Cavities (also known as caries or tooth decay) are the most common chronic disease of childhood in the United States. Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children who have poor oral health often miss more school and receive lower grades than children who don’t.

• More than half of children aged 6 to 8 have had a cavity in at least one of their baby (primary) teeth.
• More than half of adolescents aged 12 to 19 have had a cavity in at least one of their permanent teeth.
• Children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households (11%).

The good news is that cavities are preventable. Fluoride varnish can prevent about one-third (33%) of cavities in the primary (baby) teeth. Children living in communities with fluoridated tap water have fewer cavities than children whose water is not fluoridated. Similarly, children who brush daily with fluoride toothpaste will have fewer cavities.

Dental sealants can also prevent cavities for many years. Applying dental sealants to the chewing surfaces of the back teeth prevent 80% of cavities.

What Parents and Caregivers Can Do

What Are the Risk Factors for Cavities?

Your child’s chance of getting cavities can be higher if:

• Family members (older brothers, sisters, or parents) have cavities.
• They eat and drink a lot of sugary foods and drinks, like soda, especially between meals.
• They have special health care needs.
• They wear braces or orthodontics or oral appliances.

If any of these apply to your child, be sure to talk with your dentist, pediatrician, or family doctor to make sure you are taking extra steps to protect your child’s teeth.

The teeth, or dentes (singular = dens), are organs similar to bones that you use to tear, grind, and otherwise mechanically break down food.

Types of Teeth

During the course of your lifetime, you have two sets of teeth (one set of teeth is a dentition). Your 20 deciduous teeth, or baby teeth, first begin to appear at about 6 months of age. Between approximately age 6 and 12, these teeth are replaced by 32 permanent teeth. Moving from the center of the mouth toward the side, these are as follows (Figure 23.10):

• The eight incisors, four top and four bottom, are the sharp front teeth you use for biting into food.
• The four cuspids (or canines) flank the incisors and have a pointed edge (cusp) to tear up food. These fang-like teeth are superb for piercing tough or fleshy foods.
• Posterior to the cuspids are the eight premolars (or bicuspids), which have an overall flatter shape with two rounded cusps useful for mashing foods.
• The most posterior and largest are the 12 molars, which have several pointed cusps used to crush food so it is ready for swallowing. The third members of each set of three molars, top and bottom, are commonly referred to as the wisdom teeth, because their eruption is commonly delayed until early adulthood. It is not uncommon for wisdom teeth to fail to erupt; that is, they remain impacted. In these cases, the teeth are typically removed by orthodontic surgery.

Anatomy of a Tooth

The teeth are secured in the alveolar processes (sockets) of the maxilla and the mandible. Gingivae (commonly called the gums) are soft tissues that line the alveolar processes and surround the necks of the teeth. Teeth are also held in their sockets by a connective tissue called the periodontal ligament.

The two main parts of a tooth are the crown, which is the portion projecting above the gum line, and the root, which is embedded within the maxilla and mandible. Both parts contain an inner pulp cavity, containing loose connective tissue through which run nerves and blood vessels. The region of the pulp cavity that runs through the root of the tooth is called the root canal. Surrounding the pulp cavity is dentin, a bone-like tissue. In the root of each tooth, the dentin is covered by an even harder bone-like layer called cementum. In the crown of each tooth, the dentin is covered by an outer layer of enamel, the hardest substance in the body (Figure 23.11).

Although enamel protects the underlying dentin and pulp cavity, it is still nonetheless susceptible to mechanical and chemical erosion, or what is known as tooth decay. The most common form, dental caries (cavities) develops when colonies of bacteria feeding on sugars in the mouth release acids that cause soft tissue inflammation and degradation of the calcium crystals of the enamel. The digestive functions of the mouth are summarized in Table 23.4.

It's important to keep your child’s first teeth — or baby teeth — healthy. Baby teeth hold space for adult teeth. Taking care of your child’s teeth will protect them from tooth decay (cavities).

Tooth decay can:

• Cause your child pain
• Make it hard for your child to chew
• Lead to your child having a harder time in school
• Create problems with your child’s adult teeth

Take simple steps to prevent tooth decay.

