PEDIATRICIAN DR.PAUL Answers: Dental caries or cavities are seen frequently, but thanks to better preventative measures, there has been a decrease over the last 20 years.

One of the most important factors related to cavities is the consumption of carbohydrates or sugar. Actually, the development of dental caries depends more on how often a child consumes sugary foods rather than the exact amount. In children who still drink from the bottle, one of the most important causes of caries is putting them to bed with a bottle. Both juice and milk contain sugar, which remains on the babies teeth over night resulting in the formation of "Nursing Bottle Caries", usually in the upper teeth.

Aside from the pain and discomfort of the cavities, the treatment can also be painful. In extreme cases, the teeth cannot be salvaged, and need to be removed. In very young children, extraction may require heavy sedation or even a general anaesthetic. Clearly then, the goal is to prevent cavities in children.

Here are some helpful tips:

• Fluoride is the most effective measure against dental caries and, depending on local fluoride levels in the drinking water, children may need additional supplementation. Your local municipality should be able to tell you the amount of fluoride in your drinking water. Knowing this, your doctor can then decide if supplementation is needed and how much. This is important, as we do not want to give too much fluoride to children. For the same reason, when brushing teeth in older children, toothpaste (which contains fluoride) should be put sparingly on the toothbrush. Squeeze out an amount about the size of a pea. More is unnecessary. It's important to avoid excessive fluoride ingestion. For the same reason, begin using toothpaste only when your child is old enough to understand not to swallow it.



• Modifying the child's diet to decrease the frequency of sugar consumption is very important. Bottle fed children should never be put to bed with the bottle. If this is not possible, try to give them water at naptime or bedtime.



• Oral hygiene and care is essential. As soon as teeth develop, they should be cleaned daily with a wet gauze or wash cloth.



• Review proper tooth-brushing techniques with your dentist, and be sure that your children can brush properly before allowing them to brush on their own. As long as the spaces between the teeth are wide enough to allow the toothbrush access, flossing is not necessary. As soon as the spaces between the teeth are tight enough to allow it regular, daily flossing should also begin.



• Finally, get your child used to going to the dentist. I recommend you schedule the first dental visit be when your child is two years of age. This gives the dentist the opportunity to examine for existing cavities, and look for any abnormalities in your child's dental development.