Maggie McKay (Host): Dental hygiene is important at every age, but especially early on when your young children's teeth are developing. Today, we'll find out why with Dr. Craig Volk Vinall.

Welcome to The Peds Pod by Le Bonheur Children's Hospital. I'm Maggie McKay. Good oral health can be a key indicator of overall health and well-being. For young children, early checkups reduce the risk of tooth decay and cavities. Early checkups also help ensure that your child's teeth are coming in properly and allow dentists to monitor their development. Starting dental checkups early sets a precedent in helping your growing little one establish a lifelong foundation of good oral health.

Dr. Craig Vinall, Residency Program Director for Pediatric Dentistry at the University of Tennessee, is here to talk about what parents can do to keep their kids' smiles bright. so much for being here, Dr. Vinall.

Craig Volk Vinall, DDS: Thank you. I appreciate it.

Host: So even before the first visit to the dentist, how soon should parents start dental care with their baby at home? And what does that look like?

Craig Volk Vinall, DDS: Actually, dental care for your child starts as early as in utero. We talk about managing cavities and caries experience and oral bacteria in expectant mothers. And there's programs nationally to increase dental access and dental care to moms of expectant children, because we know that moms who have higher volume of bacteria in their mouth are more likely to pass those bacteria onto their children. And so, it really starts before the baby is even born. After birth, we talk about cleaning lips and gums after feeding with a wet washcloth, a moist washcloth. Trying to limit access to other children's in their homes maybe toys and pacifiers that they've been sucking on, and moms and dads trying not to kiss baby directly on the mouth, because the bacteria that cause cavities is contagious.

And so, the way the kids are exposed to it is through their family and through their peers, often through their primary caregiver. So, trying to limit that caries experience and exposure is big. And then, learning to wipe children's mouth out after feeding, and that limits the cavity feeding carbohydrates that are on the mouth. But they also just get the child used to having somebody working and being in their mouth, because that is a foreign experience. So, it starts very young.

Host: Okay. I'm back at the cavities being contagious. Is that true for adults kissing?

Craig Volk Vinall, DDS: It actually is true, but with adults it's not as prevalent because we all get exposed to the same bacteria that cause cavities throughout our lifetimes. As adults, we've all been exposed to it by the time that adults are kissing. But for children, they aren't exposed until we give it to them. So whether it is through their playmate's passy or a toy that they both sucked on or mom kissed them on the mouth, that is how we get our first exposure to the bacteria.

Host: When should parents schedule their child's first dental visit?

Craig Volk Vinall, DDS: So, the American Academy of Pediatric Dentistry recommends the first visit for children to the dentist be within six months of the eruption of the first tooth or by one, 12 months of age, whichever is first. So, usually, one. Some children are born with teeth. And so, we want to see them earlier. But most kids get their first teeth around five or six months of age. And so, that one year checkup is generally six months after the first tooth. So, usually, about one.

Host: We have only been talking for a couple minutes and I've already learned so many things. I never knew a baby could be born with teeth.

Craig Volk Vinall, DDS: We see kids who are born with teeth and we have other kids who have teeth that are up shortly after birth. And those teeth can at times be issues for breastfeeding, they could be sore for the child or they can cause trauma underneath the child's tongue, and sometimes they're totally fine. But depending upon, if they're causing symptoms for mom or for child, we may or may not have to treat them.

Host: So, this is a big one. How can parents prepare their child for the first visit to the dentist? Because, you know, sometimes it's not very pleasant and they're scared. What can they expect?

Craig Volk Vinall, DDS: Well, we talked about wiping children's mouth out when they're young and trying to limit the amount of food and carbohydrates that are remaining on kid's gum tissue. And that should definitely continue once teeth erupt. And then, we start talking about brushing as well. But a lot of those early experiences help towards our dental encounters that come later. Because the more accustomed a child is to having somebody in and around their mouth, the easier those experiences are going to come.

And we know one of the greatest fears of childhood is fear of the unknown. So, it's normal for a child to come in and be afraid of the dentist. That's another reason we try to see them as young as we do. We want them to be in our office and be exposed and be used to people being in and around their mouths. And it is, it's just a normal essential everyday part of healthcare. And you take them to see your pediatrician at regular intervals for wellness checks. That's how they get used to going to the doctor. And we want them to get used to going to the dentist too. Fortunately, we're not having to give the vaccines. And so, a lot of times our first visits are significantly easier than the other ones, but it's just getting children familiar with it.

