Nutrition Noteworthy

As future pediatricians some of us will be asked seemingly benign questions, the answers to which are not simple and are mired in current public health controversy. One of these questions will be about dental hygiene for infants. This paper poses some common questions parents may ask, and attempts to provide the information necessary to provide the best answers possible. Plaque is a buildup of microorganisms that produce acid as a byproduct of sugar metabolism. This acid demineralizes the tooth's enamel; fluoride slows acid production and provides the substrate for remineralization. Development of caries depends on the relative rates of de- and remineralization. Los Angeles' water supply is unusual for a major city in the US because it contains amounts of fluoride well below the optimal levels recommended by public health officials (1.0 ppm). Despite the low fluoride content, fluoride supplementation for infants is not recommended by the American Academy of Pediatrics due to evidence of dental fluorosis (mottling of teeth) after exposure to excess fluoride. The clearest recommendations for parents of infants are to only provide sweets at mealtimes, including sweetened beverages, and to brush their children's teeth with a low fluoride toothpaste as soon as the teeth erupt.