at a higher risk of tooth decay, it’s still preventable if you stay on top of brushing and flossing. In addition to the normal twice-a-day-routine, brushing and rinsing after all snacks and meals is an added step you can take to protect your teeth. If you find yourself craving unhealthy foods, substituting healthier snacks (low or no sugar) will help to cut down on potential oral health problems.
While it may seem advantageous to brush your teeth immediately after vomiting, it’s actually counterproductive unless you first rinse your mouth with a mixture of water and baking soda to neutralize the stomach acid from your vomit.
If you find it challenging to brush your teeth due to a strong gag-reflex, don’t give up! Instead, change up your routine by trying things like using a small, soft toothbrush designed for children, brushing later in the morning when you don’t gag as much, and concentrating on your breathing as you brush your back teeth.
Pyogenic Granuloma (“Pregnancy Tumors”)
While the name sounds alarming, “pregnancy tumors” aren’t cancerous and typically don’t lead to any serious medical complications. They appear as small, red or fleshy colored lumps of tissue located between the teeth or along the gum line. They are relatively uncommon as they only develop in up to 5% of pregnancies.
If the lump is small and doesn’t bother you, you may not need to treat it – they often go away after pregnancy on their own. If it does bother you, it may be removed under local anesthetic. Consult your dentist.
Safety Concerns for Oral Health Treatment in Pregnant Women
Not all medications related to oral health treatment are safe.
Among others, Nitrous Oxide (or laughing gas) is considered to be risky for pregnant women. Always be sure to consult your doctor or pharmacist before taking any medication.
Oral x-rays are considered to be safe during pregnancy.
As long as proper shielding of the stomach and thyroid is in place, it’s safe to get x-rays of your mouth when you are pregnant. Leaded vests are used to shield the fetus from the small dose of radiation in x-rays.
Oral Health for Infants and Young Children
While tooth decay for young children is generally preventable, it’s a huge problem in America. Over 40% of children are affected by tooth decay by the time they reach kindergarten, and 53% of children 6 to 8 years of age have experience with cavities (untreated cavities, filled teeth, or missing teeth as a result of a cavity).
Establish a dental home by age 1.
The American Academy of Pediatric Dentistry (AAPD) recommends that all infants have a dentist home established by age one. However, a lack of education is a primary concern – a majority of pediatricians and general dentists aren’t advising parents to take their child to see a dentist by age one, and about half of all pediatric dentists don’t see infants by their first birthday.
Prevent the sharing of decay-causing bacteria.
Since the bacteria that cause tooth decay are transmittable from one person to another, the AAPD recommends that parents refrain from sharing spoons, bottles, pacifiers, etc. Also, be sure to thoroughly wash sippy cups and bottles between uses.
Painkillers and chilled teething rings can help to soothe gums during teething.
While not all infants and young children experience discomfort during teething, there are several good solutions for those who do. Painkillers such as infant acetaminophen or ibuprofen and chilled teething rings (or frozen washcloths) are recommended by the AAPD. However, over-the-counter teething gels (topical anesthetics) are not recommended due to “potential toxicity of these products in infants.”
Positive oral health habits should start with the arrival of a child’s first tooth.
Starting when the first tooth emerges, parents should begin brushing their children’s teeth after breakfast and before bed using a small headed, soft toothbrush. Under age three, it’s recommended that no more than a smear or rice-size bead of toothpaste containing fluoride be used. As soon as two teeth touch, start gently flossing between them once a day.
It’s also important to schedule and keep regular cleaning and evaluation appointments with a pediatric dentist. The typical frequency recommendation is every six months.
Start establishing healthy eating habits by 12 months of age.
If you want to lower your child’s risk of cavities (and other health problems), it’s important to start a healthy diet young since eating habits start to form as early as one year of age. Habits that increase the risk of tooth decay and other oral health problems include nighttime bottle feeding with juice, repeated use of a sippy or no-spill cup (without washing between uses), and frequent sugary snacks or drinks between meals.
Examples of snacks to limit include cookies, granola bars, soda, and even fruit juice – the AAPD recommends limiting juice intake to 4-6 ounces per day, and it should not be a substitute for whole fruit or used throughout the day to calm a fussy child.
The use of pacifiers and thumb sucking should stop by age four.
While many children gradually quit sucking on pacifiers or their fingers and thumbs between the ages of two and four, some children may need help breaking the habit. Prolonged thumb sucking can interfere with the proper growth of the mouth, and it can cause problems with the proper alignment of the teeth.
