Dentistry with Dr. Ian Kott, DDS

Intro and pediatric dental basics 0:00

Hello, welcome to this week's episode of the Baby Manual podcast. Today, I am super excited to be talking with Dr. Ian Cot, who is a DDS. He's a board certified pediatric dentist. And I've had the pleasure of knowing him for several years and I always asked him questions about things like bottles and pacifiers and thumb sucking and toothpaste and all kinds of things. So I think he's gonna be really awesome for you guys to listen to as new parents. Dr Cott, thank you so much for being here. How are you doing?

I'm doing well. Thanks for having me. Awesome. So yeah, let's just start off with like basic dental care. I know I have past episodes of this where I talk about when children get their first teeth and I always tell parents to start brushing with plain water as soon as the first tooth come out. But what other sort of recommendations do you have, especially about things like fluoride? Sure. Well, absolutely. You're right that the first time you want to start brushing your child's teeth is when they start coming in.

It's not a bad idea to just start putting your fingers in their mouth and using a toothbrush even before they get teeth so that they can get used to it because that's the main challenges is getting the child comfortable enough so that you can brush easily. The number one thing that I always find is beneficial is making sure that can see what you're doing rather than just guessing. If you are used to brushing your own teeth, you might move two or three inches back and forth, but in a child who just gets their first tooth just a little bit back-and-forth, getting them used it and using toothpaste, If you're not using a fluoride toothpaste when they first start coming in, I really think, like you said, water is fine.

It's more the mechanical debridement of the teeth with a toothbrush versus the finger brushes that have just little rubber flanges on them. They work a lot better. Yeah. I think also children like to bite those finger toothbrushes and that can really hurt. Yes, as a pediatric dentist, you learn to get your fingers out of the way pretty quickly. Yeah, I'm sure. Is toothpaste without fluoride even worth using then? I feel like the like sort of training toothpastes don't really do a lot. It's just flavor, right?

Yeah. But the training aspect of it is for spitting. something that is flavorful that they can use so that can learn how to manipulate the saliva and the toothpaste in the mouth in order to get it out. If they're just using water, most likely they are going to swallow. So the benefit is learning how spit, which is the benefits of it. But in a sense, toothpaste without fluoride and toothpaste with fluorides, they brush that's cleaning the teeth versus the toothpaste. It's not like soap where soap will loosen the debris on your dinner plate.

The toothpaste doesn't necessarily do that. it's just having a good new toothbrush with straight bristles that aren't all carrot topped and if the child does chew it a lot you might need to switch it out more frequently. Or you can just let them have that toothbrush and then you'll have one toothbrush that you would use to help as a follow up after they brush. Nice. Do you have any tricks for toddlers who are not liking having their toothbrush or fighting tooth brushing? Well, you'd have to be as creative as you.

Can for for everything with a child. But what we used to do at my house is we used to call it making a nest and like I was saying earlier think it's easy to do it in the bathtub.

Brushing routines and fluoride guidance 4:00

I don't think if they're sitting on your lap and you're trying to brush like this, I always have the child lie down so that I can look down and see. And the benefit of having them lie-down is that their head will be stable and have one hand to hold the lips out of the way and another hand brush at the same time. So whether they're lying on the floor or the changing table or bed or couch, it's up to you. But we used to make a nest and each kid would then come with a blanket and a pillow and couple of stuffies and who was going to watch and I would have my legs beat out and the child would lay in my lap and they would line up the stuffy's to day it was a different stuffy and who got to go first but making it fun and easy and comfortable because all that I think that kids like nighttime routine if it's fun.

And so bath time can be fun if you just leave them in the bath. an older child, they're not gonna enjoy it as much and they may just play and not wash their hair or whatever, but making it fun and having a routine that is reproducible that involves the child. Not just you telling them, lay down, you do this. Why don't you go get this stuffy? I think that Mr. Giraffe wants to watch your teeth get cleaned today. I like that. And then you could also pretend to brush the stuffies teeth too. Oh, always.

