Q&A: teeth!

Today I've got an easy tooth question and a tougher one.

Amber writes:

"Is it okay to brush my son's teeth. He is 9 months old? If so what kind of toothpaste do I use?"

Yes! There are a couple of ways you can go with tooth-brushing, but they both involve xylitol. Xylitol is a sugar from birch trees, and it kills the bacteria that causes tooth decay. It's got a pleasant, mild flavor. The children of mothers who use xylitol toothpaste and/or gum in the first two years of their children's lives have fewer dental problems up through age five than kids whose moms don't use any xylitol products. So the first thing you could do is switch to xylitol toothpaste yourself (there are some great brands online like Squigle and Epic, and I love Tom's of Maine CinnaMint flavor) or start chewing gum with xylitol.

But even if you don't use xylitol toothpaste your kids can. Tom's of Maine makes a liquid toothpaste  for kids with xylitol that comes in a few flavors (our favorite is grape), and it's in Gerber baby toothpaste, too. For a 9-month-old you want to use just a teeny bit of the toothpaste with some water. You can use an extremely soft-bristled brush, or one of those things that fits over your index finger with little nubbly parts that lets you brush by sticking your finger inside the baby's mouth. (Be warned, though, that if your baby has a tooth and chomps down the soft toothbrush will not protect your finger and it will hurt like you didn't think possible).

If your baby is too young for toothpaste or a brush (gags or won't open mouth or otherwise resists), you can get Spiffies xylitol wipes to wipe their little baby teeth. They're individually-packaged wipes (the size of wet wipes) coated in a xylitol solution. They taste like very mild grape, and you just use them to wipe the surfaces of all the teeth and gums.

If you nurse to sleep and can't imagine waking up your baby to brush, you can still brush or wipe with Spiffies right before you nurse. Some of the xylitol will stay on the teeth, and since the nipple squirts milk in the back of the mouth instead of the front, the milk won't wash all the xylitol off.

Now for the rougher question. Jennifer writes:

"I just got back from our first trip to the pediatric dentist with my 17 month old. Peanut has white spots on her teeth, and we're told they are early signs of caries forming, eek! (My worst nightmare realized.) She's a nursing toddler who is totally attached to Mama's boobs during her naps, and she's an all night nurser. The dentist recommended brushing her teeth with flouride at least 3 times per day, using a concentrated flouride gel at night before bed, flossing at night, and swiping her mouth after each drink besides water. I don't know about your toddlers, but mine is pretty typical and eats and drinks all day long! What a pain in the tookas, not to mention having to pin your child with the figure four... i never knew i was a natural born wrestler (poor little Peanut.) 

In case you were wondering what we feed Peanut, she eats a moderately organic diet, generally low in sugar, some meat and dairy. No juice, no sweets, but an occasional Hug A Bear cookie or Graham cracker (whole grain and organic, of course). She's been a picky and small eater until most recently, which I think may have contributed to some potential vitamin deficiencies. (I read somewhere that deficiencies in calcium, vitamin A and phosphorus can weaken tooth enamel.)

The dentist did not say that nursing has damaged her teeth, but certainly any sugars in her mouth will promote further demineralisation of the tooth enamel. Daddy-o's been expressing a desire to put Peanut down lately so changing our bedtime routine seemed to make sense (even though I would have nursed her to sleep as long as she wanted.) For the last 1 1/2 weeks Daddy-o has been putting her to sleep and I'm usually called into action by about 1-2am when I nurse her back to sleep, (we've all been sick especially my husband, so cutting out all nursing until early morning has been put on hold.) We are doing our best to try to keep her mouth as clean as possible while also trying to reverse the damage to her enamel the acid has done. Boy does this suck!

This is all very stressful for me as I worry about the prospect of dental work, and it really bites to have to pin my daughter down to brush her teeth several times a day... and it's very likely she'll still have a cavity after all is said and done. Has anyone gone through this process and what was it like for them? What could I expect if she really needs cavities filled (I can't even imagine the torture of that day!) We're going for a follow up to the dentist in 3 months."

I asked about xylitol to prevent any more damage, and she updated:

"yeah, we're using spiffies now too... they came in the mail the week we went to the dentist... my understanding is that xylitol helps to combat the strep mutans bacteria present in plaque... our daughter already has damage to her tooth enamel... when this starts to happen it's called demineralisation, that's when the damaging environment has been around long enough to soften the teeth... you need the nasty bacteria plus sugars from food to interact in order for the damaging acid to form... this lovely cocktail eats away at the tooth enamel... they skinny is that i should have been using the spiffies wipes a long time ago and i should have been more diligent at "getting in there" and not just have her chew on a tooth brush before bed... at this point, flouride is needed to remineralise the tooth enamel, which basically means to make it strong again so that the white spots don't turn into irreversible, decaying holes... in essence, the flouride is the antibiotic and any other cleaning agents like  xylitol are the band aids protecting from further damage....

my LLL leader sent me this link on the subject... i thought you might like to check it out... just brace yourself for the pics, they are some of the worse cases of Baby Bottle Mouth (totally freaked me out) anyway, i think we're doing all we can but i just wondered how other well-intentioned parents dealt with this issue... even if the problem was truly genetic...

thanks moxie... "


So once again a reader answers her own question by providing a pertinent link. And, yeah, some gross pictures if you click through from that first page to the PDF presentation (the first page is fine, with no photos).

So it sounds like xylitol is the first line of defense, but once the enamel is damaged, the only help is fluoride. If anyone else can share experiences with this problem, Jen and I would really appreciate it. I have no idea how a 17-month-old will make it through the process of having a cavity filled, but it might not be rough at all. So any stories would be appreciated.