Most babies will get their first tooth around age 6 months. Start these healthy habits now so your child’s smile will stay healthy!

• Wipe your baby's gums with a clean cloth 2 times a day before they get any teeth
• Start cleaning your baby’s teeth 2 times a day as soon as they come in
• Teach your child to brush 2 times a day
• Protect your child’s teeth with fluoride
• Give your child healthy, low-sugar foods and drinks
• Take your child to the dentist for regular checkups

What is tooth decay?

Tooth decay happens because bacteria (germs) in our mouths turn sugar from the food we eat into acid. When these bacteria use the sugar, they make acid. Over time, the acid can cause cavities (holes) in teeth.

Is my child at risk for tooth decay?

Tooth decay is one of the most common childhood diseases. More than 4 in 10 kids have had decay in their baby teeth.

Eating and drinking lots of sugary foods and drinks puts your child at higher risk for tooth decay. But healthy habits, like brushing and going to the dentist, can prevent tooth decay.

Children who frequently consume foods and drinks containing natural and/or added sugars during the day are more likely to develop tooth decay than those who consume them less often. Parents may not know that many of the foods and drinks they give children contain sugar.

How Often Children Consume Foods and Drinks with Sugar During the Day Matters

Sugar plays a key role in tooth decay. Many foods, like milk and milk products, fruit, vegetables, grains, and processed and prepared foods, contain sugar.

Bacteria that cause tooth decay break down foods and drinks that contain sugar to form acid. Each time a person consumes foods or drinks containing sugar, acid is in the mouth for 20 to 40 minutes. Children who are fed meals and snacks at scheduled times are at lower risk for developing tooth decay than children who are fed often during the day.

The peaks in the top graph (Regularly Scheduled Meals and Snacks = Few Acid Attacks) show that acid is in the child’s mouth five times during the day, for a total of a little more than 1½ hours. The peaks in the bottom graph (Fed Often During the Day = Many Acid Attacks) show that acid is in the child’s mouth nine times during the day, for a total of 3 hours (about twice as long as for children who are fed meals and snacks at scheduled times). If a child consumes food and drinks containing sugar often, over time the child is more likely to develop tooth decay.

Finding Hidden Sugar

Many foods and drinks contain added sugar. Sugar in foods can be listed by many different names. The best place to check for sugar is in the ingredients list on the food label. Look for words like:

• Beet sugar
• Brown sugar
• Cane sugar
• Corn sweeteners
• Corn syrup
• Cane juice
• High fructose corn syrup
• Honey
• Malt syrup
• Maple syrup
• Molasses
• Raw sugar
• White sugar

Tips to Help Parents Limit Their Child’s Sugar Intake

Head Start staff can help prevent tooth decay by teaching parents about hidden sugar in food and drinks. Staff can also provide information on feeding and eating habits that can reduce their child’s risk for developing tooth decay.

• Explain to parents the role sugar plays in the tooth decay process and that how often a child consumes foods and drinks containing sugar can make a big difference.
• Show parents how to identify sugars listed on ingredient labels.
• Work with parents to set up a schedule for serving meals and snacks.
• Encourage parents not to feed their child or graze on foods and drinks often through the day, especially those containing natural and/or added sugar.

Tooth decay is caused by bacteria in the mouth that use sugar in food to make acid. Acid removes minerals from the outer tooth surface (enamel). Over time, acid breaks down the tooth surface and creates a cavity (hole) in the tooth.