The American Dental Association (ADA) recommends the following steps:
- Don’t scold. Instead of scolding the child for thumb sucking, offer praise for not doing so.
- Focus on the root of the problem. Children often suck their fingers when feeling insecure. Focus on correcting the cause of the anxiety and comfort the child.
- Use rewards. Reward the child when he or she avoids thumb sucking during a difficult period, such as being separated from family members.
- Consult your doctor or dentist for extra help. If your child still can’t overcome the thumb-sucking habit, consult your pediatrician or dentist. There are medications and apparatuses designed to break kids of the habit.
Start teaching your child to be responsible for their oral health.
While most children are ready to brush their teeth without supervision by age seven or eight, each child is different. Other than the obvious concern of being able to brush your teeth without swallowing toothpaste, children are ready to brush their teeth when they have the motor skills and discipline to brush all of the surfaces on their teeth (as opposed to just a few strokes on the front teeth).
Here are some tips for helping your child to develop excellent oral health habits:
- Be consistent yourself. Kids tend to emulate what they see their parents do. If you consistently brush and floss your teeth, it will be much easier to insist that they do it as well.
- Make it enjoyable. While you are still assisting your children in brushing their teeth, consider ideas like reading a 2-minute book or dancing to their favorite song. You can also try rewarding your child with a sticker chart.
- Insist on consistency. The more brushing and flossing becomes second nature, the better your kids long-term oral health. Try not to skip brushing even on long days or vacation.
- Be thorough. Your dentist can assist in demonstrating the proper method of brushing your child’s teeth. Be sure that they are following the general guidelines: two minutes of brushing front, bottom and back of all teeth. “Smart” toothbrushes can make this process easier by vibrating when it’s time to stop brushing and keeping track of how long they brushed their teeth.
- Don’t forget the tongue. A good routine includes brushing your tongue to ensure fresh breath and kill germs
- Flossing is a vital piece of the routine. Flossing once a day before brushing is important. Floss picks (or other devices) may be easier for some kids to use if they struggle with traditional floss.
Be consistent with dental cleanings and checkups.
As a general rule, kids should be seen by a dentist for a checkup and cleaning every six months. Additionally, you should talk to your dentist about scheduling an appointment between cleanings if your child exhibits any of the following symptoms:
- White spots on the teeth
- Visible cavities that are brown or black
- Pain in the area around a tooth
- Sensitivity to sweet, hot, or cold foods and drinks
Limit sugary snacks.
As with toddlers, a good diet is a large part of preventing cavities and other oral health problems. Kids who eat a lot of sugary snacks and drink sugary drinks are at a higher risk of tooth decay.
Oral Health for Children and Teens
Tooth decay is a serious problem for American youth – almost one out of five (18.6%) have untreated cavities. Among more mundane risks (such as a sugary diet) teens can sometimes have a much higher risk of oral health problems if they:
- Smoke or chew tobacco
- Have mouth jewelry
- Use meth (meth mouth)
- Have an eating disorder
Oral Health Routines
Tweens and Teens should be responsible for maintaining the habit of brushing their teeth twice daily and flossing once a day. However, it’s wise to check in and make sure they are staying on track. It’s important to discuss the benefits of good oral hygiene, as well as the consequences of poor oral health habits.
Due to the increase of sex hormones in teens, they are more susceptible to gingivitis (gum infection), which can generally be prevented by consistently practicing proper brushing and flossing techniques. Continue with regular dental cleanings and evaluations to be sure that their oral health is on track.
As tweens and teens begin to make their own decisions about the food they eat, it’s important to encourage them to make good decisions. Some teens face a higher risk of tooth decay due to regular consumption of sugary foods and acidic, sugary drinks such as soda.
The ADA recommends paying extra attention to the type and frequency of snacking, the amount of sugary drinks, and choosing sugarless chewing gum. Those who have braces should follow their orthodontist’s instructions and avoid foods that can cause brackets or wires to break.
If your child has a bad bite or teeth that are out of place, he or she may be at a higher risk of cavities or gum disease due to the difficulty in cleaning his or her teeth. Braces can help to correct these problems and decrease the risk of oral health problems in the future. They can also relieve the discomfort and difficulty when chewing that can come with a bad bite or misplaced teeth. On top of the tangible benefits of braces, they can also help to increase your child’s confidence by giving him or her the gift of a nice smile.
