By June Spence

Want to help keep your child’s smile sparkling? Duke pediatric dentist Martha Ann Keels, DDs, PhD, fields some FAQs about children’s dental health.

Why choose a pediatric dentist instead of a regular dentist?

You can think of it as a parallel to choosing a pediatrician for your child over a general practitioner -- they’ve chosen pediatrics as their passion. Pediatric dentists have two to three more years of training that focuses just on pediatrics, and they’ve treated hundreds of children, whereas general dentists typically get very limited exposure to children in dental school.

That said, there are far fewer pediatric dentists than general dentists out there. If you don’t have the option of a pediatric dentist in your area, make sure your general dentist is comfortable and knowledgeable about treating children. It’s worth doing some research to ensure that your child’s early visits go well -- trying to rebuild trust after a bad experience can be very difficult.

At what age should I bring my child in for her first dentist visit, and how can I help prepare her for it?

Most dental guidelines say you should have a dental home by age one. I fine-tune that to recommend bringing children in once they have eight teeth.

One way to help make sure your child does not have a negative experience is to prevent tooth decay. Start brushing as soon as their teeth appear, and then your child will get used to you -- and the dentist -- being in their mouth. You can use a washcloth for the first eight incisors, but molars needa toothbrush. Practice leaning them back and counting their teeth.

There are lots of books in the library and online to share; Dora the Explorer and the Berenstain Bears have stories about going to the dentist, and there’s a great new book out called Tooth Fairy Island. Keep it light and fun -- skip the dental drill parts!

When should flossing start?

As soon as there are any two teeth touching, they need to floss between them. With primary teeth, those back molars are normally the first to touch. Young children get most of their cavities in between their baby molars, which flossing helps prevent.

At what age can kids be allowed to brush by themselves?

Supervise brushing and flossing at least until age eight -- you want to make sure they conceptually understand what they’re preventing.

Develop routines that stick. It doesn’t matter much whether they brush before or after breakfast, for example, and it may be easier to get it done before. Make it fun. Disclosing rinses and tablets that stain the teeth can show them how thoroughly they brushed.

Also train your child to be a tongue inspector. Have them practice cleaning their teeth with their tongue; prompt them to make sure the teeth feel slick after meals. You can get your teeth about 80 percent clean with your tongue. Toothbrushing and flossing removes the food particles and plaque remaining after your tongue sweep.

Are all sweets equally bad for the teeth?

No: M&Ms are actually a dentist’s favorite candy because they melt! Ice cream also has a fast clearance off the teeth. Stay away from sticky and sour candies, like gummies -- including gummy vitamins. Go for chalky, dissolvable, chewable vitamins.

The second most common tooth disease after cavities is acid erosion directly from food; those sour candies, fruit rollups, gummies, Skittles and Starbursts are burning holes in the teeth. For the same reason, don’t drink soda -- it’s extremely acidic. Likewise, avoid juice or limit it to four ounces a day for children under eight.

When should orthodontic care start, and what role does the dentist play?

Pediatric dentists are looking at orthodontics from day one, but definitely by age seven, a child should have an orthodontic screening. Braces are now used for a lot more things -- protrusive teeth need treating not just for looks, but to prevent breakage or trauma. A seven- or eight-year-old, for example, may only need a few braces for a year. A small movement here or there may prevent bigger problems when they’re 10 or 12.

How often should you change toothbrushes?

At least every three months or when the color strip on the bristles fades. To help keep bacteria in check, run the toothbrush under hot water or pour mouthwash over it -- and any time you’ve been sick, especially after strep throat, throw the brush away and get a new one.

How important are baby teeth? Do I really need to worry much about cavities before my kids get their permanent teeth?

Baby teeth are much thinner and therefore more cavity-prone. When neglected, decay can quickly lead to an abscess, which is very painful. If baby teeth have to be pulled, that predisposes permanent teeth to becoming crowded because you’re losing that placeholder for the adult teeth.

And remember, many children have their baby teeth until age 12. A healthy smile is key to their self-esteem. With proper dental care and good habits, kids can make it to age 100 fit and healthy and cavity-free. I just saw one of my patients who is in college now and he has never had a cavity. That’s my wish for all my patients; I would love never to drill another cavity.