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Toddler teeth: sugar-laden juices and sodas are a recipe for dental disaster, especially for children with special needs as dental hygiene can often be challenging. But did you know that tea drinking can actually help stave off tooth decay and strengthen teeth, increasing the odds of a lifetime of successful dental health?

Tooth decay in children is on the rise in the United States. According to the Centers for Disease Control and Prevention (CDC), tooth decay rose 4 percent in the two-to five-year-old age group in the last four years. These statistics are disturbing to dental professionals because of the ability to prevent approximately 85 percent of tooth decay.

Early childhood decay (ECD) is a phenomenon that is seen in children under the age of five. ECD is caused by the continuous use of the bottle filled with anything but water past the age of 12 months. Milk, formula, juices, sodas, and breast milk in a youngster's bottle put a child at risk for ECD. The most common time a child over the age of one year receives a bottle is before bedtime. This is detrimental to the teeth. Saliva production is reduced during sleep, so the ability of nature to wash the teeth off is diminished. The bedtime beverage sits on the teeth nourishing the bacteria.

As a dentist, I have often found parents to be surprised when they learn of their child's tooth decay. I can only assume that since the child does not have a driver's license or keys to the car, the parent must be bringing the items that cause tooth decay into the house. Perhaps I am wrong. Forgive my sarcasm, but when I have put a 15-month-old under general anesthesia to treat 10 of his 11 teeth for rampant tooth decay, I get a bit upset. I am often told by parents that their child needs the bottle to sleep. In most cases, it is not the child that needs the bottle but rather the parent. Research shows that it takes three days to break a habit with a child. The risk of early childhood decay and general anesthesia on a child is far too great not to suffer through those three days.

The American Academy of Pediatrics recommends children be seen by a dentist by 12 months. The dentist can help educate the parent to prevent tooth decay. It is important to note that if the infant is reliant on the bottle for nutrition, due to a medical condition, past the age of 12 months, it may be necessary to keep the child on the bottle. Please seek your dentist's advice on an oral hygiene protocol.


Early childhood tooth decay increases the risk of more decay later. Such children may develop poor eating habits, speech problems, problems, low self esteem, social problems, low weight, slowed growth, and irritability. Unlike adults, children do not experience tooth pain until the decay has done significant damage. Parents are often unaware the child even has a problem until an abscess presents. Typically, children under the age of five years require general anesthesia for dental treatment. Besides the obvious risks of general anesthesia, costs can escalate to over $6000 to restore the mouth.

In order for a tooth to become decayed, three things must exist: a tooth, bacteria, and sugar. Until a child is two years of age, the bacteria that cause decay are not present in their mouth, unless they have been exposed to the bacteria through a parent or close contact. Yes, decay is contagious, or at least the bacteria that cause decay is contagious. It is easily spread through salivary contact (for example: a kiss, sharing straws, and food). The third factor, sugar, is completely controllable if limited appropriately.

Bacteria that cause tooth decay flourish in an acidic environment. The pH of the mouth is 7.4, which is neutral. Your teeth are content at this pH. Tooth enamel starts to breakdown when the salivary pH drops below 5.5. Every time you have a meal, the pH drops slightly and teeth breakdown. In the hours between meals, the saliva neutralizes and repairs the teeth. This process continues all day.

The pH of soda and juice is between 2.4 and 3.3. It is not uncommon for kids to drink these beverages throughout the day, not just with meals. By doing this, the teeth do not have a chance to repair and decay occurs uninhibited. Soda products have no nutritional value, and the added sugar in these beverages exacerbates the problem. Don't be fooled by diet drinks, they are equally as acidic and can easily break the teeth down.

Tea is the second most consumed beverage in the world, second only to water. Yet, in the United States, tea is consumed less than fruit drinks and sodas. Fruit drinks and sodas are loaded with sugar and provide little to no nutritional value. However, when so many families are leading hectic, activity-filled lifestyles, the "quick fix" beverage in a juice box, bottle, or can is much easier than stopping to brew a cup of tea.

Camomile teas are about as close to a neutral pH as tea can get. Some studies have indicated they are less then .001 from neutral. This beverage would be the least likely to contribute to tooth decay in children. Rooibos teas, which are naturally caffeine free, have a pH around 5.0. Black and green teas are slightly more acidic with a pH ranging from 3.0-7.0. The latter three teas mentioned have a higher chance of causing tooth decay if based on pH alone.

