As our infants begin the teething process, parents must learn to navigate avenues to ensure proper pediatric dental care. For parents who are blind or visually impaired, our children’s mouths can represent a dark abyss. We want to ensure healthy oral care for our kids but discovering how to do this without sight can be an anxiety-provoking experience. Part of the answer lies in finding the right dentist for your family, one who will offer both information and support to you as a parent who is blind or visually impaired.
I interviewed Dr. Victor Avis, D.D.S., a dentist in Staten Island with training in multiple specialties of dentistry, regarding the facts and techniques every parent who is blind or visually impaired should know to ensure a solid foundation for pediatric oral hygiene. Dr. Victor P. Avis, D.D.S., refers to his dental practice as The Avis Alternative. The Avis Alternative represents excellence in the multiple specialties of dentistry, all by one doctor with one team skilled in treating children and adults. In addition, Dr. Victor P. Avis is dedicated to making a difference in the health of his patients and recognizes that oral health is connected to overall health and that dental disease is most often a sign and symptom of an underlying lifestyle issue. To this end, Dr. Victor P. Avis has developed a team of colleagues to work alongside the Avis team to positively affect the patient’s sleep, nutrition, exercise, and stress.
When to Start Brushing:
Holly: At what age should a parent begin brushing a child’s teeth?
Dr. Avis: The first “baby teeth” typically erupt at six months. However, this could happen as early as four months and as late as eight months. The first teeth to erupt are usually the two lower central incisors. Prior to eruption, the infant may be irritable, display increased salivation, and desire teething. This is all a normal reaction to the discomfort from the newly erupting teeth. As soon as any teeth have erupted into the mouth, the parent should begin oral hygiene practices.
Safe Dental Products for Children:
Holly: What products should parents use or what do you recommend in the infant/toddler stage of dental health? (toothbrush, finger brush)
Dr. Avis: At first, it may be easier to clean teeth with a washcloth and water. However, as more teeth erupt and you can stabilize the child’s head, I recommend that you switch to a toothbrush.
Holly: Describe the different kinds of toothpaste and which type best fits infants/toddlers.
Dr. Avis: Toothpaste is a more controversial issue. Fluoride at a concentration of .7mg/liter is safe. Studies support that communities that introduced fluoride in this concentration into public drinking water have a lower number of dental caries. However, fluoride in a higher concentration is toxic, and toothpaste is not designed to be ingested. With these concepts, I advise parents to not be reductionist in their thinking, i.e. do not try to reduce all good or bad with regards to dental health to the use or disuse of fluoride. In the early 1900s, Dr. Weston Price studied populations who were not exposed to processed foods and sugar and found that these populations had not only healthier teeth but improved facial growth and airway development. Bottom line, if you eschew fluoride, a healthy diet of non-processed and minimal refined sugar, must be part of your family health strategy. Frankly, fluoride or no fluoride, good nutrition is critically important for your family’s health.
What to Look for in a Dentist:
Holly: Do you have to go to a pediatric dentist or can any dentist see a child?
Dr. Avis: General dentists and pediatric dentists can both be well qualified to see children as patients. If a child has extensive dental challenges that require sedation or behavioral management issues, a pediatric dentist has additional training in these areas which might prove helpful.
Holly: What characteristics should you look for in a dentist as a blind/visually impaired parent?
Dr. Avis: Your child’s dentist should have a warm, welcoming office culture and a personality that puts one at ease and fosters relationship. This relationship facilitates trust and an eagerness to follow the dentist’s recommendations. This will support and encourage good, long-term health and well-being.
Best Method for Brushing a Child’s Teeth:
Holly: Describe the best method a blind/visually impaired parent can brush their child’s teeth? Motion? Movement? Top to Bottom?
Dr. Avis: Best practice for brushing a child’s teeth is to place the child in your lap and cradle the head in your non-dominant arm between the bicep and forearm. Then your dominant hand is free for brushing, and the child’s head is properly stabilized. Use an extra-soft pediatric sized toothbrush. Brushing can be a fun bonding experience filled with singing as well as the development of good oral hygiene. Ideally, the motion is from the gum up and side-to-side but most important is to just make sure to brush all surfaces of each and every tooth.
Planning the First Visit:
Holly: At what age should a child first see a dentist?
Dr. Avis: The baby should first see the dentist when she is in the womb! Why? Good parental oral health is associated with good baby health. A pregnant woman’s dental disease has been associated with pre-term delivery and low birth weight babies. Second, parents need counseling about things we have touched on in this article and more before the baby is born.
After birth, a baby can accompany mom to a dental visit. This can help with desensitization and acclimation. By six months, when first teeth have arrived, is another good reminder for a baby’s first visit to the dentist. It is at these early visits that the foundational habits for proper breathing, oral posture, oral hygiene, and weaning are taught or reviewed.
Holly: How can a parent who is nervous about dental care make the experience a positive one for their child?
