Pediatric Health Care


Oral Health Is Important


Oral Health Is Important
By Fred S. Ferguson, D.D.S.; Director Pediatric Dental HIV Program


They are important for chewing foods, speech, and development of adult teeth. Baby teeth can also affect the growth and appearance of your child. At times, infants and toddlers may have trouble-sleeping or eating solid foods. During these stressful times, parents sometimes use bottles to pacify children or to help maintain their weight. Overuse of bottles may cause tooth decay (cavities) which can lead to pain, infection, malnourishment and poor weight gain. These are serious problems for a child with HIV infection.


In the mouth, sugars are broken down by germs (bacteria) into acids. It is these acids that cause tooth decay. Sugars are in milk, formulas, juices and many medications. The liquid and pudding foods your doctor recommends to maintain your child's weight have sugars. It is important to clean your child's mouth to prevent cavities and bleeding gums.


Children with HIV infection may suffer thrush (candidiasis) and other infections in their mouth. Cleaning your child's mouth and limiting sugars may he important in controlling thrush. Thrush is most often seen as white patches or reddened areas that appear on the roof of the mouth and/or tongue. Tell your pediatrician if you see sores or thrush in your child's mouth.


Clean your child's mouth each day, even before you can see the first baby tooth. As often as possible, clean the mouth after each feeding and before bed. Be sure to wash your hands before and after cleaning your child's mouth.


For infants:

  • Sit your child on your lap, facing away from you. Support your child's head with your arm and hand.
  • Use the index finger and thumb of your supporting hand to gently open the mouth and support the lower jaw.
  • Wrap a piece of gauze or clean washcloth around the index finger of your other hand. Moisten it with water. Be sure to wipe the roof of the mouth, tongue, cheeks, and pocket areas between the jaw and cheeks, as well as the tooth bearing areas.
  • You can use a children's soft toothbrush to clean the teeth.

For children who can stand or sit:

  • Position yourself behind the child and clean the entire mouth as described above.


  • Use only a "pea-sizes" amount of toothpaste on the gauze pad, washcloth, or toothbrush. If your child doesn't like the flavor, try another brand of toothpaste.
  • Offer encouragement for toddlers and older children to clean their own teeth and mouth, and offer praise each step of the way as they learn how to do it.
  • Be a role model and clean your teeth after each meal. Children often like to imitate adults. If they watch you brush, they will be more likely to brush too.
  • Explain why it is important to clean their teeth and mouth. Help your child until he or she can do it alone.
  • For a fussy child, consider asking another person to help you clean the child's mouth.
  • It may be helpful to use a distraction such as music or the TV while cleaning your child's teeth and mouth. Try to use the same routine daily.
  • If you still have trouble after trying these suggestions, consult your child's dentist or pediatrician for additional help.


  • Try not to leave a bottle of milk, formula, or juice in the crib or bed with your child.
  • If you child needs a bottle to go to sleep, give the bottle to the child in your lap.
  • If you must leave your child in the crib with a bottle, thin the contents with water. You can get your child used to water in two or three weeks if you add a little more water to the bottle each night until it is all water.
  • All non-feeding bottles (bottles used to keep your child calm) should be diluted with water and gradually converted to water.
  • If you give medicines by mouth while your child sleeps, follow with a little water in the same way that you give the medicine. You can also use a plastic or bulb syringe to give a little water along the side of each cheek.
  • Aim to top bottle feedings by your child's first birthday. This is the ideal, but may be difficult for a sick or disabled baby. It is important that the baby gets enough fluids. Ask your pediatrician for advice on use of the bottle for ongoing feeding problems.
  • Your child's first dental visit should be before the first birthday.


  • Never give your child a pacifier moistened with a sweetened liquid.
  • Avoid sweetened cereals, especially when eaten dry.
  • Offer water or apple juice diluted with water as in-between meal snacks, instead of juice-ades such as punch or other sugary liquids, unless told by your child's pediatrician to use these.
  • As often as possible, follow snacks with water or brushing.

As often as possible, clean or rinse your child's mouth with water after bottles, foods, or medicine.


If your water system is not fluoridated, then fluoride should be included in your child's vitamins. Ask your pediatrician about fluoride.

Watch children who brush their own teeth and help them make sure their mouth is clean.

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