Sweet Tooth

“I finally took her to a dentist who told me my daughter had ‘milk bottle teeth’ and that the upper teeth were so far gone he couldn’t even cap them – they must be extracted,” the parent’s letter read. In response, Seyler discussed the dental perils of giving children a bottle when putting them to bed for the night or for a long nap.

“Drinking from a bottle at meal times doesn’t cause decay of the teeth because … the liquid is swallowed almost at once,” Seyler wrote. “If a child keeps the bottle in his mouth during sleep, the teeth are kept ‘bathed’ in the liquid … and tooth decay is inevitable, even if the liquid is ordinary milk. Fruit juices or sweetened beverages are the worst producers of nursing bottle decay.”

Dr. Neil Peterson, who has a practice at 5019 W. North Ave., still hands out copies of that column to his patients. Sadly, 36 years later, bottle mouth and tooth decay in children is still a major concern.

On a recent spring morning, Peterson’s sunlit waiting room was crowded with young patients and their parents. In one of the exam rooms, a rambunctious 2-year-old named Justin was being coaxed into the reclining examination chair. As Justin settled into place, his father told the dentist the little tyke had been complaining that his mouth hurt. It was no wonder. Upon examination, Peterson could see that little Justin had a mouthful of cavities – decay was present in nearly every tooth.

Justin’s situation isn’t unusual in Peterson’s dental practice, where a majority of patients come from lower-income families. A 2009 state Department of Health Services’ survey on the oral health of Wisconsin children found disparities in tooth decay experience based on racial, ethnic and socioeconomic status. The department reported, “the poorer you are, the more likely it is that your teeth hurt – and it is especially likely if you are African-American or Hispanic.”

For each of his patients, Peterson does as much teaching as possible – and not just to the kids, but to parents and child-care givers as well – on how and when to brush and floss their children’s teeth. Peterson also assigns a little homework: a worksheet for kids to chart which teeth they’re brushing and flossing each day. (Hint: It should be all of them.)

Oral health has been generally improving for the U.S. population in recent decades, thanks in part to fluoride in drinking water supplies, toothpaste and other over-the-counter oral hygiene products as well as improved dental sealants. The only exception is for Justin’s age group. The Centers for Disease Control and Prevention found that the prevalence of cavities has increased in the 2-to-5-year-old category. Left untreated, tooth decay causes pain and other infections that can affect a child’s eating, speaking and learning.

Nicola, a busy mother of five daughters ranging in age from 9 to 19 years old, is no stranger to childhood tooth decay. She discovered firsthand the damaging impact of excessive baby bottle use on a young child’s teeth shortly after adopting her youngest daughter, Lyric, then age 3. The Milwaukee mom found the girl had severe tooth decay in several of her tiny teeth.

“When Lyric came to me, she was sucking a bottle,” says Nicola. “I looked in her mouth and saw all that decay, and I thought, ‘I know what this is from.’ ” She successfully weaned Lyric a few weeks later, but the damage was done. Within a few months, the toddler had several teeth extracted.

Today, now 9 years old, Lyric’s teeth are healthy. Nicola says her daughters’ dental health has always been a high priority for her, getting the girls in for routine dental checkups, reminding them to brush and floss regularly, and limiting their access to candy and sweets. She refuses to buy soda and encourages the girls to drink milk and water instead.

To fight tooth decay, Milwaukee-area dentists recommend multiple approaches that all stem from the basics of good oral hygiene. “Dental decay is a very complicated disease caused by many factors,” says Dr. Edward Trochlell, a pediatric dentist at Drs. Rollefson, Trochlell & Associates, a private practice in Brookfield. “You can’t do just one thing to fight it. You have to go at it with everything you’ve got.”

Despite state and national data to the contrary, Trochlell is seeing more cavities in kids from all age and socioeconomic groups. “I have been practicing dentistry for 35 years, and in that time I have not seen a substantial reduction in the decay rate. Cavities aren’t going out of style anytime soon.”

Trochlell’s daughter, Dr. Angela Trochlell, who practices pediatric dentistry with her father, attributes that trend partly to what today’s youth are eating and drinking and to their families’ busy lifestyles. Eating snacks and meals in the car while on the way to sports practices, jobs or other extracurricular activities makes it hard to brush one’s teeth immediately afterward.

“And there definitely is a dietary factor,” she says. “Older kids are drinking more energy drinks and coffee drinks, and kids are drinking more Gatorade instead of just drinking water. Juice drinking also remains very prevalent.”

“Sports drinks are a huge thing with kids now,” Ed Trochlell says. “They drink these drinks because they have some electrolytes, but there is sugar involved, and most sports drinks are somewhat acidic in nature. By definition, that acidic liquid is more erosive to the tooth structure. Any acid in the mouth will help promote decay.”