And if you do have an older child who hasn't been to the dentist yet, then talking to them about it in simple, non-threatening, lay terms. One thing I would try to stay away from is some parents try to show their children YouTube videos before they come into the dentist. And sometimes dental YouTube videos can be unnerving, or traumatic, or scary, and that's not always necessarily the best route to take with your child. A YouTube video may not lead them in the right direction.

For children with special healthcare needs, and young children too, we do what are call storyboards or storybooks, where you can show pictures of the dentist and the dental office. And some kids, especially children with special healthcare needs, do better with routines. And so, maybe they need to have some trips before the actual trip of just mom and dad driving to the parking lot and sitting outside. And if you let your pediatric dentist know you're coming, then the next time, you know, that you can come and sit in the lobby and nobody will think it's weird. Just come in, sit in the lobby and leave or come in and walk back and walk through the back. These are things that we can do to get a child used to being in the office. So, it's not as threatening. But a lot of it is just how it's presented, and the earlier, the easier.

Host: That's a great idea. I remember when my son was young, they had, of course, a big TV screen right in front of them and they could choose what they wanted to watch. Of course, they were all kid-appropriate movies or shows. So, it took their mind off it. Also, a big box of toys that at the end of the visit, they get to pick one and take it home. As children get older, how should parents change or alter their brushing routine?

Craig Volk Vinall, DDS: So as children get older, we want to allow them a little bit more autonomy and allow them a little bit more responsibility. And one of the first things that sometimes parents do is let children start brushing themselves. And that's not always the best situation. We say that children oftentimes don't have the fine motor skills and ability and attention to detail to brush their teeth on their own well until they're about eight or nine and they can tie their own shoes. That's kind of the guiding point that we look for. But encouraging children to be brushing twice a day, morning and night. We say before school and before bed, but sometimes before school can be deceiving because that means do I not have to do it on weekends and summertime? But in morning after breakfast, and then at night before bed, last thing before bed every day. So, we go to bed with clean teeth. A common mistake for kids and for adolescents is they do brush their teeth, but then they have a snack afterwards. Well, now, they're going to bed with dirty teeth instead of clean teeth. So, it really does need to be the last thing right before going to sleep.

And as we do impart more autonomy, they continue to have some supervision, it's one of the times that we see caries incidents increase with kids is early adolescence. And it's because they're getting more autonomy, they're getting less oversight, they have more access to foods and snacks and drinks that are probably higher in sugar, and their diet isn't as monitored, but neither is their brushing. So, parents really do need to continue to be observant and diligent, and making sure that kids are brushing and that they're doing it well. Maybe I talk about allowing children to do it on their own in the morning and then mom and dad being a little bit more observant and present in the evening.

Host: You mentioned responsibility. How can parents teach their children to be responsible for their own dental health as they age? And you touched on it a little bit, but some people use charts, every time they brush, they check it off. And then, at the end of the week, I don't know, they get some reward.

Craig Volk Vinall, DDS: Absolutely. Positive reinforcement is great for, you know, any habit that we want children to develop. Positive reinforcement with calendars and stickers can work or prizes. I think every child's different. And I think parents know their children and know what motivates their children better than certainly the provider who only sees them occasionally. So, I think that's probably more of an individual parent thing and what you think motivates your child the most. But I explain it as, you know, we take our kids to the doctor to make sure that they're healthy and if they needed some medicine or they needed something to maintain their overall systemic medical health, we would make sure that they were doing it. And Dentistry in and of itself can have systemic complications and systemic effects.

And we do need to make sure that they're doing that as well. And we teach them to shower and to comb their hair and to do other normal everyday hygiene things. So, they're presentable when they go outside and to take care of themselves. And brushing should just be one of those daily habits that we work hard to instill. But, you know, with all habits, children often follow the lead of their parents. And so, their parents need to value it and be leading by example.

Host: That's a very good point. Well, let's talk about the debate over fluoride versus fluoride-free toothpaste. What do you think?

