How can parents keep dental problems at bay? 

The most common chronic disease among children is tooth decay. By age 5, about half of all children show signs of it. Not surprisingly, these problems can lead to more serious health problems down the road.

The good news is, tooth decay is completely preventable. This month, Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, offers advice for establishing good oral-hygiene habits in children and addressing common oral problems.

KIDS VT: When do baby teeth first come in?

LEWIS FIRST: The first tooth typically appears around 6 months, but it can be anywhere from 4 months to a year or even more. After that, kids generally average one new tooth a month, with the last set of molars coming in by about age 2 ½. The permanent teeth start coming around age 6 or 7, but some kids will lose a tooth by 5. Permanent teeth continue to arrive until adolescence, when the process ends with the arrival of the wisdom teeth.

KVT: Are there dental problems unique to Vermont?

LF: If you look at the ranking of states in which people drink fluoridated water, Vermont is among the lowest. That's because most well water isn't fluoridated. There's no question that fluoride is an effective tool in preventing tooth decay and strengthening enamel, but you have to know how much your child is getting. No fluoride is not good, but too much can cause fluorosis, or discoloration of the teeth.

KVT: What should families do if they're on well water?

LF: Kids who drink only well water should use some kind of fluoride supplement in the form of drops or tablets or possibly a fluoride varnish for older children, provided during their dental visits. Fluoridated toothpaste can be used after age 2 but is not by itself an adequate source of fluoride.

KVT: Any advice for teaching kids to brush and floss?

It's not until age 5 or 6 that kids have the manual dexterity to get into all the nooks and crannies of the back teeth. So parents need to supervise brushing and make the process fun. Make a game of it. For example, parents can foam up their own mouths and make it look funny. Some parents will pull out sunglasses and say, "Wow! Those teeth sure are looking bright!" Some will name each room of the house as the child brushes "upstairs" and "downstairs." Kids should also be taught to floss as soon as their teeth start touching, which is about age 3 or sometimes a bit sooner.

KVT: Are antimicrobial mouthwashes safe for children?

LF: The danger of kids using mouthwashes is that many contain alcohol and kids do not necessarily know how to swish and spit. You can keep the mouth just as clean with toothpaste and a toothbrush.

KVT: What causes bad breath in children?

LF: It's usually caused by bacterial germs that are working on the food in their mouth and producing sulfur compounds. The more germs or bacteria in there, the more sulfur released and the increased risk of tooth decay. For younger children, a dirty security blanket or old stuffed animal can also introduce bacteria into their mouths. If your child is a mouth breather, their saliva dries up at night and the bacteria sticks around longer, which can cause bad breath. Garlic, onions and other strong-smelling foods can add to the problem.

KVT: What's the cure?

LF: Careful brushing and flossing twice a day for at least two minutes. Sometimes brushing the tongue can help older kids and teenagers. If kids chew gum, it should be sugarless. Chewing gum increases saliva production, and that also helps wash bacteria away. If the bad breath still doesn't get better, there may be something caught in the back of the nose or it could be a tonsil problem. If bad breath lasts a long time despite these suggestions, parents should see a dentist or health care provider.

KVT: When does teeth grinding occur?

LF: It's quite common when kids still have their baby teeth, and typically occurs in young children when they're sleeping. Somewhere between 10 and 50 percent of the population grind their teeth at some point.

KVT: What causes it?

LF: Sometimes it's due to tooth or jaw alignment problems, particularly as the baby teeth come through, resulting in a bite problem. It can also be caused by stress. The good news is, teeth grinding is usually a short-term problem and disappears by adolescence. Kids have no control over it, but if it goes on for a long period of time or is irritating everyone in the house, the child should been seen by a dentist to see if orthodontic work is needed.

KVT: How is it corrected if the teeth look fine?

LF: Your child's dentist or doctor may try to find out what is stressing the child and work on strategies to reduce the stress and, in turn, the teeth grinding. In rare cases, a dentist may recommend a mouth guard for an older child or teen until the problem resolves. But often, a nice, relaxing bedtime routine to help lower kids' stress before sleep is just the cure you're looking for.