Depending on the needs of your child, metal braces typically cost between $3,000 and $7,000. Some insurance plans may cover a portion of the cost, so be sure to research the specifics of your plan.
While brushing and flossing is more difficult with braces, it’s even more important since all the brackets and wires create more places for plaque to collect. In addition to being consistent with oral hygiene while wearing braces, it’s also important for your child to follow through with the orthodontist’s instructions, such as wearing rubber bands. Failing to do so can delay his or her progress and require more time and expense before the braces can be removed.
A common dental issue for older teeth is problematic wisdom teeth. Wisdom teeth often grow incorrectly, or there may not be room in the mouth. Reasons for removing wisdom teeth include:
- Tooth pain
- Damage to adjacent teeth
- Gum disease
- Tooth decay (if it is not possible or desirable to restore the tooth)
Oral Health for Children with Disabilities
11 million (or 15%) of American children have “special health care needs” (SHCN), which means that they have any “physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.”
While a child’s disability and needs can sometimes take precedence over proper oral health habits, the negative impact of oral health diseases should not be overlooked. For instance, serious chronic illnesses (including heart disease, diabetes, and respiratory diseases) have been linked to poor oral health.
Challenges to Prevention and Treatment of Oral Health Problems
These children are at an increased risk for oral health problems due to factors such as:
- Regularly taking medications containing sugar
- Special diets
- The need to eat frequently
- Poor oral hygiene
In addition to the personal challenges SHCN children face, environmental factors contribute to the fact that only about 18% receive oral health care in a high-quality system (as defined by the Maternal and Child Health Bureau).
Those factors include:
- The cost of care
- Difficulty finding a dentist that will treat them
- Dental offices inaccessible to children with SHCN
Other barriers include “oral defensiveness” and a child’s or parent’s fear of the dentist. Some of the groups most affected by these barriers are children with Down Syndrome, Autism Spectrum Disorder, or Cerebral Palsy.
Overcoming Oral Health Barriers
Establish a dental home as soon as possible.
Not only are SHCN children with a dental home much more likely to receive preventative care, but there is also the opportunity to develop an individualized plan that can meet the needs of your child’s specific situation. The sooner this plan is created, the better the chance for good oral health habits to mitigate the challenges mentioned above.
Find a pediatric dentist that works with special needs.
Because pediatric dentists have an additional 2-3 years of training after dental school to specialize in areas such as reducing anxiety associated with dental visits, they tend to provide the best care for children with SHCN. Additionally, certain pediatric dentists may have specific training and experience and in treating SHCN children.
Beyond simply calling around to find a suitable pediatric dentist, you can utilize your network to find dentists that are set up to treat children with similar challenges as your own. Your child’s primary care physician may be able to give you quality recommendations. Also, if you belong to a parent support group or know other parents that have kids with SHCN needs, they may be able to recommend a pediatric dentist with the appropriate experience and training.
Take a holistic, coordinated approach to oral health.
To overcome the barriers and challenges to good oral health and quality, professional treatment, you should work with your child’s doctor, dentist, nutritionist, and any other health professionals to develop a holistic plan to prevent and treat oral health problems.
Take advantage of federal and state programs if cost is a barrier for your family.
States are required to devote 30% of their federal allocations to services for children and adolescents with special needs. Because of that, there are multiple ways for you to get help affording quality dental care for your SHCN child. For instance, Medicaid covers dental care in some states.
Since each state is different, research the programs available to you in your state. To get started, you can apply for Medicaid and CHIP here.
- American Academy of Developmental Medicine and Dentistry: This organization strives to help those with neurodevelopmental disorders and intellectual disabilities achieve better health through research, advocacy, training, and patient care.
- American Cleft Palate-Craniofacial Association: The ACP-CA works to improve the coordination of care for individuals impacted by cleft lip, cleft palate, and other craniofacial anomalies. The Cleft Palate Foundation provides information and resources for both health professionals and families affected by these conditions.
- Association of University Centers on Disabilities: This is a national network of university-based programs that help to bridge the gap between universities and the public by providing oral health treatment, training, research, and advocacy.
- Family Voices: Family Voices’ focus is on achieving family-centered care for children and teens with special health care needs. Its national network is designed to serve as a hub of resources to connect professionals and families while helping them make informed, family-centered decisions.
