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スポック博士の育児書806-10 ORAL HEALTH英並

2016-10-19 18:17:57 | 育児
In regions with high levels of natural fluoride in the water,
tooth decay is rare. The addition of fluoride to the water in most


American cities has had a similarly beneficial effect Children
can also get fluoride in the form of tablets or drops. It also helps
to put fluoride directly onto the teeth, in the form of tooth-
pastes, mouth rinses, or special preparations that dentists use.

Fluoride in the water. For decades, fluoride has been added in
very small, safe amounts to the water of many communities as a
public health measure. If you're not sure whether your water has
enough fluoride, you can call the information number on your
water bill and ask. Adequate fluoridation is 0.7 to 1.0 ppm (parts
per million). If you have your own well, call your county health
department for advice. If your water is low on fluoride, your
family mostly drinks bottled water, or you use a home purifica-
tion system that takes out all the fluoride and other minerals, it
makes sense for you and your child to use a fluoride supplement
(drops or pills).

Fluoride for babies. If you're breast-feeding and drinking fluor-
idated water, you don't need to give your baby extra fluoride. If
your water is not fluoridated, consider giving your baby an in-
fant vitamin with fluoride. Baby formulas contain little fluoride,
but if you mix the formula with fluoridated water, your child
will get plenty of fluoride. If not, consider adding fluoride

Enough, but not too much. Your child's doctor or nurse practi-
tioner and dentist can help make sure your child gets the right
amount of fluoride. If there is no fluoride in your water supply,
your doctor or nurse practitioner may prescribe the appropriate
daily dose for your infant, which will vary depending on your
community and your child's age and weight. Too much fluoride
can cause unattractive white and brown specks on the teeth, so
it's important to give the correct amount. Your child may also re-
ceive periodical topical applications of special fluoride solutions
in the dentist's office. Fluoridated toothpastes are also beneficial



for their surface effect on the enamel. But be careful: Children
who eat toothpaste, as most young children will, are at risk of
getting too much fluoride. So use very small amounts (pea size),
and keep the toothpaste away from very young children so that it
doesn't become a convenient bathroom snack.


Getting to know the dentist and the dental office staff is very
worthwhile. The best time to take your child to the dentist is
shortly after the first tooth erupts, usually by twelve months of
age. You can ask the dentist questions about your child's dental
care and learn more about dental problems. In early preventive
visits, the dentist is able to detect developing problems in the
early stages, when they are solved more easily, painlessly, and in-
expensively. More important, your child will have positive early
experiences in the dentist's office. By the time she is three, she
will be a dental-office veteran. Most future visits will be preven-
tive in nature, rather than the traditional drill-and-fill sessions
that haunt the childhood memories of so many adults.


Some children get a lot of cavities, others almost none. Why is
this so? We still don't know all the factors that lead to tooth decay
(dental caries), but we do know that heredity plays a role, as do
the diet of the pregnant mother, the child, and access or lack of
access to good dental care.

Bacteria and plaque. The principal cause of tooth decay is acid
produced by bacteria living in the mouth. The bacteria combine
with food debris to form a material called dental plaque that
sticks to tooth surfaces. The more hours of the day this plaque
remains on the teeth, the greater the number of bacteria and the
more acid is produced. This acid dissolves the minerals that


make up the enamel and dentin of the tooth, eventually destroy-
ing the tooth.


make up the enamel and dentin of the tooth, eventually destroy-
ing the tooth.

The bacteria live off sugars and starches in the child's diet.
Anything that keeps sugars sitting in the mouth for a long time is
likely to be good for the bacteria and bad for the teeth. That is
why frequent between-meal snacking promotes tooth decay. Es-
pecially harmful are lollipops, sticky candy, dried fruit, soda
pop, and sweets like cookies and crackers, which cling to the

Saliva contains substances that help teeth resist attack by bac-
teria. Since the body produces less saliva during sleep, nighttime
is when cavities form the most. That is why brushing the teeth
before bed is so important. Foods that promote saliva—such as
sugarless gum—can help fight cavities. There are also sub-
stances in some sugarless chewing gums, xylitol and sorbitol,
that kill cavity-forming bacteria and another substance, casein,
that strengthens teeth.

Baby-bottle cavities. An especially severe type of tooth decay is
nursing caries or baby-bottle tooth decay. When formula or
breast milk sits on a baby's teeth for a long time, the sugars in the
milk promote the growth of cavity-forming bacteria, which
then destroy the teeth. The teeth most at risk are the upper front
teeth, since the tongue covers the lower teeth during nursing and
sucking. There is normally enough time between feedings for
the flow of saliva to clean the teeth. But when babies keep a nip-
ple in their mouths much of the time, this normal cleaning may
not have a chance to occur. The worst baby-bottle tooth decay
happens when babies fall asleep with the bottle in their mouths.
While they sleep, the formula sits on their teeth and the bacteria
multiply away.

Baby-bottle decay may start even before the first birthday.
Sometimes nursing caries is so severe that the infected teeth
have to be removed. For this reason, a baby should not be put to
bed with a bottle of milk, juice, or other sweetened fluid. The



only acceptable fluid for sleep time is water. Even diluted sweet
fluids can promote decay.


Effective brushing. How can tooth decay be prevented? The se-
cret is daily, consistent removal of dental plaque before it does its
nasty work. First, a tip about cleaning babies' teeth: use a soft-
bristled toothbrush. There is a myth that one should use a soft
gauze or cloth to wipe a baby's teeth and gums so as not to dam-
age the delicate gum tissue. Those "delicate" gum tissues chew
on table legs, cribs, coffee tables, siblings, and anything else in
their way. A baby's gums are no more delicate than alligator
hide. Brush, don't wipe. Babies love it.

A child's teeth should be carefully brushed after breakfast and
before bedtime, with daily flossing between adjoining teeth,
usually before the evening brushing. If possible, an after-lunch


brushing is helpful too, to remove food residue. Starting at
about two, your child may insist on doing everything herself, but
most young children do not have the manual dexterity required
for proper brushing and flossing until they are nine or ten years
old. You can let your young child begin the brushing by herself
from the earliest ages, but you will probably need to finish up to
ensure that all dental plaque has been eliminated. You can grad-
ually let your child take over completely when she proves capa-
ble, usually between six and ten years.

Flossing. Some parents question the need to floss a child's teeth.
Most teeth in the back of a child's mouth are in close contact
with those on either side. Even some front teeth may be in tight
contact with their neighbors. Such teeth are so close together
that food and dental plaque can get wedged in between. No mat-
ter how vigorously or carefully they are brushed, the bristles
cannot penetrate to clear out the food and plaque. Dental floss
disrupts and dislodges that debris so that the toothbrush can
sweep it away.

It's worth getting your child used to gentle flossing as soon as
you notice food wedged between her teeth. Your child's dentist



or dental hygienist can demonstrate all the methods used to
hold a child for perfect brushing and flossing.
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