Dr. Avis: An early start and knowledge that a healthy lifestyle and dental supervision can successfully prevent dental disease and promote health works to ensure your children will have a positive feeling towards their dental professionals. This should help prevent the transference of the parent’s possible anxiety. Also, if the parent is anxious, do not tell your child and then let your child see the dentist without your hovering and negative energy.
Caring for Dental Emergencies:
Holly: What are some of the signs your child is having a dental emergency (visual and nonvisual)?
Dr. Avis: A sign or symptom of dental emergencies with children would typically be pain and/or swelling. If either of these conditions occurs, it is best to visit your dentist. Adult teeth erupting in the wrong position, a bump on the gum, a dark spot on a tooth, or a hole in a tooth are all reasons to go see the dentist as soon as possible. Some parents think, “it’s only a baby tooth, why worry?” Bottom line, this is an ill-informed position. The baby teeth have a very important role, and their premature loss can create a “domino effect” of increasingly more difficult dental problems. Furthermore, diseased baby teeth can hurt your child and having to “fix” these teeth by filling or extraction are procedures to ideally prevent.
Tips for Maintaining Your Child’s Oral Health:
Holly: What’s the best advice you could give a blind/visually impaired parent about maintaining good oral health for their child?
Dr. Avis: First, take care of your own dental health. Model the behavior that you want your children to develop. Second, the bacteria that cause dental cavities and gum disease are transferred from parent to child. Keep your mouth healthy! Third, excellent nutritional habits promote dental health and overall well-being. If the parents adapt a healthy lifestyle, the children are more likely to do so as well.
Holly: Are there any foods/drinks you should avoid to maintain good oral health?
- For drinks, it’s very simple—water, water, and water. Avoid sugar or added chemicals, which are in most all other drinks and/or beverages. Start the children this way, and they are less likely to crave the empty calories and harm contained in processed juices and soft drinks.
- For food, emphasize fruits, vegetables, and whole grains. Meat and chicken are best if organic, grass-fed, and raised in a non-factory farming environment.
Effects of Thumb-Sucking on Facial Development:
Holly: Describe how thumb-sucking and bottle use can impact health as well. How can you stop that behavior?
Dr. Avis: Thumb-sucking pushes the tongue down in the mouth. The tongue down causes the palate to form more narrowly and, as the palate is the floor of the nose, the less than optimal development of the nasal cavity. Furthermore, a narrow palate typically will cause a deviated septum. Finally, thumb suckers are mouth breathers. Mouth breathers have a greater risk for airway related issues. When one breathes through the mouth, air is not filtered, not humidified, not warmed or cooled to the optimal temperature, and not mixed with an important gas, nitric oxide. Myofunctional therapy (“oral facial muscle therapy that uses measurement and exercise to correct a deviated swallow, commonly called ‘tongue thrust'”) is the best approach to helping children overcome thumb-sucking.
What Visually Impaired Parents Need to Know:
Holly: What should I know that I might have never heard from my pediatrician, dentist, pediatric dentist, or lactation consultant?
- Breastfeeding should not hurt; if so, expect a tongue tie might be the underlying cause for the painful and inefficient latch. Type 3 and 4 tongue and lip restrictions should be treated as soon as they are recognized. Ask if the doctor or healthcare practitioner feels qualified to make this assessment.
- “Baby-Led Weaning” by Gill Rapley is an important book and introduces a conceptual approach to weaning that is important for optimal facial growth and development. It is important to get babies and toddlers to develop good facial muscle tone.
- The nose is for breathing, and the mouth is for speech and eating. Encourage your child to have their lips together except when speaking. “Close Your Mouth” by Patrick McKeown is a great resource.
- The tongue is to a child’s facial growth and development as the “rudder” is to a sailboat. Unlike any other muscle in the body, it attaches only on one side and attaches to five different bones. When postured correctly, tongue tip to the palate, posterior to the incisive papilla (raised tissue behind the upper front teeth), and the remainder suctioned to the “roof” of the mouth, the tongue will encourage optimal development of the nasal cavity, width to the dental arches, forward growth to the upper and lower jaws, best possible airway development, space for all the teeth, and optimal facial aesthetics. Once the above principles of tongue posture and nasal breathing are understood, parents can better understand why bottle use and pacifiers encourage low tongue posture and thus inadequate palatal development. Furthermore, habits like nail-biting, noisy chewing and lips apart posture are indicative of mouth breathing. Sippy cups without a hard projection, just a lid with a rim and holes, and no pacifiers is my recommendation.
- Improper facial growth and development can be recognized by a well-trained dentist as early as age four. Early recognition and management may positively affect behavior, learning, cognitive development, sleep, airway, attractiveness, and dental development.
Closing Thoughts from Dr. Avis:
In summary, parents need to brush teeth as soon as they appear. A healthy diet and good oral hygiene will ensure a healthy dentition. Sleep apnea and sleep-disordered breathing are presently a common chronic health problem in both children and adults. To help prevent it is most important to help your child to become a nasal breather and learn proper oral posture at an early age (GOPex Good Oral Posture exercises by Dr. Sandra Kahn and Dr. Simon Wong).
Do you have dental questions for Dr. Avis? Leave you questions below.