Yes, yes. Yeah. Or the child can brush stuffie's teeth at the same time. A normal two minute thing. If you say you're gonna brush your teeth for two minutes, a routine like is usually five to seven minutes. Everything takes longer with kid time, right? For sure. Sometimes I would suggest to parents letting the children brush the parents teeth first. And then the parent can brush, the kids teeth so that they get that sort of back and forth, like, make a game out of it or give them the choice of like do you want to start and I'll finish up with your teeth or do You want me to Start with Your Teeth and then you can finish it up.

Exactly. Just some other potential ideas that always end in the same outcome. Right. As long as the teeth get brushed, I don't care how it happens. That's great. Let's talk about other things related to cavities. I know drinking milk out of bottles is a potential for that. What are your suggestions about milk in bottles and breastfeeding after one year of age? I now the Academy of Pediatrics suggests breast feeding until two years of Well, I think it's first important to understand that any fermentable carbohydrate will cause a cavity.

So breast milk, milk juice, anything that a child liquid will consume that has a carbohydrate, whether it is fructose or lactose, organic or non-organic will, cause the cavity The first thing is understanding that hygiene, proper hygiene is the main thing as to preventing cavities. Second thing, is frequency. And so kids that will graze on a liquid, and it's easier for kids to grazed on liquids with a bottle, as well as long term nursing. So it is not necessarily the daytime nursing that They're feeding for 20 or 30 minutes and then they're awake and they are up doing things.

A lot of the problems really come at the nighttime nursing, especially if you're co-sleeping because sometimes that child will stay on a latch for all night long, even if they just getting a few drops throughout the night. that can cause the breakdown of the enamel, as well as child going to bed with a bottle. The bottle with the milk can sit on the teeth for all night long, and that could cause cavities. It's important to know, though, also that Nursing pre-solid foods, I believe, doesn't cause cavities.

It's once they start eating solid foods that the oral environment will start to change and they will acquire the particular bacteria that can break down the lactose in the breast milk or the cow milk, or sheep milk whatever, and that produces the lactic acid. So it's the long-term constant bathing of the teeth in liquid carbohydrates that can cause the problem. So doing it most of time, if you're nursing at nighttime, you are not going to wake up and try to brush the child's teeth. Making sure that you do a really, really good job before they go to bed to get all the plaque off your teeth because it takes about 24 hours for the bacteria to produce a biofilm sufficient enough to Produce cavities.

So If you're if you do a really good job brushing you are going to reduce the risk of nighttime nursing causing cavity for sure. And I think it's also important for parents to know that when you say about these carbohydrates sort of snacking on, like we have a lot of snacky foods in the U.S. and I feel like toddlers are constantly snacky on something. And so even if it is not sweet, even it it not candy in particular, anything that's carbohydrate based like mac and cheese, you know, pasta has a lotta carbs in it, those kind of things can also cause cavities, right?

Absolutely. When I start having to fix cavities on young kids and we determine that they're grazing all the time and snacking on these types of chips and crackers

Bottle use, nursing, and cavity risk 10:00

and pastas and rices, some of the things that I recommend are pure protein-based things like beef jerky, snacks like that don't cause cavities. Cheese doesn't really cause cavity because there is lactose in there, but it's not as available. fresh vegetables, those certainly don't. So things like celery sticks and peanut butter or carrot sticks in hummus. Those are wonderful snacks that you could let them graze on all day long and not really be worried that it's gonna cause a cavity. Awesome. And bottles of water are okay at night, right?

From a Cavity standpoint, bottles with water or fine. Yes. A bottle can also cause changes in swallowing habits and behaviors. I don't know if you wanted to get into that, but, you know, some of these recommendations about when should I stop using a bottle or when I should stop nursing and when to stop sucking the thumb or using the pacifier, those all have to do with swallows and what your tongue does to swallow as well as how it helps the formation of your skeletal system and how expands your top jaw with a swallow.

Yeah, so when does that start becoming an issue? Is there a certain age that we absolutely have to stop this by? Or can we wait until their grown-up teeth are in? Does it have be earlier? So it all has to do with how your teeth come in, when they come and when the fit together. So if you don't have any teeth, then swallowing will just happen naturally and you can get natural expansion of your top jaw. But as soon as you start getting back teeth, not the front teeth which are the first ones to come in, but so around age one is when you'll start to get back molars.