With the exception of herbal tisanes, all tea contains an ingredient that actually strengthens the enamel and makes the teeth more resistant to decay. That ingredient is naturally occurring fluoride, and all real teas have trace elements of this mineral. As teeth naturally repair themselves, the hydroxyapetite crystals that make up the teeth are reinforced with the fluoride ion from the tea, creating a stronger more resistant structure. Green, black, and rooibos teas are also rich in vitamins, minerals, and antioxidants, making them a much better beverage choice for children. To avoid excess caffeine, rooibos and decaffeinated teas are recommended.

The necessity to sweeten tea is at the parent's discretion. Though heavy sugar content in tea is not recommended, light sweetening with sugar does not appear to increase risk of tooth decay. As a comparison, consider that one sugar cube contains 4 grams of sugar. For a cup of tea, one or two should suffice. A cup of soda can have as much as 30 g of sugar. Again, the fluoride in tea and the low acidity make it an ideal choice. For parents who wish to limit sugar content, Xylitol is a safe, artificial sweetener that has actually been proven to rebuild enamel. Not only will you get sweet tea, but also strong teeth.

Tea is not recommended to give to infants under the age of three months. At that young age, nutrition, calories, and fat are vitally important for brain and growth development. By supplementing the infant's diet with tea at this young age, the stomach will be filled with tea, and the child may refuse the milk products. Tea is a beverage that children should be encouraged to consume. The health benefits for body and teeth are numerous and make this beverage a much better choice than more sugary acidic beverages. In the 20 years I have been in the dental field, I have never once diagnosed rampant decay in a child or an adult due to consumption of tea. The ability of a child to learn to like a food or beverage is affected by the way it is presented. Though tea has not gotten the attention it deserves, it can be made a fun treat by adding a sugar cube or a cloud of whipping cream. You might just be surprised ... kids love it.

Recommendations to help children stay free of tooth decay

* Wipe infant teeth and gums with a soft washcloth after meals and at bedtime

* Brush teeth as soon as the first tooth appears

* Do not put a child to sleep with a bottle

* Restrict bottle use after 12 months of age

* Limit sugar consumption

* Limit acidic beverages

* Soda should be consumed at meals only to limit the exposure to acid on the teeth

* First dental visit should happen by age 12 months

* Talk to your pediatrician or dentist about fluoride supplementation

Xylitol aids in the reduction of tooth decay

Xylitol is a natural sweetener found in many fruits and vegetables. Xylitol is a sweetener that has been available in crystalline form since the mid 1970's. Xylitol has similar sweetness to table sugar, with 40 percent less of the caloric intake. Xylitol is pleasant tasting with the added benefit of lacking an aftertaste.

When Xylitol products are consumed or chewed more than two times a day, they have an cariostatic affect on the oral environment. Since dental decay is caused by bacteria, the reduction of bacteria by use of Xylitol results in a decrease of dental decay. Xylitol is the only sweetener to function this way on bacteria.

For a person who is at risk for tooth decay, it is recommended that Xylitol chewing gum, mints, or other confectionaries be used after every meal. Since many chewing gum manufacturers use Xylitol as the primary sweetener, these products are relatively easy to find in local grocery stores . Chewing gum or mints after each meal will also stimulate salivary flow, which aids in washing the teeth clean of bacteria. After several months of use, the amount of tooth decay causing bacteria will decrease, resulting in a reduction in tooth decay. This is especially beneficial for children and adults with special needs, as the decay risk in this population tends to be very high.

Acute Otitis media, more commonly known as "middle ear infection" is caused by bacteria traveling from the back of the throat through the eustachian tube into the ear canal. Since Xylitol acts as a bacteriastatic, the amount of the bacteria in the back of the throat will be reduced. This will result in decreased ear infections.

It is important to note that an infant or toddler may not have the ability to chew or swallow gum or mints. In that case, it would be beneficial to add 1 gram of crystalline form of Xylitol to 3 oz of herbal tea or water. This protocol is not recommended for infants under the age of three months.

For more information about Xylitol, visit

Kristina Wiley, DDS graduated from University of Southern California School of Dentistry in 1993. She received awards of excellence for her work with pediatric and patients and those with special needs while in dental school. Post graduation, she did residency training in Pediatric dentistry at the University of Texas, Houston Medical Center. In 2005, she began Linde Lane, which promotes KIDS TEA to aid in the reduction of tooth decay. She currently has a private, general practice in Dixon, California and is on staff at Northbay Hospital, where she performs dental surgery procedures for patients with special needs under general anesthesia. For questions, please email her at:
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Title Annotation:Diet & nutrition
Author:Wiley, Kristina
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Feb 1, 2008
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