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Toddlers: 12 - 24 Months
quidditchcapn1120
member
Re: the bottle past one year- a dentist's perspective
quidditchcapn1120
member
I saw the debate from last night regarding extended bottle feeding and I just wanted to clear up some misconceptions.
First, for some kids, giving up the bottle/paci/finger sucking habit is HARD. Trust me, we get that. Pediatric dentists work with orofacial myologists and speech therapists for this very reason. If it wasn't sometimes hard to give up, there wouldn't be an issue.
That being said, dentists and pediatricians are not telling you to give up the bottle for the heck of it. There are very specific and proven consequences to both long-term bottle feeding and what we call 'non-nutritive sucking habits' (i.e. paci or finger sucking). And I'm not just talking about cavities (although this is an important sequelae as well).
First, these actions cause a negative pressure to be exerted on the hard palate. Over time, this causes the growth of the palate to continue in more of a vertical fashion, leading to a v-shaped palate as opposed to a rounded hard palate. In addition, as the anterior primary teeth grow in, they start to become flared toward the face. Also, because of the growth restriction of the palate, the top molar teeth come in toward the tongue side of where they should be. What does all this mean? First, the front teeth start to be in an anterior open bite. This means the top and bottom front teeth don't touch together when the child bites down. This delays speech as it is hard to say certain sounds (try saying the 's' sound while your teeth are far apart). It also means your child will have trouble eating things that require shearing from the front teeth (can you imagine trying to bite off a piece of lettuce without touching your front teeth together?). The back teeth grow in what is called posterior crossbite positioning. Top teeth should be slightly overhanging the bottom teeth like a lid on a jar; a crossbite means they fit opposite of this.
Why should you care, the baby teeth are just going to fall out, right? Well, first, since the growth of the palate is restricted, it means that you will likely have a crowding problem in the permanent teeth. This will definitely increase your child's chance of needing braces but can also cause impacted teeth, meaning certain teeth don't come in except with help from your orthodontist or oral surgeon. Also, the baby teeth roots act a guide for how the permanent teeth come in. The permanent teeth slide down the roots of adjacent teeth as they are erupting meaning if a sucking habit has caused an open bite or crossbite in the baby teeth, it might also cause it in the permanent teeth. This can mean that chewing and speech delays I talked about above can persist when the child gets permanent teeth.
These problems are more likely to be seen in children who continue the habit past 24 months. Nobody should be judging, sometimes it's hard. I have a 24 year old patient who still sucks her thumb and yes, she has all these problems. If you have any questions please let me know.
First, for some kids, giving up the bottle/paci/finger sucking habit is HARD. Trust me, we get that. Pediatric dentists work with orofacial myologists and speech therapists for this very reason. If it wasn't sometimes hard to give up, there wouldn't be an issue.
That being said, dentists and pediatricians are not telling you to give up the bottle for the heck of it. There are very specific and proven consequences to both long-term bottle feeding and what we call 'non-nutritive sucking habits' (i.e. paci or finger sucking). And I'm not just talking about cavities (although this is an important sequelae as well).
First, these actions cause a negative pressure to be exerted on the hard palate. Over time, this causes the growth of the palate to continue in more of a vertical fashion, leading to a v-shaped palate as opposed to a rounded hard palate. In addition, as the anterior primary teeth grow in, they start to become flared toward the face. Also, because of the growth restriction of the palate, the top molar teeth come in toward the tongue side of where they should be. What does all this mean? First, the front teeth start to be in an anterior open bite. This means the top and bottom front teeth don't touch together when the child bites down. This delays speech as it is hard to say certain sounds (try saying the 's' sound while your teeth are far apart). It also means your child will have trouble eating things that require shearing from the front teeth (can you imagine trying to bite off a piece of lettuce without touching your front teeth together?). The back teeth grow in what is called posterior crossbite positioning. Top teeth should be slightly overhanging the bottom teeth like a lid on a jar; a crossbite means they fit opposite of this.
Why should you care, the baby teeth are just going to fall out, right? Well, first, since the growth of the palate is restricted, it means that you will likely have a crowding problem in the permanent teeth. This will definitely increase your child's chance of needing braces but can also cause impacted teeth, meaning certain teeth don't come in except with help from your orthodontist or oral surgeon. Also, the baby teeth roots act a guide for how the permanent teeth come in. The permanent teeth slide down the roots of adjacent teeth as they are erupting meaning if a sucking habit has caused an open bite or crossbite in the baby teeth, it might also cause it in the permanent teeth. This can mean that chewing and speech delays I talked about above can persist when the child gets permanent teeth.
