What a pediatrician needs to know about teeth in children: caries, fluorosis, basic care protocols: A review

Cover Page

Cite item

Full Text

Abstract

Caries is one of the most common chronic diseases in children. The unmet need for dental care of baby teeth is high and has an adverse effect on the growth, sleep, nutrition, and quality of life of the child and their family. It is clinically proven that fluoride-containing toothpastes prevent caries and contribute to its control. The anti-caries efficacy of these products is determined by three key factors: fluoride concentration, frequency of hygiene procedures, and post-brushing procedures, including the use of mouthwash upon completion. In the event of improper use of such pastes (ingestion and excessive use), there is a risk of dental fluorosis. Proper use of fluoride-containing oral hygiene products can increase preventive efficacy and minimize the risk of fluorosis. This review systematizes the evidence supporting the routine use of fluoride-containing toothpaste to maximize prophylactic benefits while reducing associated risks. In accordance with the amendments to the Order “On the Procedure for Preventive Medical Examinations of Minors” of the Ministry of Health of Russia dated August 10, 2017 No. 514н, which come into force on September 1, 2025, dental examinations must be carried out annually, starting from the age of 12 months; therefore, the pediatrician needs to participate in the fostering the proper attitudes and practices in the child’s oral care, local fluoride application and limiting sugar consumption.

Full Text

Restricted Access

About the authors

Irina N. Zakharova

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: zakharova-rmapo@yandex.ru
ORCID iD: 0000-0003-4200-4598

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Yana V. Orobinskaya

Russian Medical Academy of Continuous Professional Education; Khimki Clinical Hospital

