Bottled "Designer" Waters Can Cause Pediatric Dental Problems

HIGHLIGHTS: Well-meaning parents who give their babies "designer" bottled waters to drink may be unwittingly contributing to their young children's dental problems, according to Denis Weintraub, D.D.S., a pediatric dentist, orthodontist and dental anesthesiologist at Cedars-Sinai Medical Center. Early examinations and education on proper dental care can help avoid many dental problems.

AVAILABLE FOR INTERVIEWS: Denis Weintraub, D.D.S., co-director, Hospital Dentistry, Ambulatory Care Center Dental Clinic

EARLY DENTAL EXAMS FOR CHILDREN CAN AVERT PROBLEMS POSED BY BOTTLED WATER AND "BOTTLE CARIES," SAYS CEDARS-SINAI PEDIATRIC DENTIST

LOS ANGELES (Feb. 26, 1999) -- Well-meaning parents may be unwittingly contributing to their young children's dental problems, according to Denis Weintraub, D.D.S., a pediatric dentist, orthodontist and dental anesthesiologist who is co-director, Hospital Dentistry, Ambulatory Care Center Dental Clinic at Cedars-Sinai Medical Center. Many of these problems could be easily avoided with early check-ups -- 12 months old is the American Academy of Pediatric Dentistry recommendation -- that include examination and education on proper dental care.

One of a number of concerns is the trend of giving babies "designer" bottled water, which may be popular with health-conscious parents but potentially harmful for baby. Bottled water contains no fluoride, which is essential in preventing tooth decay. The result is an increased susceptibility to cavities, said Dr. Weintraub.

"Many people mistakenly think that the water coming out of the tap is 'poisonous,' " he explained. "In reality, tap water contains a critical component -- fluoride -- that is necessary for tooth health. New laws now ensure that there is an optimal amount of fluoride in California tap water."

Another concern is decay of the front teeth caused by long periods "on the bottle." Called "bottle caries," these cavities often goes unrecognized until there is significant damage to the teeth. The problem arises when liquids -- formula, milk, juice and even breast milk -- "pool" between the back of the front teeth and the tongue, particularly in sleeping children.

"The high sugar content of these liquids attacks the teeth, though parents typically don't see the damage because it's behind the teeth," said Dr. Weintraub. "I have people coming to my office thinking their child must have bitten on something because their tooth shattered. What actually happened is that decay made the tooth so brittle that it broke off."

This condition may require capping of the front teeth -- a procedure that Dr. Weintraub performs all too often. "I'm in the operating room a lot -- four or five times a week -- as a result of bottle caries," he said, adding that the procedure usually requires sedation in young patients, who aren't able to endure a lengthy stay in the dental chair.

A change in family habits, including "stopping the bottle" in some instances, is part of the prescription for healthy teeth. A visit to the dentist can provide parents with important know-how on such topics as effective cleaning, decay prevention and tooth damage.

"For very young children, proper cleaning of the teeth can be accomplished using a washcloth, tissue or cotton swab -- it doesn't necessarily mean brushing," he described. "Most pediatric dentists are cautious about children's use of toothpaste, which has a relatively high fluoride content, since they may not be able to spit it out properly."

Sealants are another effective preventive measure that parents can pursue to avoid cavities in their children's teeth. This clear "coating" can be applied to the permanent back teeth, beginning with the six-year molars, which most children get between ages five and seven, and, subsequently, to the 12-year molars, which typically appear between ages 11 and 13.

Injuries to the tooth, commonly resulting from falls or blows, are important for parents to recognize and respond to, Dr. Weintraub stressed. Cracked and broken teeth should be evaluated by a dentist for appropriate treatment.

"If a baby tooth is knocked out, there is less concern since a permanent tooth will eventually grow in its place," he said. "In the case of a permanent tooth, we attempt to implant the tooth, which is most successful if the patient seeks treatment within 30 minutes of the injury."

If the tooth sustains a blow, parents may notice discoloration caused by blood leaking inside the tooth from the damaged nerve. This "dirty" appearance does not mean the tooth is going to die, Dr. Weintraub pointed out. In many cases, the tooth will lighten in color over time. A doctor's evaluation and an X-ray are recommended to be sure there is no abscess forming. If parents notice reddening and inflammation of the gum or any sign of pus, they should follow up with their dentist right away. A root canal or extraction of the tooth may become necessary.

For parents, the best way to ensure a healthy smile that lasts a lifetime is early dental care for their child, Dr. Weintraub stated. "Ask your pediatrician to recommend a qualified pediatric dentist or a family dentist who works with children, and make an appointment for an evaluation -- don't wait until there's a problem."

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