And when they come, if they interdigitate is how we call it, they lock in when bite down, that then sets the width and you can't really get a lot of natural expansion because the teeth are locking in. So we, as a general rule, say by age two is when you want to stop doing all, we'll call them non-nutritive habits. If you could stop thumb sucking, which is much harder to do, if you take a pacifier away, you stop using bottles with water at nighttime, I never tell parents to stop nursing it too. I just tell them you stop when you're ready, because that's nutritive.

They're still getting nutrition as well as bonding, so you have to decide when to do that. But as long as the teeth are coming in, that is why we say age 2, typically when the And if you have too narrow of a jaw and the teeth lock in, then for the next four or five years, you're going to have a narrow palate which could lead to more difficulty swallowing, increased roof of your mouth, which then would close down your nasal septum and make it more difficult to breathe through your nose, Which you could then find that some kids are mouth breathers because they can't breathe to their nose.

But you also need to rule out any possible allergies that could be causing that too. Cool. Do you have any tips and tricks for parents to wean these things away? I know with bottles of milk what I tell parents is to start watering it down progressively. So start with like maybe for a week you do one quarter of water and three quarters milk or formula and then half and half. And then go down to one-quarter milk with three-quarters water. Then eventually just all water, and a lot of times at that point the children are just not as dependent on it and more willing to give it up.

And I know with pacifiers, we often will recommend things like progressively shortening the tip. Like you cut the top of it off and it's just not as pleasant to suck on at that point. Sometimes that doesn't work. Do you have other tips, especially for things, like thumb sucking? I they make devices that will block the children from sucking their thumb, but that just feels really inhumane to me. I don't know if there's a better way. Yeah, there's lots of ways to do it. And just like getting your kid to brush their teeth, you just have to go with what feels good for you and try different things.

There are the things that you can paint on that taste bad. I know kids that love that and they'll chew it off and swallow it because they like that bitter taste. There are devices that you can put over the hand that make it so that when it goes in, they can't create a latch and they cant suck on it. I've known parents to sew gloves onto pajamas so when they put their hand in. They don't like the glove in the mouth. Band-aids are another thing. The real challenge with thumb sucking is that these children have opinions and they have desires and you can't take it away.

And you could, you know, pull it out and then in middle of the night it goes back in. So it really comes down, what I have found typically works the best happens when the child is more willing to bargain with you. You could then say, hey, this is what we want you to do. This is the reason why you don't want to it. But a four-year-old may not understand it, so a six or a seven- year- old may be able to comprehend that and you can reason with them a little bit better. And then, you know, finding some sort of a reward system where it's like, listen, if you really can stop sucking your thumb for a month, then maybe, this special prize, we can get you.

Thumb sucking, pacifiers, and weaning strategies 16:00

I did have somebody do a promise of vacation. And as soon as the vacation was over, They went back to sucking their thumb. So it really should, if you're going to do something like that, something that you could then remove also as a way to remind them back. It works good cutting the tips of the pacifiers off for some. Others, they'll go to thumb sucking because they find it works better. So you gotta watch. You gotta be creative. I had, you know, the little green ones that they often give out in the hospitals to new parents.

They, I have a family cut the end of that off and then the thumb went in there because the child like, like the green thing on their day. And so they just turned it into that. Yeah. It's practice. Then you can't cut that thumb off. Yeah, I've also seen some creative ideas like burying the pacifiers in the ground. And then the next day a toy magically grows in that place or donating them sometimes, you know, talking about giving them to another family, even though you're not probably actually giving him to other family.

But, um, just getting them out of the house, but saying, You know that there are other children that need these pacifier. Some children. Yeah. I love those story ones. Or, you know, we talk about the tooth fairy. You could have the pacifier fairy that comes and leaves a treat. We have Halloween time. we call it the switch witch, where the candy goes out on the front porch and somebody comes in and trades that. So you can certainly do any of those creative ways. I loved all of them. Yeah, that's great.

So when should children first start going to the dentist? I always tell them around a year of age, but I know some babies will get teeth earlier. Is it actually more like a few months after their first tooth? What if they don't have teeth at a? Yeah. What do you suggest? American Academy of Pediatric Dentistry says six months. After the eruption of their Because if they haven't had any teeth by age one, we want to, you know, kind of check and see, is there any reason why the teeth aren't coming in?