Factors That Cause Tooth Decay

• Parent has untreated tooth decay. Parents with untreated tooth decay have high amounts of bacteria that can cause decay. Parents can pass these bacteria to their child through saliva-sharing activities. Examples of these activities are cleaning a pacifier by mouth and giving it to their child and sharing forks or spoons.
• Child has frequent between-meal snacks or drinks that contain sugar. When children snack on foods containing natural or added sugar often throughout the day, their teeth are bathed in acid for long periods of time. This gives acid more time to break tooth surfaces down and create tooth decay than it would if the child ate regularly scheduled meals and snacks.
• Child is put to bed with a bottle with liquids that contain natural or added sugar. When children are put to bed with a bottle or sippy cup containing breast milk, infant formula, or any liquid with natural or added sugar, their teeth are bathed in acid for long periods of time. The acid has more time to break tooth surfaces down and create tooth decay.
• Child has dental plaque on teeth. Dental plaque is a film on the surface of the tooth that is a mix of saliva, food, and the bacteria that cause tooth decay. If dental plaque is not removed by brushing with fluoride toothpaste twice a day, it increases the child’s risk for developing decay.
• Child has a medical condition or a disability. Children with medical conditions, such as asthma, may take medicines that contain sugar or make their mouths dry. Children with disabilities may have oral habits that can wear or break teeth, or they may eat soft foods that can lead to more dental plaque on teeth, or they may be physically unable to clean their teeth well.
• Child has had tooth decay in the past. Once children have had tooth decay, their risk for developing more tooth decay increases. This is true even for children who have had fillings.
• Child has early signs of tooth decay. Chalky white spots along the gum line of the upper teeth are the beginning of tooth decay.

Factors That Protect Teeth from Tooth Decay

In addition to lowering the factors that can cause tooth decay, it is important to increase the factors that protect teeth from decay. These include:

• Child receives fluoride. Fluoride puts minerals back into teeth that acid has removed. It also prevents the bacteria that cause tooth decay from growing. Three main ways children can receive fluoride to help protect against tooth decay are:
  • Fluoridated water. Fluoride is added to many community water supplies. Fluoride can be consumed by drinking tap water and eating foods made with tap water.
  • Fluoride toothpaste. As soon as the first tooth comes in, parents should brush their child’s teeth with fluoride toothpaste twice a day.
  • Fluoride treatments. Staff in medical and dental offices and clinics can put fluoride varnish on a child’s teeth as soon as the first tooth comes into the mouth and then every few months afterward
• Child has a regular source of oral health care. Children who have regular dental visits are checked regularly for early signs of tooth decay. Services to protect teeth from tooth decay and repair early stages of tooth decay are also provided.

Keeping the Factors in Balance

The key to preventing tooth decay is keeping a balance between the factors that cause tooth decay and the factors that protect against decay. The goal is to lower the factors that cause decay as much as possible and increase the factors that prevent tooth decay as much possible.

Take these steps to help you take good care of your child’s teeth.

Start with the first tooth.

As soon as your baby’s teeth start coming in, clean them regularly with plain water and a soft children’s toothbrush. Clean your baby’s teeth 2 times a day — especially right before bedtime.

If your child is younger than 2 years, ask their doctor or dentist when it's time to start using fluoride toothpaste.

Teach your child to brush 2 times a day with fluoride toothpaste.

Starting at age 2 or 3 years, use a pea-sized amount of toothpaste to brush your child’s teeth. Make sure your child spits out the toothpaste after brushing — if young children swallow too much fluoride toothpaste, their adult teeth may have white spots.

Around age 7 or 8 years, kids can start to brush their own teeth. Watch your kids to make sure they:

• Brush all of their teeth
• Brush for about 2 minutes each time
• Spit out the toothpaste instead of swallowing it

Make brushing teeth fun.

Getting kids to brush their teeth can be hard. Here are some ways you can help make it fun for them:

• Let your child choose a toothbrush in a favorite color or with a character from a TV show or movie — just make sure it’s the right size for your child’s mouth
• Find books or shows with stories about brushing — then you can use the characters as an example when it's time for your child to brush their own teeth
• Sing or play a song to help your child brush for 2 minutes

Protect your child’s teeth with fluoride.

Fluoride is a mineral that helps protect teeth from decay.

Use fluoride toothpaste.

When you shop for toothpaste, read the label to be sure it has fluoride.

Ask your child’s doctor about fluoride varnish.

After your child’s first tooth comes in, ask the doctor to give your child fluoride varnish (a thin coating of fluoride put on the teeth). Fluoride varnish helps prevent tooth decay.

Find out if there’s fluoride in your water.