Another culprit of tooth decay in babies and toddlers is the ever-popular sippy cup. The problem stems not only from the beverage content (such as juice), but also because the shape of the cup’s mouthpiece shoots liquid directly onto a child’s front teeth, leaving behind an unmistakable path of decay.

“It’s a matter of frequency,” Angela Trochlell explains. “If the child is carrying the sippy cup around the house and sipping frequently over a longer period of time rather than drinking only at mealtime, it changes the oral environment to one where there will be more cavities.” If the child wants the cup for a sense of security, fill it with water rather than juice or milk, she recommends.

The Wisconsin Dental Association, American Dental Association and the American Academy of Pediatric Dentistry all recommend that children be seen by a dentist for the first time by age 1 or whenever their first tooth erupts. In an effort to get parents into good oral hygiene routines and to establish a relationship with a dental practice or “dental home” for children at an early age, the Trochlells’ practice launched a well-baby program in 2001 that encourages parents of babies up to 18 months to bring them in for a complimentary first dental visit. At these visits, an oral hygienist meets with parents, goes over the dos and don’ts of baby and pediatric dental care, and teaches parents how to brush their child’s teeth. The babies also get their first fluoride treatment.

“It’s been a very successful program,” says Edward Trochlell.

Dr. Brian Hodgson, a pediatric dentist on the faculty of Marquette University’s School of Dentistry, says parents also should make sure their children are getting a proper amount of fluoride, either by drinking tap water from communities that add the mineral to their municipal water systems or by using a fluoride toothpaste or mouth rinse. Kids who rely heavily on bottled water or whose home water supplies come from private wells with no source of fluoride can end up with teeth less resistant to fighting the acid that comes from plaque bacteria and sugars in the mouth, Hodgson says.

As for brushing, from age 6 months through age 2, kids should have a bit of fluoride toothpaste smeared on their toothbrush. From ages 2-5, the amount on the brush should be pea-sized, or wet the brush with a fluoride rinse. Most importantly, Hodgson warns parents to make sure the child doesn’t swallow the toothpaste or rinse after brushing. Too much fluoride isn’t good either.

“Research supports that we need a specific amount of fluoride to have an impact on dental cavity rates,” Hodgson says.

Ultimately, though, it all comes down to diet. Like Dr. Seyler’s advice in the Milwaukee Journal so long ago, Hodgson reminds parents to restrict not only kids’ intake of junk food, but also how often kids are snacking between meals.

“Stick to three meals a day and maybe two snacks and that’s it,” he says. “Anything in between should be a healthy snack – carrots or cheese cubes or vegetables. That’s probably the No. 1 thing the parent can do to reduce their child’s risk.”

Health Tips by Julie Sensat Waldren
Eat Your Leafy Greens Foods rich in folate and vitamin B6 may help reduce the risk of heart failure in men and of stroke and heart disease in women, found a study of Japanese adults in Stroke: Journal of the American Heart Association. The AHA recommends eating B-rich foods – such as citrus fruits, tomatoes, fortified grains and leafy green vegetables – to help lower homocysteine, an amino acid in the blood related to a higher risk of cardiovascular disease.

Live Long and Drink Milk Want to live to a ripe old age? Drink more milk. A report in the American Journal of Epidemiology found that men who got more calcium in their diets (nearly 2,000 milligrams daily) had a 25 percent lower risk of mortality during a 10-year followup period. The primary sources of calcium were milk products and cereal. Calcium has been shown to reduce blood pressure, cholesterol and blood sugar.

Driving Under the Influence In a Psychonomic Bulletin and Review study, only 2.5 percent of drivers could multitask well enough to hold complicated conversations on hands-free cell phones without impairing their driving. Researchers say these rare people are “supertaskers.” As for the rest of us, research shows driving while talking on a cell leads to “inattention blindness,” causing drivers not to see up to half of their surroundings. The National Safety Council estimates one of every four motor vehicle crashes involves cell phones.

Support for Your Aging Knee In a study of knee osteoarthritis sufferers ages 45 to 87, using a knee brace eased their pain, stiffness and disability and allowed them to continue an active lifestyle. Osteoarthritis is caused by wear and tear on the cartilage, affecting many people in middle age and older. Braces help realign the knee and take pressure off damaged areas. The research was presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

Walk Away Strokes A daily power walk may help reduce risk of stroke. A study inStroke: Journal of the American Heart Association found that women who regularly walked at a brisk pace (3 mph or more) or walked two or more hours per week had a 30 to 37 percent lower risk of stroke. Stroke is the third-leading cause of death in America, and a physically active lifestyle can reduce stroke risk across genders.