Email: zakharova-rmapo@yandex.ru
ORCID iD: 0009-0005-2121-4010

Assistant

Russian Federation, Moscow; Khimki

References

  1. Morris AL, Tadi P. Anatomy, Head and Neck, Teeth. 2023. StatPearls. Treasure Island (FL): StatPearls Publishing, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557543/ Accessed: 14.07.2025.
  2. Hu JC, Simmer JP. Developmental biology and genetics of dental malformations. Orthod Craniofac Res. 2007;10(2):45-52. doi: 10.1111/j.1601-6343.2007.00384.x
  3. Gil-Bona A, Bidlack FB. Tooth Enamel and its Dynamic Protein Matrix. Int J Mol Sci. 2020;21(12):4458. doi: 10.3390/ijms21124458
  4. Ntani G, Day PF, Baird J, et al; Southampton Women’s Survey Study Group. Maternal and early life factors of tooth emergence patterns and number of teeth at 1 and 2 years of age. J Dev Orig Health Dis. 2015;6(4):299-307. doi: 10.1017/S2040174415001130
  5. Дроботько Л.Н., Зуева Т.Е. Прорезывание временных зубов у детей. Медицинский Совет. 2022;(12):21-7 [Drobotko LN, Zueva TE. Eruption of temporary teeth in children. Medical Council. 2022;(12):21-7 (in Russian)]. doi: 10.21518/2079-701X-2022-16-12-21-27
  6. Hovorakova M, Lesot H, Peterka M, Peterkova R. Early development of the human dentition revisited. J Anat. 2018;233(2):135-45. doi: 10.1111/joa.12825
  7. McKinney R, Olmo H. Developmental Disturbances of the Teeth, Anomalies of Structure. 2023;7. Available at: https://www.ncbi.nlm.nih.gov/books/NBK574516/ Accessed: 14.07.2025.
  8. Henry G. Anatomy of the Human Body. New York City: Lea & Febiger, 1918. Available at: http://www. bartleby. com. Accessed: 14.07.2025.
  9. Kreiborg S, Jensen BL. Tooth formation and eruption - lessons learnt from cleidocranial dysplasia. Eur J Oral Sci. 2018;126(Suppl. 1):72-80. doi: 10.1111/eos.12418
  10. Memarpour M, Soltanimehr E, Eskandarian T. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies. BMC Oral Health. 2015;15:88. doi: 10.1186/s12903-015-0070-2
  11. Заплатников А.Л., Касьянова А.Н., Майкова И.Д. Синдром прорезывания зубов у младенцев: новый взгляд на старую проблему. РМЖ. 2018;5(II):68-71. Режим доступа: https://www.rmj.ru/articles/pediatriya/Sindrom_prorezyvaniya_zubov_u_mladencev_novyy_vzglyad_na_staruyu_problemu/ Ссылка активна на 14.07.2025 [Zaplatnikov AL, Kasianova AN, Maikova ID. Sindrom prorezyvaniia zubov u mladentsev: novyi vzgliad na staruiu problemu. RMZh. 2018;5(II):68-71. Available at: https://www.rmj.ru/articles/pediatriya/Sindrom_prorezyvaniya_zubov_u_mladencev_novyy_vzglyad_na_staruyu_problemu/ Accessed: 14.07.2025 (in Russian)].
  12. Consolini DM. Teething. MCD MANUAL Professional Version. Available at: https://www.msdmanuals.com/professional/pediatrics/care-of-newborns-and-infants/teething. Accessed: 16.08.2025.
  13. American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on early childhood caries (ECC): unique challenges and treatment options. Pediatr Dent. 2005-2006;27(7 Suppl.):34-5.
  14. Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012;102(9):1729-34. doi: 10.2105/AJPH.2011.300478
  15. Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: The human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140(6):650-7. doi: 10.14219/jada.archive.2009.0250
  16. Nanci A. Ten Cate’s oral histology: development, structure, and function (9th ed.). Elsevier, 2018.
  17. Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent. 2019;29(3):384-6. doi: 10.1111/ipd.12490
  18. Manchanda S, Sardana D, Peng S, et al. Is Mutans Streptococci count a risk predictor of Early Childhood Caries? A systematic review and meta-analysis. BMC Oral Health. 2023;23(1):648. doi: 10.1186/s12903-023-03346-8
  19. Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies. Pediatr Dent. 2019;41(2):95-112.
  20. Van Houte J, Gibbs G, Butera C. Oral flora of children with „nursing bottle caries“. J Dent Res. 1982;61(2):382-5. doi: 10.1177/00220345820610020201
  21. Parisotto TM, Steiner-Oliveira C, Silva CM, et al. Early childhood caries and mutans streptococci: a systematic review. Oral Health Prev Dent. 2010;8(1):59-70.
  22. Kim HE, Liu Y, Dhall A, et al. Synergism of Streptococcus mutans and Candida albicans Reinforces Biofilm Maturation and Acidogenicity in Saliva: An In Vitro Study. Front Cell Infect Microbiol. 2021;10:623980. doi: 10.3389/fcimb.2020.623980
  23. Wan AK, Seow WK, Purdie DM, et al. A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. J Dent Res. 2003;82(7):504-8. doi: 10.1177/154405910308200703
  24. Bowen WH, Lawrence RA. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics. 2005;116(4):921-6. doi: 10.1542/peds.2004-462
  25. Holgerson PL, Vestman NR, Claesson R, et al. Oral microbial profile discriminates breast-fed from formula-fed infants. J Pediatr Gastroenterol Nutr. 2013;56(2):127-36. doi: 10.1097/MPG.0b013e31826f2bc6
  26. Abanto J, Maruyama JM, Pinheiro E, et al; MINA-Brazil Study Group. Prolonged breastfeeding, sugar consumption and dental caries at 2 years of age: A birth cohort study. Community Dent Oral Epidemiol. 2023;51(3):575-82. doi: 10.1111/cdoe.12813
