Tooth Decay

Prevention

A combination of bacteria and food causes tooth decay and cavities. You can prevent tooth decay by taking steps to limit the bacteria and by eating healthy foods.

Dental care: Brushing and flossing your teeth

Brushing and flossing

Brushing and flossing help limit bacteria on your teeth.

Brushing

• Get into a routine for brushing. Brush your teeth twice a day, in the morning and before bedtime.
• Use a toothbrush with soft, rounded-end bristles and a small enough head that allows you to reach all parts of your teeth and mouth. Replace your toothbrush every 3 to 4 months.
• You may also use an electric toothbrush that has been given the American Dental Association (ADA) seal of acceptance. Studies show that powered toothbrushes with a rotating and oscillating (back-and-forth) action are more effective at cleaning teeth than are other toothbrushes, including other powered toothbrushes.²
• Use a fluoride toothpaste. Some fluoride toothpastes also offer tartar control, which may help slow the formation of hard mineral buildup (tartar) on the teeth.
• Place the brush at a 45-degree angle where the teeth meet the gums. Hold the brush firmly, and gently rock the brush back and forth using small circular movements. Do not scrub, because vigorous brushing can make the gums pull away from the teeth and can scratch your tooth enamel.
• Brush all surfaces of the teeth, tongue-side and cheek-side. Pay special attention to the front teeth and all surfaces of the back teeth.
• Brush chewing surfaces vigorously with short back-and-forth strokes.
• Brush your tongue from back to front. Some people put some toothpaste or mouthwash on their toothbrush when they do this. Brushing your tongue helps remove plaque, which can cause bad breath and help bacteria grow. Some toothbrushes now have a specific brush to use for your tongue.
• Use disclosing tablets every now and then to see whether any plaque remains on your teeth. Disclosing tablets are chewable and will color any plaque left on the teeth after you brush. You can buy them at most drugstores.

Flossing

Floss once a day. The type of floss you use is not important. Choose the type and flavor that works best for you. Use any of the following methods:

• The finger wrap method : Cut off a piece of floss 18 in (45.72 cm) to 20 in (50.8 cm) long. Wrap one end around your left middle finger and the other end around your right middle finger, until your hands are about 2 in (5.08 cm) to 3 in (7.62 cm) apart.
• The circle method : Use a piece of floss about 12 in (30.48 cm) long. Tie the ends together, forming a loop. If the loop is too large, wrap the floss around your fingers to make it smaller.
• A plastic flossing tool makes flossing easier. You can find them at most drugstores.

Gently work the floss between the teeth toward the gums. Curve the floss around each tooth into a U-shape, and gently slide it under the gum line. Move the floss firmly up and down several times to scrape off the plaque. Popping the floss in and out between the teeth without scraping will not remove much plaque and can hurt your gums.

You may want to try electric cleaning devices (interdental cleaning devices or interdental brushes) that are made to clean between your teeth. They can be as effective as using dental floss.

If your gums bleed when you floss, the bleeding should stop as your gums become healthier.

Healthy diet

• Eat many types of food, especially whole grains, vegetables, and fruits, and food that is low in saturated fat and sodium. Good nutrition is vital for children as their teeth develop, and for adults to maintain healthy gums and avoid tooth decay. For nutrition advice, see the guidelines in MyPyramid .
• Mozzarella and other cheeses, peanuts, yogurt, milk, and sugar-free chewing gum (especially gum that contains xylitol) are good for your teeth. They help clear your mouth of harmful sugars and protect against plaque. These make great after-meal snacks.
• Avoid foods that contain a lot of sugar, especially sticky, sweet foods like taffy and raisins. The longer sugar stays in contact with your teeth, the more damage the sugar will do.
• Avoid between-meal snacks.
• Do not snack before bedtime, as food left on the teeth is more likely to cause cavities at night. Saliva production decreases while you sleep, so saliva does not clean your mouth well during sleeping hours.

