Dental Health for Children

Following a conversation with a friend and a visit to the dentist, I decided to compile some information about Oral Health for babies and toddlers.Sources:

1. "A Practical Guide to Infant Oral Health" by Joanna Douglass, DDS, Alan Douglass, MD, and Hugh Silk, MD, from American Family Physician 70:11, December 1, 2004

2. Our dentist and her hygienist, Dr. Jolle Hami 1864 Centre St West West Roxbury, MA 02132 (617) 327-4321

3. A colleague of Julie's who did a fellowship on pediatric oral health.

Source #1 is in front of me, I saw #2 yesterday and #3 is from memory.

Nutrition:
The main thing everyone says is not to give children sweetened drinks, i.e. juice (1,2,3). Natural occuring sugars tend not to promote tooth decay, that is the lactose in milk and dairy products and the fructose in fruit and vegetables, but sugar added to food will.

The authors of (1) also suggest limiting snacks to set times rather than having constant food around.

Brushing at Home:
Okay, so when are you supposed to start brushing? As soon as the kid has teeth (1,2,3).

And here's the part that's confusing: should you use a flouride toothpaste? Flouride is important to protect the teeth but too much is not good either. Swallowing 5 mg fluoride per kg of the child's weight "can cause nausea and vomiting." (1) [That's half a tube for the average five year old.]

That's the extreme case. A little bit too much fluoride will cause fluorosis (1,2), "an unaesthetic mottling of the teeth." (1)

This is where you branch off on the decision tree. If your water supply is low on fluoride (less than 0.6 parts per million) then your child should use fluoride supplements from about 6 months of age (1).

If you live in a municipal area where the water is fluoridated, as it is here in Boston, it will most likely be above 0.6 ppm (optimally it will be at 1.0 ppm) (1,2,3). In that case, your child is getting enough fluoride through the drinking water (1,2,3).

And they don't have to drink it. They are getting enough fluoride from the water you cook with and the water that you washed an apple with, etc (2,3).

So, if your water is fluorinated, what do you do about toothpaste? Well, you can get infant toothpaste without fluoride (Tom's of Maine makes some) or you have to get your kid to spit out the toothpaste. General guidelines will say that you should start using fluoride toothpaste when your child is 2 years old, but it's all based on when they can learn to spit (1,2).

In our case, Mari (13 months) is using toothpaste without fluoride and Austin (32 months) is using toothpaste (still kiddie flavored) with fluoride. (For those wondering, Tom's strawberry toothpaste for kids tastes like strawberry bubblegum that loses its flavor really quickly)

How do you get your kids to brush? There are articles about this in parenting magazines I'm sure, but here are a couple of tips that worked for us:

-Let them watch you brush. They love to imitate, those little monkeys.

-Sing a song about brushing that is consistent and thereby gives them a sense of how long the brushing will take (Catherine R. suggested it and Julie does this)

-Explain which teeth you are brushing so they expect a certain pattern and will wait until all the teeth are brushed (this is what I do)

-Wait until they shout "NO!" and then shove the toothbrush in. Sometimes crying is good for something.

Flossing:
Flossing is mostly necessary between molars (2). Austin has two molars on top and four on the bottom so we were told to floss between the pairs of molars on the bottom once a day. This should be fun.

Dental Visits:
This is something that surprised me. The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend that kids see a dentist by around 12 months (1,2,3). Check with your health insurance; with these new recommendations, insurers --health insurers, not dental -- are paying for dental health for children.

There are specifically trained pediatric dentists. This is a specialty and not every dentist will deal with children under 3. Call around or search the web.

The first visit is basically a checkup, to count teeth and to get kids accustomed to the dentist. The dentist also takes time to explain to parents how to brush the teeth and give advice like this.

The kids are supposed to return every 6 months. At the latest visit, Austin had his teeth polished and a fluoride treatment. He got stickers afterward and was very pleased.

Conclusion:
The teeth: something else to worry about.



Bonus bizarre fact:
Poor oral hygiene in pregnant women is correlated with premature birth (1).

Cousin Neve!

Austin and Mari have a cousin in California! Neve Cheng O'Sullivan, born early this morning to Vera and Stephen. We get to see her in December!

Empathy Imitation

A couple of days ago Austin and Mari were batting their arms at each other and stealing each other's toys. This happens regularly. They stopped (this also happens regularly). Then Austin stood up and bumped his head on the kitchen counter and started crying.

Julie sat down with him and was making sympathetic noises and patting him when Mari crawled over. I think all three of us (Julie, Austin and me) expected Mari to attack him while he was down, but instead she crawled into Julie's lap with him and then reached up and kissed him.

Austin's memory

Austin's memory is amazing. For a while, he would be be reminded of various things; we'd be playing with the Fisher Price farm and he'd say, Remember we went to the farm and saw sheep?