  27. Branger B, Camelot F, Droz D, et al. Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention. Arch Pediatr. 2019;26(8):497-503. doi: 10.1016/j.arcped.2019.10.004
  28. Alexaki F, Kostopoulou M, Koleventi K, Lygidakis NN. Does breastfeeding increase the risk of early childhood caries (ECC)? A systematic review. Eur Arch Paediatr Dent. 2025;26(4):645-56. doi: 10.1007/s40368-025-01051-4
  29. Echeverria MS, Schuch HS, Cenci MS, et al. Early Sugar Introduction Associated with Early Childhood Caries Occurrence. Caries Res. 2023;57(2):152-8. doi: 10.1159/000529210
  30. Moynihan P, Tanner LM, Holmes RD, et al. Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries. JDR Clin Trans Res. 2019;4(3):202-16. doi: 10.1177/2380084418824262
  31. Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3(3):CD007868. doi: 10.1002/14651858.CD007868.pub3
  32. Atia GS, May J. Dental fluorosis in the paediatric patient. Dent Update. 2013;40(10):836-9. doi: 10.12968/denu.2013.40.10.836
  33. Gavila P, Ajrithirong P, Chumnanprai S, et al. Salivary proteomic signatures in severe dental fluorosis. Sci Rep. 2024;14(1):18372. doi: 10.1038/s41598-024-69409-0
  34. Боринский Ю.Н., Кушнир С.М., Давыдов Б.Н., Боринская Е.Ю. Риск и профилактика флюороза у детей раннего возраста при разных видах вскармливания. Российский вестник перинатологии и педиатрии. 2011;56(5):11-4. Режим доступа: https://cyberleninka.ru/article/n/risk-i-profilaktika-flyuoroza-u-detey-rannego-vozrasta-pri-raznyh-vidah-vskarmlivaniya. Ссылка активна на 14.07.2025 [Borinsky YuN, Kushnir SM, Davydov BN, Borinskaya EYu. Risk and prevention of fluorosis in infants during different types of feeding. Ros Vestn Perinatol Pediat. 2011;56(5):11-4. Available at: https://cyberleninka.ru/article/n/risk-i-profilaktika-flyuoroza-u-detey-rannego-vozrasta-pri-raznyh-vidah-vskarmlivaniya. Accessed: 14.07.2025 (in Russian)].
  35. Nazzal H, Duggal MS, Kowash MB, et al. Comparison of residual salivary fluoride retention using amine fluoride toothpastes in caries-free and caries-prone children. Eur Arch Paediatr Dent. 2016;17(3):165-9. doi: 10.1007/s40368-015-0220-x
  36. Kang BH, Park SN, Sohng KY, Moon JS. Effect of a tooth-brushing education program on oral health of preschool children. J Korean Acad Nurs. 2008;38(6): 914-22 (in Korean). doi: 10.4040/jkan.2008.38.6.914
  37. Toumba KJ, Twetman S, Splieth C, et al. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent. 2019;20(6):507-16. doi: 10.1007/s40368-019-00464-2
  38. Kanagaratnam S, Schluter PJ. An update of the evidence on factors that influence the impact of fluoride toothpaste on dental caries in New Zealand. NZ Dental Journal. 2022;118:85-94. Available at: https://assets.nzda.org.nz/files/Archives/NZDJ_Articles/2022/September_2022/An_update_of_tht_evidence_on_factors_that_influence_the_impact_of_fluoride_toothpaste_on_dental_caries_in_New_Zealand.pdf. Accessed: 14.07.2025.
  39. Prevention and Management of Dental Caries in Children. Available at: https://www.sdcep.org.uk/published-guidance/caries-in-children/ Accessed: 16.08.2025.
  40. Леонтьев В.К., Маслак Е.Е., Авраамова О.Г., Шевченко О.В. Итоги совещания экспертов «Фториды для профилактики, лечения кариеса и кислотной эрозии. Новые продукты бренда Sensodyne». Институт стоматологии. 2024;(3):64-6 [Leontiev VK, Maslak EE, Avraamova OG, Shevchenko OV. The results of expert consultations „Fluorides for the prevention and treatment of caries and acid erosion. New Sensodyne brand products“. Dental Institute. 2024;(3):64-6 (in Russian)].
  41. Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8-18. doi: 10.1177/0022034513508954
  42. Приказ Минздрава России от 10 августа 2017 г. №514н о порядке проведения профилактических медицинских осмотров несовершеннолетних. Режим доступа: https://normativ.kontur.ru/document?moduleId=1&documentId=500364. Ссылка активна на 08.08.2025 [Prikaz Minzdrava Rossii ot 10 avgusta 2017 g. № 514n o poriadke provedeniia profilakticheskikh meditsinskikh osmotrov nesovershennoletnikh. Available at: https://normativ.kontur.ru/document?moduleId=1&documen tId=500364. Accessed: 08.08.2025 (in Russian)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Front view of the skull. The child’s age is 6.5 years [8]. The first permanent molars of the mandible were completely erupted (~ 6 years), and the central incisors of the mandible were partially erupted (~ 6–6.5 years). Mineralization of the solid tissues of the permanent second molars in the enamel area is incomplete.

Download (131KB)
Indexing metadata
3. Fig. 2. Timing of baby teeth eruption.

Download (71KB)
Indexing metadata
4. Fig. 3. Participants in the group with fluorosis in study (a, c, e). The appearance of the teeth includes white opaque spots, areas of staining ranging from yellow to brown, and an uneven surface with pits. Participants with healthy teeth (b, d, f). The appearance of the teeth includes a smooth, shiny, pale, creamy-white, and translucent surface [33].

Download (188KB)
Indexing metadata

Copyright (c) 2025 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 74329 от 19.11.2018 г.