Fluoride is added to the drinking water in many towns and cities. Check with your child’s doctor or your local water company to find out if your tap water has fluoride in it.

Give your child tap water to drink.

If your water has fluoride added, be sure to give your child tap water (not bottled water) to drink. Most bottled water doesn’t have enough fluoride in it to protect your child’s teeth from decay.

Ask for supplements if your water doesn't have added fluoride.

If your tap water doesn’t have fluoride added, ask your child’s doctor or dentist for fluoride supplements (drops or tablets). Children age 6 months and older can take fluoride supplements.

What about the cost of fluoride supplements?

Fluoride supplements for kids ages 6 months to 5 years who don’t have fluoride in their water are covered under the Affordable Care Act. Depending on your insurance plan, your child may be able to get fluoride supplements at no cost to you.

Fluoride is the safest and best way to prevent tooth decay. For generations, many communities have added fluoride to their public water (tap) supply to prevent tooth decay. Fluoride is also added to most toothpaste brands and can be professionally applied using varnish or gel.

Understanding Tooth Decay

To understand how fluoride works, it is important to know how tooth decay occurs. Tooth decay can be explained using two simple, related equations.

How Fluoride Prevents Tooth Decay

Fluoride protects teeth from developing tooth decay in three ways:

• It makes teeth strong and more resistant to acid.
• It can stop early tooth decay by putting minerals back into teeth.
• It interferes with bacteria's ability to make acid.

Tips to Help Parents Prevent Tooth Decay with Fluoride

• Reassure parents that fluoride is safe. Fluoride is a mineral that is found naturally in water, soil, plants, and rocks. There is strong scientific evidence to show that fluoride does not cause health problems in children or adults.
• Urge parents to serve fluoridated water to their children. Whenever possible, encourage parents to serve their children water from the tap. Healthy Habits for Happy Smiles: Encouraging Your Child to Drink Water offers tips on making water appealing to children. If parents prefer to serve bottled water, show them how to find out if the water has fluoride. Often, bottled water does not have fluoride.
• Encourage parents to brush their child's teeth with fluoride toothpaste twice a day. The best times to brush are in the morning and at bedtime. Parents should put a rice-size amount on the toothbrushes of children under age 3 and a pea-size amount on the brushes of children ages 3 and older. Children can spit out any remaining toothpaste but should not rinse after brushing. Healthy Habits for Happy Smiles: Brushing Your Child's Teeth provides additional tips and photos of toothpaste amounts that can be shared with parents.
• Remind parents to ask their child's dentist or doctor about fluoride varnish. Fluoride varnish can be painted onto a child's teeth in their dental or medical office. Varnish can be applied up to four times a year. It strengthens enamel, making teeth less likely to develop tooth decay. Fluoride varnish should be used in addition to fluoridated water and fluoride toothpaste.

Fluoride is found in nature in soil, plants, and water. Fluoride is safe. Drinking tap (faucet) water with fluoride, brushing with fluoride toothpaste, and having a health professional apply fluoride varnish to the teeth are important ways to make teeth strong and prevent tooth decay.

Fluoride in Water

• Since most water doesn’t have enough natural fluoride to prevent tooth decay, many communities add fluoride to their water supply (tap water) used for drinking and cooking.
• Give your child tap water with fluoride. If you are not sure if your water has enough fluoride, ask your child’s dental clinic for help in finding out.
• Some bottled waters contain fluoride, and some do not. Check with the bottled water’s manufacturer to ask about the fluoride content of a particular brand.
• If your tap water does not have enough fluoride, ask your dental or medical clinic if your child needs fluoride drops or tablets.

Fluoride Toothpaste

• Brush your child’s teeth after breakfast and before bed once the first tooth begins to show.
• Use a child-sized toothbrush with soft bristles and fluoride toothpaste.

Fluoride Varnish

• Fluoride varnish is painted on a child’s teeth to prevent or reduce cavities.
• It is not permanent but keeps fluoride on the teeth for several hours.
• Fluoride varnish has a pleasant taste and is well tolerated by children.

