In 1944, 90 percent of American children between the ages of 5 and 17 suffered tooth decay; today, the percentage has been cut in half, thanks to fluoridated drinking water, toothpaste and improved dental hygiene. Wider use of fluoride supplements and topical fluoride solutions should reduce the incidence of tooth decay even further. (Consult your pediatrician before using these preparations, especially if your local water supply is fluoridated.)

Many parents mistakenly assume that because a child's primary (baby) teeth are only temporary, they need not be protected from decay. In fact, healthy primary teeth are important for speech development and proper placement of the permanent teeth.

WHAT CAUSES TOOTH DECAY?
When normal mouth bacteria attack carbohydrates (such as sugars) on the teeth, they produce acids that can strip and break down the calcium and protein in tooth enamel, producing caries, or decay. The most common sites are the biting surfaces of the molars and the places where the teeth adjoin. Untreated decay will eventually invade the living inner structures of the tooth.

Infants can develop severe tooth decay if they are allowed to fall asleep nursing or sucking bottles. Liquid from the bottle pools behind the upper front teeth, providing an ideal setting for bacteria to multiply and cause serious decay.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS TOOTH DECAY?
Children old enough to talk will complain of tooth pain that occurs on exposure to cold, heat, or pressure, such as biting down. Detecting tooth decay in babies is trickier. Look for altered eating habits (such as chewing only on one side of the mouth) and sensitivity to hot or cold liquids. Looking in the child's mouth may allow you to detect dental problems, but this method is far less effective than a dentist's examination.

PREVENTING TOOTH DECAY
The earlier the child learns good oral hygiene, the better the chance of healthy teeth during adulthood. To promote good dental health, do the following:

• Clean an infant's gums with cloth or gauze daily before teething begins. Some dentists believe that this practice will help reduce discomfort and bacterial growth when the teeth begin to break through, usually between the ages of four and ten months.

• Continue cleaning twice a day after the first teeth begin to appear by rubbing them with a washcloth, without toothpaste.

• When the back molars appear, introduce the child to the toothbrush.

• Use fluoridated toothpaste and fluoride rinses. Introduce toothpaste gradually; the taste is strong for small children.

• Use an amount only about the size of a pea; too much fluoridated toothpaste can cause the child's tooth enamel to mottle.

• When the spaces between teeth close up (usually when the back molars grow in), begin flossing the child's teeth or using a water pic at least once a day to clear bacteria from between the teeth.

• Teach the child to brush and floss as early as possible. However, be prepared to help with oral hygiene until the child develops adequate hand-eye coordination, usually by age seven.

• Wean the child from bedtime bottle or breast feeding when the first teeth begin to erupt, or substitute clear water.

• Never put the child to bed with a bottle.

• When possible, brush the child's teeth after every meal and before bedtime. Brushing before bedtime is especially important because bacterial activity often increases during sleep.

• Take the child for twice yearly visits to the dentist beginning at about two years of age.

• Discuss with the dentist the possiblity of applying a sealant (protective coating of a clear, hard material) to the child's tooth surfaces. The sealant acts as a barrier between the tooth's enamel and decay-causing bacteria.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.