Caring for your child’s teeth and gums


Dental caries and gum disease are the two mouth problems most frequently found in children. Since the introduction of a provincial health plan, young Quebecers have enjoyed a much better level of oral health. However, the rate of dental cavities in Quebec is still higher than in most other areas of Canada. 

Cavities and gum disease can result in life-long problems for children. These problems are often difficult to diagnose, especially in very young ­children who cannot say what is bothering them. Dental specialists at The Montreal Children’s Hospital of the McGill University Health Centre encourage parents to look after their children’s teeth so these problems can be avoided or treated.

What causes cavities?

Nursing Caries or Early Childhood Caries affect very young children who frequently have milk, juice or soft drinks at bedtime and any other time of day. The condition also affects children who constantly drink breast milk, or use a pacifier that has been dipped in something sweet. According to Dr. Stéphane Schwartz, a pediatric dentist at The Children’s, “Cavities can begin at eight months. First they attack the upper front teeth, and then move on to the molars. The lower front teeth are generally not affected because they are protected by the tongue and saliva. At night or nap time, a baby should only be given a bottle containing water and during the day, children should not have other drinks too frequently.

“Dental cavities in general can attack the primary teeth (baby teeth), or permanent teeth, if they are not cleaned properly and become covered with dental plaque.” Dr. Schwartz explains plaque is a transparent film that attaches to the dental enamel and results in the development of bacteria. When the bacteria come into contact with food particles, they give off acids that affect the enamel, which then starts the process of tooth decay.

When should I start brushing my baby’s teeth?

When the first front teeth appear, clean them with a clean, moist face cloth. Once a few teeth are in place, use a small, soft-bristled brush. Very little toothpaste is needed. Teach your child to rinse his mouth so he does not swallow any toothpaste.

Your child should have his first dental examination at the age of one. This is the ideal time to make sure teeth are developing normally, even though there is not a full complement of primary teeth.

What about fluoride?

According to Dr. Schwartz, fluoride is an agent that contributes to the development of more resistant tooth enamel. If you live in an area where there is no fluoride in the water supply*, you should give your child fluoride supplements following your dentist’s recommendation. The dentist can also apply a fluoride treatment directly on the teeth. The dentist’s recommendations should be strictly followed.

* Ask your municipality if fluoride is added to your water supply.

What are the principal causes of gum problems?

Dental plaque is not only harmful to teeth but is harmful to gums as well. The bacteria from plaque acts as a chemical irritant, and gums that are not cleaned properly become red and bleed easily. This condition is reversible by ­having plaque removed regularly.

Viral hepatic infections (herpes) are often found in children between the ages of one and four years, and can be found in older children as well. The first symptoms are the appearance of redness and swelling of the gums (gingivitis). Your child may also have a fever. The infection surfaces with little white bumps on the tongue, inside the lips and on the gums. These are painful, and your child will likely refuse to eat. Sometimes it is necessary to treat the lesions with soothing products (to be prescribed by your dentist) to allow your child to eat or drink. This is a contagious infection, and other family members should avoid sharing dishes or cutlery with your infected child. The infection usually disappears within two weeks. Occasionally, the dentist will prescribe antibiotics to avoid another type of infection (bacterial) setting in.

Acute gingivitis is bacterial in nature and attacks older children, usually adolescents. Gingivitis is manifested by bleeding gums, pain and bad breath. It is caused by a lack of proper oral hygiene and by an unbalanced diet. Antibiotics can control acute gingivitis, but only professional cleanings and improved oral hygiene can prevent recurring bouts of this problem.

Aphthous ulcers are small, very painful ulcers that appear in the mucosa of the mouth. Some children are more susceptible than others to this condition. It is important to keep the mouth clean during this time, and to avoid inserting foreign objects such as crayons or sticks into the mouth. Also, acidic foods such as citrus fruits and tomatoes should be avoided during this time. These ulcers usually heal within two weeks and do not leave scars.

Other problems that may appear in the course of a child’s development include poor bite malocclusion and dental trauma.

“Parents must teach their children proper dental hygiene to help them develop and maintain healthy teeth and a healthy mouth. These habits will remain with the child for life,” states Dr. Schwartz.

09-01-06 Montreal Children's Hospital - SW