These problems are more likely to be seen in children who continue the habit past 24 months. Nobody should be judging, sometimes it's hard. I have a 24 year old patient who still sucks her thumb and yes, she has all these problems. If you have any questions please let me know.
This discussion has been closed.
Re: Re: the bottle past one year- a dentist's perspective
If you're brushing his teeth following the bottle, he's not doing it multiple times per day and has no other habits, I would not be as worried. Especially since you're getting rid of the bottle at 24 months. I can't promise no problems, just as I can't promise no problems for a child who didn't get a bottle a day past their first birthday. But I would be more concerned if there was paci/finger sucking involved simply due to the amount of force on the palate (think a soft nipple VS. The bony structure of a finger) and generally a paci/finger is sucked on for a longer amount of time during the day than a bottle.
Thank you for posting this! DS still drank out of bottles until he was 17 months...we always brushed his teeth afterwards, held him upright, didn't let him walk around with it, and never put him in bed with one. And it was once a day, with no other pacifier/finger sucking to speak of.
I think practicing healthy feeding habits, especially with bottles, is more important than if you drop bottles exactly at 12 months. And it's not always harder if you wait a couple of months later.
1) They also cause open bites. Same pressures are being exerted on the palate with the same results. If I were to personally rate the type of sippys (based totally on my opinion, not on peer-reviewed literature), I would rate 'straw' sippys the best and the hard spout sippys as worst. If you think about how your mouth has to form to suck through a straw, your lip muscles have to push back against your teeth, leading me to believe these best counteract the openbite tendencies of otter sippys.
2) Cavities. If I had to give one piece of advice to parents about their kids teeth it would be to not put juice in a sippy. Even the 'no-sugar added' kind has a TON of sugar. I would say this is the #1 reason kids 3 and 4 years old end up under general anesthesia for rampant cavities. I have a toddler that is under 10% for weight so I understand it is sometimes a good way to force calories. But the best way to do it is only offer juice during meals. They should not be allowed to sip on juice throughout an entire day. This just means their teeth are being subjected to sugar constantly throughout the day. The bacteria that feed on sugar then secrete acid that breaks down enamel. Each time your kid takes a sip of juice or soda, that acid attack lasts 30 minutes. So if your toddler takes one sip of juice every thirty minutes, their teeth are being broken down ALL DAY. Compare that to the same VOLUME of juice but that is only allowed at a mealtime. If the meal lasts a total of 30 minutes, but the kid drinks all their juice, they are getting the same amount of liquid/calories but their teeth are only being broken down for 1 hour (30 minutes of eating plus the 30 minutes of acid attack from the very last sip.
FWIW, Jackson takes a sippy. I plan on transitioning to a cup only in the next six months to a year. But I also took away the paci at 6 months to avoid dependence on it.
Thanks for the info!
We only put water and milk in the sippy, I never give juice because I just don't see the reason. He does like the straw ones, but he's so used to tilting his cup up that he does the same thing with these and they spill everywhere or don't work because the liquid goes to the front. We may just have to work on it some more.
I really should let him practice more with an open cup, he loves to use them I've just always handed him a sippy. Thankfully he ditched the paci at 4 months so that's one less thing I have to worry about!
Thanks for this info~! So do you rec 24 months also being the cutoff for paci? Thanks!
Have you tried snipping off the end of the pacifier? You can get rid of all paci's but one. Then, snip a small portion of the very end of the nipple off. Place it in her crib and don't mention that it is different. You might tell her beforehand or have her pick out her favorite paci to keep, which is the one you will snip and put in the crib. By snipping the end, it makes it so she cannot create suction around the nipple. Most of the time, the difference will be so slight that they won't notice, but it won't be as comforting so they voluntarily give it up.
Here's the thing, though.
My kid will be 2 in a week. He still has a bedtime bottle, and uses his paci to fall asleep (so, twice a day for 15 minutes or so each time). We will be weaning him off of both of those things in the new year.
He's been to the dentist to have his teeth checked out. He has absolutely no problems whatsoever with his bite, and he speaks more clearly than most kids his age and older. So just because your kid has a bottle or paci for short times during the day doesn't mean that they will always have problems with their teeth. I respect that you are a dentist or work in that field, but I don't agree that one always equals the other in this case.
As for using a bottle to correct an underbite, this will actually make the problem worse. If the problem is teeth related, it can make the top teeth come in even further towards the tongue, making the 'underbite' or posterior crossbite worse. If the problem is a skeletal problem (in other words the bottom jaw is growing faster than the upper jaw, the upper jaw is proportionately too small or a combination of the two), keeping the bottle can actually restrict the growth of the top jaw. This will make the 'underbite problem' even worse. I would (gently) tell your friend to take her child to a pediatric dentist. Once a week we go help medical students do exams and teach them basic things about the mouth; I know how much pediatricians/physicians learn about dental anatomy. It's not sufficient for that type of complex problem.