Water is important for good oral health and overall health and well-being. Drinking water every day helps move nutrients throughout the body, gets rid of waste, gives skin a healthy glow, keeps muscles moving, and promotes a healthy weight.

Drinking Water Is Important for Good Oral Health

• It strengthens teeth. Drinking water with fluoride is one of the easiest and best ways to help prevent tooth decay. Water with fluoride makes it hard for the bacteria that cause tooth decay to create acid. Fluoride also strengthens the outer layers of the teeth, making them more resistant to acid attacks. If the local, county, or state health department says not to drink water from the tap, make sure the new water source contains fluoride.
• It keeps the mouth clean. Drinking water washes away the bacteria that cause tooth decay and also washes away food left in the mouth after eating. Water also dilutes acids made by the bacteria that cause tooth decay. Even though drinking water helps keep the mouth clean, it is still important to brush the teeth with fluoride toothpaste twice a day.
• It fights dry mouth. Water helps create saliva, which is the mouth's first defense against tooth decay. Saliva contains calcium and other minerals that work into the outer layers of the teeth to keep them strong. It also keeps food moist so it can be swallowed easily and clears away food left in the mouth after eating.
• It does not contain sugar. Water is sugar-free, so drinking it doesn't allow the bacteria that cause tooth decay to make acid. Drinking water instead of beverages that have natural or added sugar lowers the risk for developing tooth decay.

Give your child healthy foods.

Healthy foods include vegetables, fruits, whole grains, beans, and lean meats.

• Get tips to help you make healthy, kid-friendly snacks.
• Find more ways to eat healthy.

Make sure your child gets enough calcium.

Calcium is a mineral that helps make teeth strong. Milk, cheese, and yogurt are good sources of calcium.

Offer your kids healthy drinks.

If sugar from drinks stays on your child’s teeth for too long, it can lead to tooth decay. To help prevent tooth decay:

• Give your kids only tap water to drink between meals.
• Serve milk or juice with a meal instead of between meals.

Don’t put your baby to bed with a bottle.

Milk or formula will stay on your child’s teeth all night and increase your child’s risk for tooth decay.

Choosing healthy drinks is just as important as choosing healthy foods. Many drinks have added sugar. When children consume drinks with sugar throughout the day, their risk for developing tooth decay increases.

Milk and Water Are Healthy Drink Choices

During a baby’s first year of life, breast milk is best. If an infant is not fed breast milk, the infant should be fed iron-fortified infant formula. The Consensus Statement. Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations recommends that children be fed whole milk until age 2, unless the child’s primary care provider recommends switching to reduced fat (1%) or nonfat (skim) milk sooner for medical reasons. Low-fat or nonfat milk and plain water are healthy drink choices for children over age 2. Children can begin drinking water at age 6 months.

Many Drinks Have Added Sugar

Parents often do not know that many drinks, like the ones listed below, have added sugar:

• Flavored milk, such as chocolate, strawberry, and vanilla milk
• Non-diet pop or soda
• Fruit drinks, such as fruit punch and juice cocktails
• Kool Aid
• Vitamin water
• Sweetened teas
• Energy drinks

Plant-based milks, such as rice, coconut, and almond milks, may be sweetened or unsweetened. Sweetened versions of these milks contain added sugar. Plant-based milks are not generally recommended for children under age 1 because they do not contain the same nutrients as cow’s milk. But they may be recommended by the child’s primary care provider if the child cannot drink cow’s milk for medical or dietary reasons.

Help Parents Make Healthy Drink Choices

Head Start staff can help parents prevent tooth decay by promoting healthy drink choices and encouraging them to limit drinks with added sugar.