Caring for your child's teeth

A child's dental care really starts with his or her mother's healthy pregnancy, because baby teeth begin to form before birth. If you are pregnant, eat a balanced, nutritious diet. And be sure to get enough vitamins and minerals. Pregnant women should have a complete dental exam and get treatment for any cavities or gum disease. For more information, see the topic Pregnancy.

By the time your child is 6 months of age, your doctor should assess the likelihood of your child having future dental problems.³ This may include a dental exam of the mother and her dental history, as the condition of her teeth can often predict her child's teeth. If the doctor thinks your child will have dental problems, be sure your child sees a dentist by his or her first birthday or 6 months after the first primary teeth appear, whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.

Experts recommend that your child's dental care start at 12 months of age.³

It's best to start good oral health habits before permanent teeth come in.

• Parents and caregivers often share spoons, forks, and other utensils with babies. The saliva you may leave on the utensil contains bacteria that can cause tooth decay. In some instances, kissing can also transfer bacteria. You can help prevent early childhood tooth decay in your child by making sure that your family practices good dental health habits.
• Do not put your infant or small child to bed with a bottle of milk, formula, juice, or any other product that contains sugar. The sugar and acids in these liquids can cause tooth decay (bottle mouth ). Do not prop the bottle up in your baby's mouth, and remove the bottle as soon as your baby is done feeding or is asleep. Breast-feeding your infant to sleep is safe, however.
• Discuss fluoride supplements with your dentist if your local water supply does not contain enough fluoride. To find out, call your local water company or health department. If you have your own well, have your water checked to determine whether your family needs fluoride supplements. You may also need to provide fluoride to your children if you use bottled water for cooking or drinking.
• When your child is around 6 years old, consider using a fluoride mouthwash if he or she has a lot of cavities. Be sure that your child does not swallow the mouthwash.
• Keep your child away from cigarette smoke (secondhand smoke). Tobacco smoke may lead to tooth decay and gum disease.^{1, 4} As your child grows, teach him or her about the dangers of smoking and secondhand smoke.
• Consider having your dentist or dental hygienist put a sealant into the grooves of the chewing surfaces of your child's back teeth to help prevent cavities. Studies show that children who have sealant applied regularly in school-linked programs have a 60% decrease in tooth decay.⁵

Brushing and flossing your child's teeth

• As soon as they come in, start cleaning your child's teeth with a soft cloth or gauze pad. As more teeth erupt, clean teeth with a soft toothbrush, using only water for the first few months.
• By the time your baby is 1 year old, use a green-pea-sized amount (or less) of fluoride toothpaste. Brush your child's teeth for the first few years, until your child can do it alone (usually at about age 3). Teach your child not to swallow the toothpaste.
• Your child can learn how to brush his or her own teeth at about 3 years of age and should be brushing his or her own teeth morning and night by age 4, although you should supervise and check for proper cleaning. Your child should be able to brush without your supervision by about 8 years of age.
• Give your child a small, soft toothbrush, and use a green-pea-sized amount of fluoride toothpaste. Encourage your child to watch you and older siblings brush teeth. A good teaching method is to have your child brush in the morning and you brush at night until your child masters the skill.
• Tips to get your child to brush his or her teeth include setting a good example and having your child brush his or her stuffed animal's teeth.

Because too much fluoride can be toxic, watch that your child does not swallow large amounts. Use caution with fluoride toothpaste or mouthwash for your child's dental care until your child's ability to control swallowing is well developed. Normal amounts of fluoride added to public water supplies, toothpastes, mouth rinses, and bottled water are safe for children and adults.

Dentist appointments

Set up regular visits with your dentist. At the visit, he or she will examine your teeth and gums for signs of tooth decay, gum disease, and other health problems.

For more information and developing good oral health habits, see the topic Basic Dental Care.

A visit to the dentist can be a scary thing for a child. You can reduce this possibility by choosing your dentist carefully and preparing your child for his or her first visit. Call your dentist for ideas about putting your child at ease before you bring him or her in.

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Author:	Jeannette Curtis	Last Updated: July 30, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Arden Christen, DDS, MSD, MA, FACD - Dentistry
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