Craig Volk Vinall, DDS: There isn't much debate quite honestly within the medical community, the healthcare community, certainly the dental community as a whole. Fluoridation and water fluoridation in particular are supported by the American Dental Association, the American Medical Association, the American Cancer Association, the CDC, the World Health Organization. All of these major professional groups agree that fluoride important in preventing tooth decay. We're talking about toothpaste, the water that we drink, depending upon if we live in a fluoridated community or not, and our toothpaste are our two largest sources to get that medicament, because it is, it's a medicament, into our developing dentition and that of our child. So, it is something that is important. Some of the controversy comes with the fact that it is a toxin. But many of the things that we put in our own bodies or provide to our children are depending upon quantities with which they're provided.

And the one time that I say be careful with toothpaste in particular is with younger children in home. And it's not so much not to use it, because there are prescribed amounts that we can talk about for children to have access to toothpaste. But where we can get into trouble and where it really can be toxic is for a child who likes the taste, to get ahold of a whole tube of toothpaste and for a child to ingest a whole tube of toothpaste. That is a serious medical emergency. That is a reason to call Poison Control and consider emergency medical services, having a whole tube of toothpaste. But in small volumes, a child who can spit, who's over three, gets a size of a pea on the toothpaste, and a child younger than that who can't spit gets a smear of toothpaste. Toothpaste in that quantities does not cause systemic illness, does not cause systemic toxicity, but it does get ingrained into our developing teeth and help fight cavities.

The CDC had published their 10 Greatest Public Health Accomplishments of the 20th Century. And water fluoridation was one of the 10 best public health things per the CDC of the 20th century. The World Health Organization came out in 2021 with the first three dental-related essential medicines. They have a list of essential medicines for the world, for public health. And there are now three dental-related materials on there and they all have fluoride in them. One is topically-applied fluoride, such as toothpaste. Another is called silver diamine fluoride, which is a stronger version of fluoride that we put on cavitated teeth or carious teeth. And the last one is glass ionomer. It is a restorative kind of filling agent that releases fluoride. The World Health Organization thinks so much of fluoride that the only dental-related materials that they have on their agent are fluoride-containing.

Host: Wow. Okay. So just in closing, Dr. Vinall, are there any extra steps parents can take to keep their child's teeth healthy?

Craig Volk Vinall, DDS: Absolutely. The simple ones right off the top to ensure that we're brushing daily and we have oral hygiene habits, that we're limiting access to the simple carbohydrates that break down into the sugars that feed the bugs that cause cavities, because cavities, like we said earlier, are from a contagious bacteria.

But the main thing those bacteria need to thrive are carbohydrates or sugars, and they prefer an acid environment. So, the more acidic foods and drinks and the more sugar that we're putting in our mouth, the better environment we have for those bacteria to thrive. So, trying to limit our access to really sugary foods, making sure that our hygiene at home is good and then, having and establishing a dental home and having a place that that child goes every six months or more as needed for dental checkups and exams and treatment when necessary. And we really want to establish those homes so that when treatment is needed, it's not as scary. It is much more scary and unnerving to go to some place you're unfamiliar with and you don't know, especially if they're going to be doing some sort of treatment on you, than it is to go somewhere you've been going for a long period of time, and you've seen these people multiple times, and you've been there every six months. And then, if you have to go somewhere, well, it may still be a little bit nerve-wracking, but at least you're comfortable with the people that are there, much more familiar environment.

Host: I love that idea you mentioned earlier about going and practicing, just sit in the waiting room and see what it's about, just so it's familiar and maybe you know the nurses when you go for the first time, the little kids.

Craig Volk Vinall, DDS: Absolutely. See the environment, see the TVs on the wall, see the colors, see the, by and large, people who treat a lot of kids and do so in any area of healthcare, ideally, but certainly in dentistry. Generally focus on trying to make it as fun as possible and enjoyable experience as possible. And so, kids going to see that and becoming more comfortable with it should help to allay some of the fears of the unknown.

Host: Absolutely. Well, thank you so much for this invaluable information. We appreciate your time. And I learned a lot, so I'm sure our listeners will as well.

Craig Volk Vinall, DDS: My pleasure. Thank you for having me.

Host: Again, that's Dr. Craig Volk Vinall. To learn more, please visit lebonheur.org. That's L-E-B-O-N-H-E-U-R.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie MacKay. Thanks for listening. This is the Peds Pod from Le Bonheur Children's Hospital.