But then today he was playing with his spoon (we had Matzo ball soup for dinner, a new favorite). He stood the spoon on one end and said, "Remember we saw a sculpture like this? In Toronto?" Before I could even think of what he was talking about he corrected himself, "No, in New York." We think he's referring to the sculpture of a man standing on another man's shoulders that sits on the bridge between Columbia's main campus and the law school.

Oh, and about two weeks ago, we were driving and he was in the backseat zoning out as usual--except he suddenly said, "Remember we had dinner with Yang yeh yeh?" It was so out of the blue that I wasn't sure he knew what he was talking about (the last time we saw Bob Yang, my godfather, was more than a month earlier). I remember we had dinner, I said, what did we eat? Hamburgers? "No!" Austin said, "Chinese food!"

The memory is a weird thing and it's odd to watch it develop.

On the catwalk

Mari is modeling some new clothes she got from her godma Maria (it's like having a dogma, dyslexically). Rowr! Eat your heart out Lizzie. 

Pumpkin carving

We went over to Ada and Pete's and ate lots of their food and then cut some up. Austin drew the face on the pumpkin on the left and I carved it out. (Hector and Andrew made the one on the right.) 

Book review: Truth and Beauty

I just finished reading Truth and Beauty, Ann Patchett's memoir of her friendship with Lucy Grealy, the poet and memoirist who had cancer as a child and who's chemo melted her jaw and disfigured her face. It's pretty great, for the most part. The writing is beautiful and the "characters" and relationships are portrayed well. What I wasn't too thrilled about is the end.

If you have no idea who Lucy Grealy was, here's a major spoiler: she's dead. And she died with heroin in her body. Given that, you can imagine what the last few chapters are like--addict promises to quit, friend is happy but not sure how to help, addict relapses.

The decline feels so inevitable that it's almost cliche. But the rest of the book has by this time been so full of life--the joy of friendships, the randomness of conversation, the thrill of two emerging careers--that you are left overall with a feeling of richness, of having known two people.

This is ironic because a) Patchett makes clear that memoirs are creations (especially memoirs by poets and novelists), and b) one of the themes of the book has to do with fame, from the local fame on a college campus to television and bookstore appearances. Basically, she points out that it's very easy to feel like you know someone because you've heard about their life (or read their memoir) but it's such an unbalanced relationship between writer and reader that any real-life encounters tend to ring false.

Ann Patchett wrote one of my favorite recent novels, Bel Canto, and has her own website here. One connection I hadn't made was that her mother wrote the book Julie and Romeo; I think I briefly heard Terry Gross talking to someone about how she encouraged her mother to write a book and was slightly chagrined that her mother's book outsold her by a lot. I may be misremembering the details, but clearly it was Ann Patchett.

One of the weird, gossip-y pleasures of Truth and Beauty involves the encounters with other writers at various retreats or jobs (Elizabeth McCracken, Alan Gurganus) or Ann hearing Lucy on Fresh Air described as "repulsive"--it ties together a weird network of minorly famous intelligensia.

Happy kids

Austin with Hannah at Drumlin Farm, early October. 

Mari at Drumlin

Our little hayseed. 

Rose is Rose

Does it disturb anyone else that Pat Brady now has a co-writer/artist?

Does this mean that she's preparing an apprentice? Is the strip getting too much for her?

Friends

So,

Austin has a charming way of referring to relationships. One day we were sitting on the grass when his grandmother (Mary) came up. "It's Nana!" Austin shouted. "And Nana, there's your friend!"

Mary was a little confused (as were we all). "My friend?"

"Grandpa!" Austin explained.

I've since tried to explain the idea of marriage to him, husbands and wives and all that, but it usually ends up in an Oedipal confusion or worse. "I'm married to mommy, and..."

"No, I'm married to Mommy!"

And then back and forth a couple times. Sometimes he gives up and says, okay, then I'm married to Mari!

I thought of this today because we saw our neighbors and Austin thought about the little boy's name and said, "John. Like Uncle John." Cogitation. "Uncle John is Titi's [Amy's] friend."

Yes, I said. And who's my friend.

"Mommy!"

Yay.

Photo test

Testing the photo posting option. Cute girl, eh?

new Blog

Okay,

We'll see how long this lasts, but I had the idea to creat a blog to post amusing stories about our lives, not so much for your entertainment and information (although I hope it entertains and informs you) but because my brain is shot.

When people ask me what's been new in our lives, I draw a blank. It's all about the kids. Then when someone asks me what's new with the kids, I draw another blank. Sutff happens every day but I never get around to solidifying them in my brain enough to recall them later. So, here we are and this is my good intention.

-Jack