- Humanitarian Foundation – Grottoes of North America: This foundation partners with dentists across the country to provide oral health services to children and teens under the age of 18 with one or more the following conditions: cerebral palsy, muscular dystrophy, intellectual disability, or an organ transplant recipient.
- Parent to Parent USA: This foundation provides support and resources for families of children with special health care needs by connecting experienced parents with parents that need help and support.
- Special Smiles: Special Smiles is a program sponsored by the Special Olympics to achieve better oral health for its athletes and the general public through oral health screening, education, and referral. The program works to increase the number of dental professionals who serve adults and children with special health care needs.
Education and Training
- Healthy Smiles for Autism: This guide provides oral hygiene tips for children with autism spectrum disorder.
- Patients with Special Needs: The University of Washington School of Dentistry provides extensive resources for a number of different conditions designed to educate parents and health care professionals.
Affording Dental Care
Of all the barriers to maintaining good oral health, “cost” may be the biggest in the U.S. There are a plethora of great dentists with advanced training and equipment, but many people from middle- and low-income families, or those without dental insurance, can’t afford treatment. Tooth decay is the single most common chronic childhood disease in the United States, and along with children who have special health care needs, children living in poverty are the most at-risk groups.
According to a 2013 survey cost is the number one factor for delaying needed dental care. For instance, almost half (47%) of all respondents indicated that they have delayed needed dental care for children due to the cost of the procedure. For those without insurance, cost is an even larger factor.
As you can see from the chart (below), the percentage of the population with dental benefits has been growing steadily, but nearly 25% of Americans are still without public or private dental coverage. Even those many of those who qualify for Medicaid don’t have access to comprehensive dental care due to the combination of a lack of dentists who accept Medicaid and the fact that many states’ Medicaid plans offer limited dental coverage, emergency dental coverage only, or no coverage at all.
Source: The National Association of Dental Plans
How to Get Financial Assistance
The Health Insurance Marketplace
You can get dental insurance from the health insurance marketplace that’s subsidized based on your level of income. For some, they may only have to pay a very small monthly amount for a quality dental plan. Click here to see if whether you qualify for financial assistance based on your income.
Medicaid provides free or very low-cost insurance for children, pregnant women, individuals with disabilities, and low-income adults. However, not all states offer dental coverage for adults. Of all the states:
- 4 states don’t offer dental coverage
- 13 states only offer emergency dental coverage
- 18 states offer limited dental coverage
- 16 states offer extensive dental coverage
Go here to see if you qualify for Medicaid and to start researching the dental care provided by your state’s Medicaid program.
The Children’s Health Insurance Program (CHIP)
If your family doesn’t qualify for Medicaid, your children may still qualify for CHIP. CHIP provides free or very low-cost insurance, and, unlike Medicaid, dental coverage is always included. Go here to get an overview and to get started on your application.
This program allows you to continue your insurance coverage at your group rate if you’ve lost your job under qualifying circumstances. It will likely be more expensive than it was when employed because you will lose any contribution that your employer made. However, it’s usually still cheaper than buying a comparable insurance policy on your own.
To be eligible for COBRA, you must sign up within 60 days of losing your job.
Charities and Nonprofit Organizations
There are many different charities and community organizations that may be able to help you find affordable dental care. One example is United Way. Go here to find the contact information for your local United Way Chapter.
Local Health Department
The Bureau of Primary Health Care supports federally-funded community health centers across the country that provide free or reduced-cost health services, including dental care. Go here to locate local centers near you.
American Dental Association (ADA) schools can be a good source of quality, low-cost dental treatment. Students are closely supervised by experienced, licensed dentists, and most schools also offer post-graduate and faculty clinics as well. Go here to find an ADA school near you.
Those who have certain conditions or fit specific parameters may be able to receive free or low-cost dental care by participating in clinical trials. The National Institutes of Dental and Craniofacial Research (NIDCR) sometimes recruits volunteers, go here to see if you qualify for studies that are actively recruiting.
To learn more about dental care and find access to additional resources, use the sources below to complete your own research.
- The American Dental Association
- The American Academy of Pediatric Dentistry
- The National Maternal and Child Oral Health Research Center
Children with Special Health Care Needs (SHCN)
- American Academy of Developmental Medicine and Dentistry
- American Cleft Palate-Craniofacial Association
- Association of University Centers on Disabilities
- Family Voices
- Healthy Smiles for Autism
- Humanitarian Foundation – Grottoes of North America:
- Parent to Parent USA
- Patients with Special Needs
- Special Smiles