We've all been there. You're tired, the older kids need help with their homework, and the baby is screaming. It's his bedtime and he really needs to go to sleep, but you don't have time to put him down properly. Quickly, you get him in pajamas, kiss him good night, put him in his crib, and shut the door. Mercifully, he's quiet and you can get back to more pressing matters. What magic trick calmed him down? You put him in with his favorite nightcap - a bottle of milk.
Well, you might as well have poured acid straight onto his teeth. According to Dr. Silvestro Iommazzo, director of pediatric dentistry at Jamaica Hospital Medical Center, soda, juice, chocolate milk, even regular milk, all have sugar in them, and when bathing teeth for a prolonged period of time, can cause severe tooth decay.
"Sugar is broken down into acids, and acids eat away at the teeth which causes cavities," Dr. Iommazzo explains. "It's not just putting a child to sleep with a bottle that does it. Many parents give their children bottles all day long. This uninterrupted flow of acid into the mouth, combined with the fact that the enamel on babies' teeth is much thinner that an adult's, causes horrible problems. Only water, especially fluoridated New York City water which is actually helpful, is not harmful if a child should fall asleep with a bottle."
Many times, the damage is so pervasive that surgery is required. Such was the case with Tanya, an 11-month-old Russian girl who was brought into Dr. Iommazzo's dental clinic last fall. Young to have so many teeth (she had all but four), every single one had a cavity. Because she was too little to safely tolerate oral sedation, an option that is sometimes employed, and because of the amount of work that needed to be done, it was determined that surgery was necessary. (Given different parameters, such as an older child with fewer cavities who could sit in a dentist's chair for at least an hour, a sedative would be administered, calming the child enough without putting him to sleep. He would then be put into a papoose board, in a blanket with Velcro straps. Novocaine would be provided and the work done). But Tanya was too young.
"Every tooth needed restoration," Dr. Iommazzo recalls. First, the surgeons used "strip crowns", bonding whole caps right onto her front teeth after the cavities were filled. Made of all plastic in white or tooth-color, these strip crowns are used in the front because they are more aesthetically pleasing. In the back, Tanya required multiple stainless steel crowns, made of nickel and chromium. These crowns, though glaringly apparent to the eye, are more durable.
"Some of her back teeth will be with her until she's a teenager," Dr. Iommazzo explains. "We needed to use something that will last."
In addition, the majority of her teeth required "pulpotomies", or baby root canals. Luckily, Tanya's teeth did not have to be extracted, a procedure that Dr. Iommazzo has to do much more often than he'd like.
"The sad thing is that I've seen her since and her mother has not learned her lesson. She's come back with even more cavities," Dr. Iommazzo reports. "Parents must understand the relationship between a high amount of sugar in the mouth and cavities. Yes, I can fix a child's teeth but I'd rather not have to."
To that end, Dr. Iommazzo recommends taking a child's bottle away at the age of one year. "They should be old enough to go on to the next step of drinking out of a cup," he says. "And a prolonged sucking action can cause malformation of the teeth and the bone." He also suggests that you take your child for his first dental visit at one year. The American Academy of Pediatric Dentistry now recommends that a child be seen as early as that. And lastly, "A pediatrician is your main source of information," he says, "so if you don't know - ask!"