• Encourage parents to give children water, ideally tap water with fluoride. See the Brush Up on Oral Health tip sheet, Encouraging Children to Drink Water. Some parents prefer to give children bottled water instead of tap water. It is important for these parents to know that the amount of fluoride in bottled water varies greatly. Most bottled water does not contain the right amount of fluoride to help prevent tooth decay. Some bottled water contains no fluoride.
• Educate parents that children should not be put to sleep with a bottle or sippy cup containing drinks with natural or added sugar. If parents put the child to bed with a bottle or sippy cup, it should contain only water.
• Share with parents infographics and videos from HealthyDrinks. Healthy Kids., which provide information on what drinks to give children from birth to age 5. Recommend them to take copies home and keep in their kitchen.
• Remind parents to give children ages 12 months and older no more than four to six ounces of 100% fruit juice per day. Encourage parents to give children frozen or fresh fruit that has been mashed or cut into bite size pieces instead of juice. If parents offer juice, tell them to serve it in a cup without a lid.
• Explain to parents that children under age 5 should not drink sugar-free drinks, like diet pop or soda. The carbonation that makes these drinks bubbly can wear away the outer covering of teeth. This makes a tooth’s outer surface thinner and more likely to develop decay.

Young children eat small amounts of food because their stomachs are small. In addition to giving your child healthy meals, giving your child a variety of healthy snacks at scheduled times during the day is important to keep your child healthy. Encourage your child to try new foods.

Tips for healthy snacks:

• Give your child a variety of healthy snacks, such as:
  • Fruits like apples, bananas, oranges, or berries
    • Give your child cut-up or whole fruit instead of fruit juice.
  • Vegetables like broccoli, carrots, celery, cucumbers, or peppers
  • Foods made with whole grains, like cereals, crackers, bread, or bagels
  • Dairy products like low-fat milk, cheese, cottage cheese, and unsweetened yogurt
• Avoid foods that may cause choking, like popcorn, nuts, seeds, raw carrots, or whole grapes. Cut food into small pieces.
• Give your child water or milk to drink with snacks.
• Do not give your child sweets like candy, cookies, and cake at snack time. And do not give your child sweet drinks like fruit flavored drinks, pop (soda), and fruit juice at snack time.

Take your child to the dentist.

Take your child to the dentist for a checkup by age 1. Ask your child’s doctor for the name of a dentist who's good with kids.

Going to the dentist for the first time can be scary. It might help your child to see you sitting in the dentist’s chair first. You can also ask the dentist to let your child sit on your lap during the checkup.

Ask your child’s dentist about how to clean your child’s teeth and other ways to keep your child’s mouth healthy. After the first visit, make sure to schedule regular dental checkups for your child.

What about the cost of dental visits?

Your health insurance plan may cover dental care for your child. Check with your insurance company to find out what’s included in your plan.

If you don’t have insurance that pays for dental care, find a free or low-cost dental care program near you.

Ask your child’s dentist about sealants.

A sealant is a thin, plastic material put on the tops of back teeth to help protect them from decay. Ask your dentist if sealants are right for your child.

Children need to visit the dental clinic to keep their teeth and mouth healthy. If children have regular dental visits, the dentist and dental hygienist can take care of their teeth and find oral health problems early. Here are tips for finding a dental clinic that is best for you and your child.

Tips for finding a dental clinic:

• Ask your child’s Head Start teacher or other parents for suggestions.
• Ask your child’s doctor for a referral.
• Visit these websites for finding a dentist in your community:
  • http://www.aapd.org/finddentist
  • https://findadentist.ada.org/
  • http://www.insurekidsnow.gov

Questions to ask when choosing a dental clinic:

• Is your clinic taking new patients?
• Does your clinic take my child’s insurance (for example, Medicaid or CHIP)?
• Do any of your staff speak my language? Can they translate so I can understand?
• Does clinic staff have training or experience treating young children?
• When is the next appointment for a new patient?
• What happens during a new patient visit?
• Is your clinic close to public transportation?
• When is your clinic open? Is it open evenings or on weekends?
• What information or forms do I need to bring to fill out your paperwork (for example, my child’s insurance card or a Head Start oral health form)?
• Are there books, toys, or other things for children in your waiting room?

It’s understandable that children sometimes get nervous about their first few dental visits. Going to the dental office or clinic is a new and unfamiliar experience for them. For young children who are not used to oral health care yet, having their teeth and mouths examined can feel intrusive. What young children hear about dental visits affects what they think an upcoming visit will be like. If they are told that bad things may happen during a dental visit, they might feel afraid.

