Q: What can I do to care for my children’s teeth and protect them from future dental problems?

A: Teeth tell a story, the story of hygiene, nutrition, and overall health. I learned this when one of my daughters visited the dentist for the first time and he asked if she had been ill during her first year of life. I knew little of the year she spent in an orphanage, and I was amazed that by looking at her teeth he could tell that she had been sick.

Dental caries, or cavities, are surprisingly prevalent in American children. More than 40 percent of kindergarten-age children have tooth decay, a condition that can cause pain, infection, and dangerous swelling. Children living in poverty are at increased risk of dental decay, as are those who receive inadequate nutrition or eat large amounts of sugary or sticky foods.

What does this mean for children who join families through adoption or foster care? Whether you adopt a newborn or an older child, certain practices contribute to tooth decay and should be avoided—such as putting children to bed with a bottle of milk. Besides the risk of choking, this practice bathes the teeth in milk, which contains sugars that feed decay-causing bacteria. To prevent decay, infants who take a bottle to bed should be given only water. (Likewise for toddlers who walk around with sipper cups.) But if a bottle of milk is part of your child’s bedtime routine, gently wipe his gums and teeth before he falls asleep.

Milk and juices should be given with meals—the food and saliva help wash away sugars—and the teeth should be cleaned afterward. Fruit juices should be limited to four ounces for children under age 5, and sugared beverages kept to a minimum. Carbonated drinks should never be given before 30 months of age, if at all. It’s also important to limit foods that leave sugar residue on the teeth. Candy, raisins, peanut butter, and other sticky and gummy foods are major culprits. If your child eats these foods, brush her teeth soon after.

Here are other things you can do to promote good dental health:

• Begin brushing your child’s teeth when the first tooth appears and start flossing when there are several teeth together. For young children, stick with water or non-fluoride cleansers. Many dentists recommend delaying the use of fluoride toothpaste until the child can rinse and spit. Even then, use very small amounts—about the size of a match head—to prevent the dental staining that results from excessive fluoride intake.
• Take your child for dental check-ups, beginning around the first birthday. Children at risk for dental caries should be seen no later than six months after the first tooth erupts. At-risk children are those who have obvious dental decay or staining; children who sleep with a bottle or breast-feed at night; and children who previously lived in poverty or had poor nutrition. If you adopt an older child, get a dental evaluation as soon as possible.
• Ask your pediatrician or dentist whether your child needs fluoride supplements. Fluoridated water strengthens tooth enamel and helps prevent decay.
• Be patient about thumb-sucking or pacifier use. For children in transition to a new home, these habits may be hard to break. As long as they’re given up before the child gets permanent teeth, there are usually no long-term effects. If your child needs another security item, offer a blanket or teddy bear.

With regular dental care, aggressive brushing and flossing, and limited use of sweets, your child can sport a healthy smile.