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March 6, 2019

Little Teeth Big Smiles


An interview with pediatric dentist, Dr. Joan Kowolik.

As parents, we all have questions about the little smiles in our households: When should we start brushing? How much candy is too much candy? If the teeth look good, do we have to go to the dentist? We went straight to the experts to find out the answer to these questions and more.

BFIN: Before a child gets teeth, should I be worried about brushing their gums?

Dr. Kowolik: It’s important to start with brushing the gums and getting them in the habit of cleaning them up before bedtime. That’s what’s most important. Use a flannel or piece of cotton, and just wipe around the gums. And it doesn’t matter if its a breastfed baby or a bottle-fed baby, because both milks will form sticky stuff around the mouth. So start as soon as you can.

BFIN: When should children begin brushing their own teeth?

Dr. Kowolik: It’s a good idea to get the young child in the habit of using a toothbrush. Before a child can really brush their teeth properly themselves, they have to be able to have dexterity. One way to see if they have it is to give them a knife to chop vegetables. If they can do that, then they are ready to brush their teeth. Before that, they can brush their front teeth and little bits of other teeth by moving the toothbrush around. A child is probably going to be 6 or 7 before they can do it themselves.

BFIN: Can children use adult toothpaste?

Dr. Kowolik: The important thing is the amount of fluoride. And toothpaste gives a flavor, and many children don’t like it. Children’s toothpaste makes it easier for children to brush their teeth.

BFIN: There’s baby toothpaste, toddler toothpaste, children’s toothpaste and adult toothpaste. Do we really have to buy all those different kinds of toothpaste?

Dr. Kowolik: Only if you want to. I don’t want you to go to the expense of buying toddler toothpaste when adult toothpaste is less expensive.

The important thing is that you buy toothpaste that is made by a recognized company. And buy it from a regular store. There was a case a few years ago of a dollar store company selling a toothpaste labeled “Crest” that was not in fact Crest. And had some things in it that were not good for children. So, go with the big name and with fluoride.

BFIN: If my child brushes their teeth and the teeth look good, do I still have to take them to the dentist?

Dr. Kowolik: Unless you have x-ray vision, yes. Because you can’t see what is happening between the teeth. Apart from brushing, you should be flossing. Flossing baby teeth is not very easy. The earlier you take your child to the dentist, the better. The American Academy of Pediatric Dentistry suggests to take your child to the dentist when they are 1 year old.

A visit also gives parents a chance to talk about the teeth and health of the mouth, diet and what they are doing with tooth brushing. On the first visits, the child will not lay down and have their teeth teeth looked at. The dentist will give a quick revision. When the child is 3 years old, then they are ready to hop on the chair, lay down and have their teeth looked at. You are going to be able to keep their teeth healthy then.

If you wait until your child is 3 to have their teeth looked at, it’s quite possible there will be something there that needs treating. I’d rather see a smiling child who is happy to see me than cavities and sore teeth.

BFIN: I have a hard time getting my kids to brush their teeth; is it really that bad if a couple days go by without them brushing?

Dr. Kowolik: Brushing before bedtime is the most important time. So if you can’t do it in the morning because you are rushing out — and this goes for adults too — if you brush at night, you are less likely to have cavities. I would say bedtime is the time you need to brush [the most]. We all miss days occasionally, like when you are traveling. But if it’s part of the bedtime routine, it will be easier for children to cooperate.

See ideas for building routines with your little one.

BFIN: How can I make brushing a positive experience?

Dr. Kowolik: With my own sons, I told them “I will put the toothpaste on and you will take the toothpaste off.” Compliments work too, “You are much better at taking the toothpaste off than I am.” I also would let them brush my teeth as I brushed theirs. It’s about not making it a chore. It’s just something you have to do, like combing your hair.

Flossing someone else’s teeth can be difficult, but it is important. Especially when the teeth are very close together, because the bristles don’t get in there.

BFIN: When is it typical for a child to lose their first teeth?

Dr. Kowolik: It depends. Kids are usually 6 to 8 years old, and it’s usually the lower teeth. But some children lose them earlier. And sometimes baby teeth stay in and permanent teeth come in behind, and parents get very worried about that. But that’s very normal. Baby teeth will fall out eventually, and the tongue will push the permanent teeth forward in line. It’s not something to be worried about.

BFIN: Is it normal for a child to have cavities?

Dr. Kowolik: No, it shouldn’t be. But unfortunately a large number of children get cavities. Cavities are the most common childhood dental disease, and it is an infection. The name of the bacteria that causes cavities is called caries, and it can be passed on from parents to children. So it is important that grownups have healthy teeth too. Even before babies have teeth, parents can pass on the bacteria, and then the teeth will grow to have cavities. It is possible to have children be cavity free. Both of my children are cavity free, and it wasn’t hard.

BFIN: If I am a parent that is prone to cavities, will my child be prone to cavities too?

Dr. Kowolik: Depends on your habits, your diet, your snacking and your soda-pop drinking. What you do is probably what you are going to do with your child. So if you have high cavities, look at your diet. How often do you put sugar into your mouth? Sugar iced tea is just as bad as soda pop. There are no genetics involved in cavities. It is the habits of the grown-ups in the child’s life that will stretch into their own life. If the child already has cavities, there are ways of preventing those cavities from becoming larger, like regular visits to the dentist.

BFIN: Any tips on making a dentist visit a positive experience?

Dr. Kowolik: Read books with your child about going to the dentist. Speak about the visit as something positive and not something bad you are dreading — children can pick up your vibe. Start your visits early so your child is familiar with what happens.

BFIN: What should I look for when looking for a dentist for my child?

Dr. Kowolik: Make sure the dentist wants to see children, because if they don’t, it’s going to be a bad experience for everyone. Make sure they accept your insurance, because if you go in and then discover they are not covered by your insurance, the cost can come as a shock. A child’s dentist doesn’t have to be a pediatric dentist; there aren’t enough in the country to see all of the children. Lastly, the dentist who is right for you might not be right for your child. Ask the dentist, “Do you like to see children?”

In October 2018, Dr. Joan Kowolik from Indiana University School of Dentistry joined Brighter Futures Indiana for a Facebook live Q&A session. This is a transcript of some of the questions parents asked. Some parts of this conversation have been edited and summarized for brevity.

See the complete Facebook Q&A live session here.

About Dr. Kowolik

Dr. Joan Kowolik is the director of Indiana University School of Dentistry (IUSD) pre-doctoral pediatric dentistry program. She is a dental graduate of the University of Edinburgh, Scotland. She received additional training in pediatric dentistry at Edinburgh and also the University of Leeds in England. Her numerous contributions to the IU School of Dentistry include her founding mentorship of the Indiana student chapter of the American Academy of Pediatric Dentistry known as the IUSD Kids Club, a group of student volunteers who provide education and preventive services at community events and schools throughout central Indiana. Together with Dr. Stuart Schrader of the Oral Biology department, Dr. Kowolik took the lead at IUSD in a major collaboration with Jane Pauley Community Health Clinic, Warren Township Metropolitan School District and Community Health Network to establish a dental clinic for Eastside children and adults.

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