Tips for Parents to Prepare Children for Dental Visits

Follow these tips to prepare children for dental visits:

• Be positive. Dental visits are easy and painless for most children. Suggest that parents use positive statements about what will happen during a visit. For example, say, “The dentist will see what a good job you do taking care of your teeth” or "When you leave the dental office, your teeth will be nice and clean.”
• Keep it short and simple. If children ask what will happen during the dental visit, advise parents to give a short, simple answer. For example, parents can say, “The dental hygienist will count how many teeth you have.” Sharing too much information about dental visits may confuse and worry children.
• Don’t bring up shots or possible pain. Many children worry about getting shots or having their teeth drilled during a dental visit. Oral health providers use “sleepy juice” to numb the gum before giving a shot, so the child barely feels it. If the child asks whether he or she will get a shot, a good answer for parents to give is, “I don’t know, but we can ask the dentist or dental hygienist.”
• Tell parents to keep their fears to themselves. If parents have fears about dental visits, tell them not to share their feelings with their child. Hearing about adults’ fears can make children afraid of dental visits too.
• Role-play visiting the dentist and dental hygienist. Tell parents to have children dress up and pretend that they are dentists or dental hygienists. Children can use white shirts as lab coats, paper napkins as patient bibs, and coffee filters and yarn as masks. Advise parents to let children pretend to examine and count their parents’, sisters’, or brothers’ teeth.
• Read books or watch videos together. Encourage parents to use age-appropriate books and videos about dental visits. Remind parents to preview them before reading or watching them with their child. Books and videos with words like hurt, pain, shot, drill, or any other words that may frighten children should not be used. Ask a children’s librarian, dentist, dental hygienist, or early childhood education expert to suggest one or two good books and videos about dental visits.
• Make dental visits fun. Encourage parents to have children bring a favorite stuffed animal or blanket to the dental visit. Let children wear a special outfit or costume to the visit. Also, suggest that parents plan a fun activity after the visit.

If your child’s dentist finds tooth decay and recommends a follow-up dental visit for treatment, it’s important for your child to get care. Receiving follow-up treatment is key to keeping your child healthy.

Why it’s important to take your child for a follow-up dental visit for treatment:

• The dental team can treat tooth decay and prevent it from getting worse and causing an infection.
• Treating tooth decay can prevent pain, trouble sleeping, behavior problems, and difficulty concentrating.
• Treating tooth decay can stop it from spreading to other teeth in your child’s mouth.

Tips to prepare your child for a follow-up dental visit for treatment:

• Be positive. For example, say, “The dentist will help keep your teeth healthy.”
• Keep it short and simple. If your child asks what will happen at the visit, you can say “The dentist will fix your tooth.”
• Don't talk about shots or possible pain.
• If you fear visiting the dentist, don’t share your feelings with your child. This could scare them.
• Read books or watch videos together with your child about dental visits. Look for books or videos that show dental visits in a positive way. Don’t read books or show videos that use words like hurt, pain, shot, or drill. Ask a children’s librarian, dentist, dental hygienist, child care provider, or teacher for recommendations.
• Let your child bring their favorite toy or blanket to the dental clinic.
• Ask one of the dental team members if your child will receive a small toy or new toothbrush at the end of their visit. Share this with your child.

Oral injuries to the face and mouth happen often among young children. Because oral injuries can affect children for the rest of their lives, it is important for parents to try to prevent these injuries.

Causes and Types of Oral Injuries

Most oral injuries happen when children fall. Children may stumble as they are learning to walk and when they are physically active. Injuries may happen when children trip on things, are pushed by another child, climb on stairs and furniture, or run with items in their mouths. Children’s top front teeth are injured most often. They can be chipped, pushed into the gum, pushed forward or back in the mouth, or knocked out. Bruises or cuts in or near the mouth are also common oral injuries. Some children receive burns from chewing on electrical cords that are plugged into a socket.