A couple weeks back someone argued with me that there is no link between cavities and breastmilk. While the jury's still out on whether breastmilk contributes to cavities on back teeth, there is a higher incidence of decay of the smooth surfaces of teeth (the surfaces toward the cheek or tongue, not the surface you chew with) in extended breastfed babies. This makes sense because breastmilk does have natural sugar in it. The bacteria that cause cavities 'eat' the sugar and then secrete acid which then destroys the enamel or protective layer of the teeth. When a baby only has bottom teeth, the tongue shields the teeth from the milk, but once those top teeth come in cavities can form easily. I still BF Jackson, but if I feed before bed, I keep a toothbrush on the nightstand and brush gently and quickly even if he is asleep.
Good luck with getting rid of that paci!
I'm sure you can tell by my previous responses that I hear that argument multiple times per day. Here are my usual responses as to what baby teeth are for:
1) To eat. Obvious, right? Well, baby teeth get cavities too and the nerve of the baby tooth is a lot closer to the outside surface than the nerve is in a permanent tooth. Because of the way tooth development works, you can't do a "normal" root canal in a baby tooth. While you can do a "baby root canal" in teeth where the cavity is big but hasn't reached the nerve yet, the most common result of a baby tooth that has a cavity in the nerve is to take it out. I have had to pull every. single. tooth. in a three-year-old. Permanent teeth don't usually start to come in until age 6-7. What is that 3 year old going to eat for another 3-4 years? You got it- baby food. If your toddler is already having trouble gaining weight, this isn't going to help.
2) Baby teeth act as a space maintainer for adult teeth to come in. When a baby tooth is lost early because of a cavity, the other teeth in the mouth are free to move around wherever there is space ( ever hear, "the path of least resistance") unless a dentist constructs a space maintainer to hold that space open. There are problems with space maintainers also, and they require follow up by the pediatric dentist/orthodontist.
3) Baby teeth can get infected. Left alone, this infection can be very serious. A few years ago, a boy died after a dental infection went untreated and spread to his brain. Just a couple days ago an adult that couldn't afford insurance died of the same thing. If you ever notice that your child has a swelling next to a tooth or pus is draining inside their mouth, get them to a pediatric dentist. If you notice this, and they have a swelling under their chin or neck, go to an ER. This infection can spread to the heart or block the airway or can spread to the brain like the individuals above. If you want to read about it, here is the link (I warned you about content though!):
https://www.ksdk.com/news/article/275318/9/24-year-old-man-dies-after-failing-to-treat-tooth-infection
https://abcnews.go.com/Health/Dental/story?id=2925584&page=1#.Tu0ZZc016eY
That's what I figured... thank you for posting this and answering questions!
TTC #1- unexplained...lost left ovary 4/07 IUI #1 2/10/09-BFN IUI #2 3/5/09-BFN IVF # 1-BFP
TTC#2- FET 4/7/11 BFP, Natural mc 5/5/11 IVF#2 ER 9/13/11, ET 9/16/11, Beta #1 9/27/11 BFP 254 Beta #2 9/30/11 793 -Twins!
You saw the part about my son being less than 10% for weight and still being BF right? I understand this concern and talked about it some. I know teeth are not the #1 concern in terms of our kid's development- but sometimes they get pushed to the side as if they are not important and that is also not the case. And also, the consequences given were said to be more for those children older than 24 months.
First, awesome post, very helpful. Since you seem very willing to answer questions, I'm going to toss one out on a slightly unrelated topic.
My poor LO has inherited my underbite. I had a class 3, requiring lots of work to correct. Hers seems to be at least as bad, if not worse, and she has some teeth coming in crazy positions. Is there anything that can be done before her permanent teeth come in? Should I visit a ped dentist? It clearly is affecting her ability to bite/chew and I think it might be impacting her speech. I know for me they wouldn't do anything until I had my permanent teeth, but maybe things have changed.
Thanks!
I would visit a pediatric dentist. That being said, unfortunately the basic principle is the same from when you were a kid. Class III's are very hard to fix and even when they are fixed with classic orthodontics, the kid can "outgrow" the 'fix' and need surgery to completely correct it. The only thing that might be different now is that it is very common to do palatal expansion in the mixed dentition (when she has some permanent teeth but still some baby teeth too) to lessen the disparity between the size of the upper jaw and lower jaw. Biggest advice- see a pediatric dentist now, and then get a referral to a board-certified orthodontist for a consult no later than age 7. Hope that helps!