Are they missing teeth? But it's not uncommon to not get first teeth until age 1. But at six months, We want it develop what we call dental home, where we can answer any questions, make sure that you're brushing because you want the brush teeth as soon as they come in. And the hardest thing are those kids that are born with neonatal teeth. And you gotta start brushing them then too. That's often very hardest on mom. Yeah, and I've seen some of those teeth get pretty discolored for parents that don't want to brush them yet.

Right. Oh, yeah. You really, you really have to rush them every day, even if they're born with those to you. Yeah. And there's some other those kids. We actually have take the tooth out because when they are nursing, the tongue goes over the teeth. underside of the tongue so raw that they'll have huge ulcerations and sores underneath their tongue. And so it's not necessarily that it hurts mom for nursing, but the the Tongue is so Raw that They can't feed. They have to take the tooth out. That's that's my least favorite thing to do in the world.

Yeah. And that's a really good point that you brought up that when babies are nursing and they get their first teeth, usually it's the bottom teeth that come in first, the two central ones. They're covered by their tongue, so it shouldn't be painful to mom to nurse when the baby has teeth. Cool. And then also that first visit, we sometimes call it a happy visit. Right. Where they just come in, they get to meet everyone, sit in the chair. Yeah. Maybe open their mouth. you know, a year or two, we just want them, the parent to feel comfortable.

We know what we're doing doesn't hurt the child. They may not like it, but we do want to get a good look because they're, and sadly, there are young kids age one that have cavities. And if they do have a cavity at age 1, it's very difficult to try to fix it. So we'd rather teach the parents how to prevent it, educate them on diet and hygiene and try to protect it. And then usually after, you know, when a kid is two or three years old, they're running in happy. Oh, I know what to do. This is great.

Awesome. So what are some other risk factors for cavities? I know we had talked about like if someone in the family has had cavites or had dental work done recently, that can sometimes be a risk factor because they're sharing those germs. And you had a lot of really good examples for me. Last time we talked this with, you know, like blowing on their food or checking it with your mouth to see if it's too hot, kissing baby on the mouth, cleaning off the pacifier with you own saliva. All those things.

The important thing to understand about a cavity is that it's a transmissible bacterial infection. So when a baby's born, sterile, no bacteria in the mouth, they start to acquire it slowly, just like everything you said, from kissing to sharing spoons and Cleaning the pacifiers and fingers in your you know, how many every baby they got their fingers and your mouth and then in their mouth And then they start getting the bacteria.

First dental visits and early cavity prevention 22:00

Yeah, so the the there's three things that can cause the cavities one is the Bacteria Two or teeth and the third thing is carbohydrates. So in order to not get a cavity, you have to disrupt one of those things. So if you, everyone's going to have bacteria and everyone needs to eat. Making sure that you brush the teeth really well to remove the bacteria, that's what you're trying to do with the brushing. If there's no bacteria on the tooth, then they can't eat the carbohydrates to produce the acids to dissolve the If you don't feed them carbohydrates, so you can reduce the risk by less carbohydrates and less frequency of snacking and grazing.

And we have the teeth. So it's a play on all those things. It's not going to be the same every day. You may be in the car and on a road trip and they may in backseat for 45 minutes and you give them a box of raisins. And one child may eat the whole box of raisins all at once in the first five minutes of the trip. And the second child maybe one at a time for the hole trip and so the child that's constantly putting one in slowly over time is what I'm calling grazing. That's going to be more likely to cause a cavity than the one that eats it all So, if you have a late night and they just came from a wedding or a party and it's 10 o'clock, well, that's the time where you're like, maybe we are going to wake them up and brush their teeth a little bit in order to make sure that they don't get cavities.

So it's constantly in flux. Try to, you know, and the other thing that I find is important too, is that yes, the most important time to brush your teeth is at nighttime before bed, because your metabolism slows down, your metabolic rate slows, down you're not producing a lot of saliva, which is the natural combatant to acid demineralization, And so doing it before bed is best. But if you do it in the morning, first thing, or in middle of the day, right after dinner, even if do that, that's better than doing a poor job just before a bed.