Impact of Oral Injuries

Preventing oral injuries is important for many reasons. Injured primary teeth can turn brown or black, cause pain, become infected, or have to be removed. Any one of these outcomes can affect the child’s self-esteem, ability to learn, and/or ability to eat healthy foods.

Early loss of primary teeth as a result of an oral injury or tooth decay can affect the condition of the child’s permanent teeth as well. Primary teeth keep space open for permanent teeth forming underneath. When primary teeth are lost too early, there may not be enough space for permanent teeth to grow.

Injuries to a child’s primary teeth can also damage the permanent teeth that are forming under the primary teeth. If a primary tooth is pushed into the gum, it can disturb the cells that are building the permanent tooth. This can cause discolored or deformed permanent teeth or permanent teeth that decay quickly. Injuries to primary and permanent teeth can affect a child’s speech, nutrition, self-confidence, and overall health.

Injuries to the head, face, and mouth are common in young children. Parents play an important role in preventing oral injuries. However, even when parents and staff do their best to keep children safe, oral injuries can happen.

First Aid Supplies for Responding to Oral Injuries

It is important that first aid kits have supplies for responding to oral injuries. Here are some items to include:

• Instructions on how to assess and provide first aid for oral injuries.
• Non-latex gloves to wear while inspecting or cleaning the injured area.
• Clean gauze and cotton swabs to stop bleeding and clean the injured area.
• Floss to remove anything stuck between teeth to relieve pain.
• Clean cloth for wrapping ice or instant cold ice packs to put on the injured area to reduce swelling.
• Plastic bags to dispose of biohazard waste, like blood-soaked gauze or gloves.
• Phone number for the child’s dentist in case of a dental emergency, like a tooth knocked loose or pushed into the gum.
• Emergency medical service phone numbers (911 or 9-911) for a medical emergency, like a child who is unconscious or has trouble breathing or has bleeding that can’t be stopped.

Giving First Aid for Oral Injuries

If a child has an oral injury, keep the child as calm as you can and assess the type of injury:

• Tongue or lip injured. Injured tongues or lips often bleed a lot. Clean the injured area and press a clean piece of gauze or a cotton swab on it to stop the bleeding. Also, keep the child’s head up and facing forward to prevent choking. Put ice wrapped in a clean cloth on the area to reduce swelling. If bleeding doesn’t stop after 30 minutes, contact the child’s parents and take the child to the dentist, doctor, or nearest urgent care center immediately.
• Tooth chipped or cracked. If a child’s tooth is chipped or cracked, contact the child’s parents and dentist immediately. Quick action can prevent infection and reduce the amount of treatment needed to fix the tooth. Clean the injured area. If the child can rinse, have the child rinse with water. Press a clean piece of gauze or a cotton swab on the gum around the tooth to stop any bleeding. If there are other injuries around the mouth, apply ice wrapped in a clean cloth on the area to reduce swelling.
• Tooth knocked out. If a tooth is knocked out, check the child’s health record to determine if it’s a primary tooth or a permanent tooth. Permanent teeth usually appear between ages 6 and 8. If it’s a primary tooth, contact the child’s parents and dentist immediately. Do not try to put the tooth back into the mouth. Doing this may damage the permanent tooth underneath. Clean the injured area. If there is bleeding, have the child bite on a clean piece of gauze on the area for 15 to 30 minutes to stop it. If there are other injuries around the mouth, apply ice wrapped in a clean cloth on the area to reduce swelling. If a child’s permanent tooth is knocked out, see the American Academy of Pediatric Dentistry’s instructions.
• Tooth knocked loose, moved, or pushed into the gum. If a child’s tooth has been knocked loose, moved forward or backward, or pushed into the gum, contact the child’s parents and dentist immediately. Ask the dentist if the child needs to be seen. If the child can rinse, have the child rinse with water. Press a clean piece of gauze or a cotton swab on the gum around the tooth to stop bleeding. If there are other injuries around the mouth, put ice wrapped in a clean cloth on the area to reduce swelling.
• Toothache. If a child has a toothache, it is likely that the tooth is decayed. An appointment should be made as soon as possible for a dentist to assess the problem and treat it.