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Pediatric Dental Care: Good teeth start with good habits, dental visits

Drs. Darcy Rindelaub, left, and Megan Kinder pose in the treatment room of their Second Street clinic in Hudson, WI. Patients enjoy panoramic views of the St. Croix River and whimsical artwork on the walls and ceiling

'Everything we treat is preventable'

Tooth decay is recognized as the most common chronic disease affecting children in the United States.

Area dentists say parents can help children avoid dental issues like cavities by establishing healthy routines early - really early.

"Prevention is the biggest thing," said pediatric dentist Dr. Darcy Rindelaub with St. Croix Kidds in Hudson, WI. "Parents don't get kids in early enough." Rindelaub and fellow practitioner Dr. Megan Kinder like to see children before the age of three and ideally, within six months of the first tooth's appearance.

"Teeth are attached to the body so if a tooth is infected, it can make kids ill rapidly," said Rindelaub. Within the past two years, she's witnessed oral infections in three children under age eight which

required immediate hospitalization.

If decayed baby teeth need to be extracted, premature removal can have an adverse effect on development and placement of permanent teeth.

Kinder will complete her pediatric dental residency at the Children's Hospital of Colorado this month.

While there, she did graduate research which involved testing blood values in children who experienced toothaches and were ultimately hospitalized with tooth abscesses. Local infections can become systemic in a matter of hours.

So how do the pair coax toddlers into the exam chair?

They don't.

First visits involve a simple "knee-to-knee" exam with the infant or toddler cradled between doctor and parent. Once the exam is over, the consultation generally centers on prevention.Like the name of Valdemort in the Harry Potter series, there are words which are not uttered at St. Croix Kidds: needles and shots.

"We have a kid-friendly environment here," said Kinder, glancing around the cheerful, kid-centric waiting area. Parents are never separated from youngsters. "There's no reason to be afraid."

"Tell-show-do," added Rindelaub. Along with state-of-the-art lasers for painless removal of decayed soft- or hard tissue, when necessary, the dentists use nitrous oxide. Coupled with an overhead flat-panel

TV, kids readily "go to their happy place," she said.

Dr. David Page of River Falls isn't quite so enthusiastic about seeing children until they're at least old enough to communicate - although he once did oral surgery on an 18-month old whose head-on encounter with a coffee table prompted the need for an emergency tooth-extraction.

Page and son-partner Dr. Michael Page like to see kids when they're old enough to remember their dental visit as a positive experience so that by the time they're six or seven, they're arguing with siblings for the right to go first.

"We don't do it fast - whether they're three or eighty-three, we tell them what's going to happen."

First visits involve counting teeth. Period. "No gaggy cleanings or x-rays. And parents stay in the waiting room rather than the treatment room. His theory is that hovering parents can create the impression for

kids that there's something they need to fear.

The second visit will likely be a cleaning session and third - a cleaning, check-up and possible fluoride application, said Page.

What sage advice to providers have to prevent tooth decay?

"Brush your teeth," said Kinder. "The last thing to touch kids' teeth at night should be the toothbrush."

It's never too early to start.

Kinder has a 10-month-old daughter, Summer, who is already sporting two small teeth. The infant is already being brushed regularly.

"'They don't like it when I brush their teeth,'" said Rindelaub, reflecting a comment heard regularly from newer parents. "That's normal for kids," she said, but encourages parents to "be consistent" good habits will develop. Gently brushing infants' and toddlers' gums stimulates healthy tissue.

Page thinks it's important for parents to convince youngsters to accept help from Mom or Dad early-on. "Kids can't really do a good job until they're about six or seven," said Page, "Parents have to convince them that they're big, but they should still let Mom help them when they're done. But coach them so it doesn't become a war."

What about toothpaste - specifically, products which contain fluoride?

"If they're under two, use just a smear" of toothpaste, said Rindelaub. "For older kids, a pea-sized(portion). And train them to spit." Page disagrees. He's of the opinion young children will swallow too much.

And baby-teeth are all calcified in-uteral so there's no real benefit to topical exposure to fluoride products until permanent teeth begin to develop. They're also already receiving a certain amount of fluoride through well-water and municipal supplements.

When it comes to sugary drinks, professionals had little disagreement.

Regardless of age, the Rindelaub and Kinder both recommend only "Water! Water! Water!", said Rindelaub. "People don't like to hear that," adding that many parents think they're doing kids a favor by bedding them with a bottle or sippy cup filled with juice, formula or a small snack.

"Sip-all-day-and-get-decay", Rindelaub quipped, disparaging diet sodas as well as sugary sports drinks. Page once spent five hours in an operating room performing five extractions, eight pediatric root canals, four fillings and creating eight crowns - for a three-year old. The child had been put to bed with a bottle of orange juice all his short life. The work was necessary to assure permanent teeth came in properly.

If the infant or toddler needs a bottle, fill it with water. Plaque is the real enemy. "And if plaque were purple, people wouldn't have any dental problems at all. But plaque is white" (largely invisible). But Page recognizes that growing kids are seemingly always hungry, often snacking during all waking hours.

"Bacteria can't store sugar so the child could eat a 10-pound bag but within 20 minutes, the (damaging effect on teeth) will pass.

"But kids need energy and we're not going to make anyone into a monk.

"(Tooth decay) is all about the frequency of carbs and evidence of plaque," said Page, a 33-year practitioner who was joined in business by his son Michael, who finished dental school a year ago. Teeth that are properly cared-for need never decay.

"Everything we treat is preventable."