The Home School Court Report
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July / August 2005

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The whole tooth and nothing but the tooth

Dr. Sayre, what can I do to keep my children from having as many cavities as I did when I was a child?

Oftentimes, parents do not really consider the importance of dental care until that first bill from the dentist arrives. The truth is, if you encourage your child to be diligent with dental hygiene, thousands of dollars can be saved in dental bills, and your child's bright smile can last into old age. A thought occurred to me when my oldest was about 8 years old: why not give the money to my children instead of to the dentist? So I made a deal with the kids. I offered to give them $200 if they could make it to age 18 without any cavities. This has turned out to be a bigger gamble than anticipated, since I now have the potential of shelling out a couple thousand dollars before this business of raising children is through! As I write this article, my 18-year-old daughter (number two of 11 children) is reminding me that I need to pay up . . .

Breast-feeding is the best way to circumvent cavities in the very young. If a child is bottle-fed, a few simple rules should be employed to minimize the risk of decay. First, do not allow a child to take a bottle to bed, or toddle around the house with bottle in hand. Bathing the teeth in sugars for long periods of time provides the optimal environment for cavity-causing bacterial colonies to grow. Second, limit bottle fluids to formula or water. Juice contains more of the harmful types of sugars than milk, and has been shown to spell trouble for those primary teeth. Lastly, to minimize the risk of "bottle carries," wean all children to a cup by the first year of age. In my experience, it is rare to see cavities in a child below the age of 2 if these guidelines are heeded.

So when should parents begin brushing their child's teeth? It is best to begin as soon as your child's teeth begin to appear, using a small amount of toothpaste (i.e., the size of a grain of rice) on a soft-bristled brush. As the teeth multiply, and especially once the molars appear, brushing becomes even more important. Parents should have direct supervision of brushing until a child is about 8 years old. At that age, a properly trained child can assume full responsibility for a daily flossing and twice-daily brushing routine.

The question of fluoride supplementation has been a hot-button issue for many years. It was discovered almost by accident that fluoride can be incorporated into the enamel matrix of teeth, making them more resistant to decay. In the early 1900s, scientists noted that a segment of the population in a specific area of Colorado had yellowed or mottled teeth. Interestingly, these poor folks with unsightly teeth were less likely to suffer from tooth decay. Investigations ultimately revealed that the water supplies in that area naturally contained the mineral fluoride in high concentrations. A great deal of research ensued to determine what would be the optimal amount of fluoride in a person's diet, and if thereare any negative effects of supplemental fluoride.

In communities where the tap water is fluoridated, it may not be advisable to provide additional fluoride to a child. There is no fluoride in the drinking water of the area of Pennsylvania where I practice, so I generally recommend that parents begin their children on a fluoride supplement at age 2 and continue until age 16. To use a well-worn phrase, ask your doctor if "fluoride is right for you."

About the author

An HSLDA board member since 1997, Dr. Rodger Sayre is a family physician, and his wife Mary is a registered nurse. They live in Tunkhannock, Pennsylvania, and teach their 11 children at home. Dr. Sayre received his medical degree from Thomas Jefferson University in Philadelphia and maintains board certification in family practice. A Geisinger Medical Group associate with a busy practice in Nicholson, Pennsylvania, he is a member of the Christian Medical Association, the American Academy of Family Physicians, and the American College of Sports Medicine.