It's a better to do a really good job once a day than two or three poor jobs a Yeah, that's good to know. What about, so you talked a lot about brushing, what about things like floss and mouthwash? Yeah. Thank you. So we often say brushing but really what we mean is brushing and flossing. They really should go hand in hand because it's too hard for a toothbrush bristle to get in between teeth. So brushing and flossing. For a lot of older kids, I actually will turn it around on them and just say, we changed the name.

It's not brushing in flossing, it flossen and brushing. because I want the kids to floss first because a lot of times they'll brush and they just forget and stop. They just go to bed or do whatever. So if you floss, first, I don't think it really matters whether you do one or the other first. But if your trying to get somebody to floss, if get them to Floss first they don' t feel done until they've brushed their teeth. It's just a mind game that you're playing with it. trying to get them to do that first.

So yes, brushing and flossing. And then for mouth rinses, I don't recommend any of the Listerine type based ones for younger kids because they often have alcohol in them and can burn the mouth and it's too minty and spicy. But if someone is more prone to cavities, I would recommend a fluoride mouth rinse after they're done brushing and flossing to help bathe the teeth in

Flossing, mouthwash, and closing advice 26:00

the fluorite, but not necessary. A child that's low risk for getting cavites, if you're using a fluoride toothpaste, just brushing and flossing alone should be sufficient. Often it's easier to think of as a mouth rinse to do the job for you. So if a family comes in and the child has cavities and they'll say, what else can I do? Should I add a Mouth Rinse? Usually what that means is that they're trying to avoid the brushing of the flushing and helping them with it because that's The number one thing, brushing and flossing.

There are certain times where we might recommend the mouth rinse or a prescription fluoride toothpaste. But in general, young kids, fluorine, toothpaste, a small amount, once a day, if you're low risk for cavities, should be sufficient. Nice. I think one of the best things I heard about flossing is that if you don't floss, it's like going to the bathroom and only wiping your butt cheeks and not your but crack. It's not doing everything. And so you really want to get in between there with the floss and get all that dirty stuff out of there.

Yeah. Yeah, so, and that makes a good point because there are, at this point, I've stopped really trying to call it flossing and trying call cleaning between your teeth. What do you do to clean around your tooth? And what do do clean between teeth? Because there floss, you can use floss. My favorite, don't know if you see this, it's called a soft pick. and so it's a little toothpick that's plastic and on the end are little figure-like projections. And so just going in and out is if you have one hand that's, I mean, it's very difficult for a young child to learn to wrap those floss and work in a mirror with the, you know, being dexterous enough to clean their teeth.

So doing it for them, and this is something that I feel an older child can use by themselves, as well as water flossers. And I really believe that if Consistently, that's fine. If you never want to floss again and you want use the soft picks, fine, you can do that. You never wanna floss and use a water pick? Fine. Just everyday consistency. Now, younger kids are harder to do it with and the water flossers make a mess and they spray the mirror and everything, but They're good for teenagers with braces, something that they'll use.

If they use it and it's easy, that's fine. So it is a good point that it doesn't have to be flossing. It just has to something to clean in between the teeth. Nice. Well, this is great. So it sounds like the big takeaways are have your children drink water, eat vegetables, clean the surfaces of the teeth and between the tea and try to avoid things like grazing at nighttime and things, like milk and juice. I never recommend juice anymore at all, just because it's basically as bad as soda for your teeth.

We didn't even talk about soda. Everyone knows soda is bad for you, too. Yeah, so much sugar. Any other tips you had for us before we close? Just bring them to the dentist early so that if we ever need to do something, they're used to us and they know what to expect. Yeah, that's a really good point. Well, thank you so much, Dr. Cot. It's been an absolute pleasure speaking with you today. As mine too. Thank you. So much for being here. Hey, if you could hit that like and subscribe button so that you'll be the first to know when new episodes come out.

it will also help other parents like yourself to be able to find the baby manual podcast. You can also listen to the 1st 4 seasons of this podcast on your favorite podcasting platform. and you can also check out my YouTube channel. I have lots of videos and shorts that will help you feel empowered as a new parent as I talk about all the common stuff that comes up in the first couple of years of life. Thank you so much. Have a wonderful day.