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Important Information about Your Toddler and Preschooler and Dental Decay

Is My Preschooler At Risk?

Approximately one in five children aged 2 to 4 years has decay in the primary or permanent teeth. Dental caries is the most common chronic disease in the US and among the most common diseases in the world. It is one of the most preventable infectious disease of the oral cavity and more common than asthma in pediatric population.

What are the Causes of Dental Decay?

 A primary cause is habitual use of a bottle or a non-spill training cup with milk or fruit juice at bedtime or throughout the day also known as "Baby Bottle Tooth Decay" or "Nursing Bottle Caries". Food sources include carbohydrates such as milk and fruit juice considering that the main type of bacteria associated with tooth decay, Streptococcus mutans, use carbohydrates for food. These bacteria present in the mouth excrete acid that causes tooth decay. Other bacteria, such as S.sobrinus, Lactobacillus acidophilus and L.casei are associated with progression of caries.

What is needed to develop caries?

You can consider a combination of four factors:

1. Your child's teeth

2. Fermentable source of carbohydrates

3. Cariogenic microorganisms (bacteria)

4. Time allowed for the bacteria to attack.

5. pH of the saliva (normally 5.6 to 7.9, but affected by    drinks and foods to become acid - about 5.5).

What Foods should my Child avoid?

Avoid using a bottle or non-spill training cup with milk or fruit juice at bedtime or throughout the day. Foods containing carbohydrates that stick to the surface of the teeth, such as sticky candy like caramel, are strong caries promoters. The American Academy of Pediatric Dentistry also recommends to avoid consumption of more than three sugar-containing snacks or beverages between meals in children prior to 5 years of age.

What are other risks of caries?

Gingivitis, an infestation of bacteria in the gingiva, and periodontal disease which may culminate in infectious disease to the blood stream and even to the heart.

What Can I do to protect my child from this common disease?

1. Oral Hygiene & Prevention

  • Oral hygiene begins at birth: moist soft cloth can be used to clean your baby's gums. Small-soft tooth brush may be used for infants. Toothpaste may be added at age two.
  • Be involved in your child's brushing and flossing until age eight.  Brushing and flossing with fluoride-containing tooth brush and floss will help reduce the number of cariogenic bacteria in the mouth.
  • Limit the intake of refined carbohydrates: sugar-containing juices, sodas, and infant formulas through a nursing bottle or non-spill cup at bedtime and throughout the day.
  • Avoid sticky candies like caramel completely.
  • Promote snacks with crunchy foods such as carrot sticks or apple slices.
  • Maintain regular dental visits to monitor and reinforce good oral health practices in your child: prevention, early diagnosis, and prompt intervention are your best weapons to promote good dental care.
  • Use of Fluoride: present in our water supply and fluoridated toothpaste

Important Note About Use of Fluoride


Fluoride is safe and effective for caries control and prevention. It affects the dentin and enamel of both the erupted and unerupted teeth.


Fluoride is found in our water fluoridated supply and in the use of fluoridated toothpaste. If the water is not fluoridated, supplementation is recommended. You must consult with a dentist or your child's pediatrician before considering supplementing with fluoride and in order to find out more details about the need and amounts of supplementation, if any.


Because children younger than 6 years of age cannot expectorate reliably, the use of fluoridated toothpaste must be monitored by their parents and the recommendation to use only a "pea-sized" amount of toothpaste must be followed. In addition, toothpastes and other substances containing fluoride should stay out of the reach of small children. Excessive supplementation or use of fluoride may cause fluorosis which produces staining to the enamel of teeth and other more severe risks in toxic levels. Discuss safety use of fluoride with the child's pediatrician and/or dentist.

By Lidia Alzate, D.C.


Brown, Judith. Nutrition Through The Life Cycle. 4th Edition.

Hay, William W., Levin, Myron J., Sondheimer, Judith, Deterding, Robin. Current Diagnosis & Treatment Pediatrics. 19th Edition. 2009.

Ross, A. Catharine, Caballero, Benjamin, Cousins, Robert J., Tucker, Katherine & Ziegler, Thomas R. Modern Nutrition in Health & Disease. 11th Edition.2014.


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