Agreed. Developmentally, it is based on--> genetics+environment/habits+susceptibility. I sucked my thumb until 5, and never saw any consequences. I also never had a cavity growing up, even though I was a terrible toothbrush-er as a kid. You can't have disease without a susceptible host.
But who's to say which children are susceptible hosts? You won't know until your child is afflicted.
I'm glad you are so willing to answer everyone's questions. Now I have one or some.
DS2 (26.5mos) has CP of the mild to moderate kind. With the CP, is he at an increased risk for anything in regards to his teeth? Also, his teeth are already crowded (at least the front 4 on the bottom and top) and I believe he will more then likely need braces or even more later in life. Also, due to the CP there have been some oral motor and swallowing issues. He had an OPM done in June where they suggested no open cup drinking at this time (hard anyway since he tends to ignore his left hand and he will need 2 hands for an open cup) so we are doing a sippy with a soft spout. He is able to use a straw although his feeding therapist thought it odd that a straw would not be advised against (along with the open cup) since the liquid goes further to the back of the mouth. So will his extended use of a sippy cause any damage?
I kind of feel like he has gotten the short end of the stick with his disability, the need for glasses, the more then likely need for braces, etc. so I'm always looking to be proactive.
One more, very specific dental question... Not sure if you'll be able to help. DD has osteogenesis imperfecta (type 1... The mildest form). Her pedi told us that if she were to have dentinogenesis imperfecta, we would be able to tell when her teeth came in. Her teeth look fine.
We took ds to the dentist at 18 mos for his first exam and I had planned to take dd at the same age. With her condition, though, do you feel there would be any benefit to taking her sooner? Although she doesn't have di, I have read that the Li can still cause brittle teeth.
I haven't had a ton of CP patients, but the ones I have seen are extremely varied in their needs. From what I have seen, there are a not a ton of dental problems inherent to CP that aren't due to medications or due to poor oral hygiene due to poor muscular control. With your son's needs I think the bigger picture here will be to help him with musculature as much as possible. When he is ready and with your pedi's permission, work up to a cup. But follow your son's and your pedi's cues. What meds is your son on (if you don't mind me asking)?
Whew, I'm glad she didn't get DI. You would be able to tell- the teeth kind of have a yellowish/bluish glean to them (most people call it opalescent, but I don't think it's quite that obvious in real life).
As far as when to take them, the AAPD suggests either at 12 months or within 6 months of the eruption of the first tooth, whichever comes first. I took Jackson at 11 months, even though I was quite capable of looking myself. I wanted him to get used to the dental environment.
That being said, most of the OI dental effects have to do with malocclusion. There's not much that can be done for bite issues (other than the preventative stuff I talked about earlier) until some (not all) of the permanent teeth come in. That is why the AAO suggests seeing an orthodontist for a (usually complimentary) initial exam at age 7. With her OI, I would definitely take her to one when she turns 7, but no need to go before then unless her pedi dentist says so.
One of the goals in feeding therapy is 2 handed use of a cup in preparation of cup drinking. Would a straw be better then a regular soft spout sippy at this point? He is unable to use a hard spout one but does seem to drink ok through a straw (straw sippy or even a straw in a drink at a restaurant) although size of straw is important. As for hygiene we do brush his teeth with training toothpaste (no flouride) every night before bed. Should I up it to morning and night?
He takes Miralax (dissolved in his milk), Zantac (liquid), and Zanaflex (newest med and taking for 5wk now and pill is crushed into applesauce). He has recently started spitting up (3x in the very recent past). Smells like vomit and not sure why it seems to have suddenly started.
A former pedi (we are a military family; this pedi was from when I moved the boys and I back to my parents during the last deployment) had stated that there may be potential enamel issues. I don't remember exactly how he said it but I interpreted it as him seeming to link that with the CP. I will state that my son has seen a pediatric dentist twice. The first was in the same town as the former pedi mentioned earlier and the second time was new state this past October. Both appointments were more of the getting him used to a dentist type of appointment. I had about everything under the sun in regards to my teeth so I would really like to avoid him having to go through all the same stuff if I can at all help it!
I re read the post, sorry for the quick reply. I would have BF'd longer but had to wean to start fertility meds and the kid wouldn't drink from a sippy at the time. We are now onto straw sippys, hopefully the cup will follow soon.
TTC #1- unexplained...lost left ovary 4/07 IUI #1 2/10/09-BFN IUI #2 3/5/09-BFN IVF # 1-BFP
TTC#2- FET 4/7/11 BFP, Natural mc 5/5/11 IVF#2 ER 9/13/11, ET 9/16/11, Beta #1 9/27/11 BFP 254 Beta #2 9/30/11 793 -Twins!