Mouth Care



The mouth serves as the entrance for a baby’s life-sustaining nourishment and the exit for his cries and laughter, and later in life, for his speech. It is bordered by the mandible (lower jawbone) and the maxilla (upper jawbone). Structures contained within the mouth include the tongue, soft palate, hart palate (roof of the mouth), tonsils, and adenoids. At birth, the muscles surrounding the mouth are remarkably strong, allowing babies to suck firmly enough to acquire adequate nutrition allowing entry for food and often other objects.

Mouth Infections

As the point of entry for food and often other objects (none of which are sterile), the mouth is continually exposed to a variety of bacteria, viruses, and other microscopic organisms. In fact, the mouth is continuously colonized by enormous numbers of bacteria, but as long as the tissues (especially the gums, teeth, and tonsils) are healthy, these bacteria normally do not cause problems. A significant exception is a human bite (or accidental puncture by a tooth), which creates a contaminated wound if the skin is broken. In such cases, the one who was bitten should be evaluated by a physician to ensure that the wound is properly cleansed. Antibiotics are usually prescribed in such cases.



Bad Breath

Bad breath can occur in children of all ages but is more common in older children with a full set of teeth. If your child has bad breath, make sure he is brushing and flossing his teeth often and regularly. Bad breath can be a sign of infection in the throat, tonsils, adenoids, gums, or sinuses. If brushing alone doesn’t help, a trip to the doctor’s and/or dentist’s office will probably be necessary to find and treat the cause.

Candida

Known commonly as thrush, this infection is caused by the common yeast Candida albicans. It is seen most often in newborns. Thrush appears as a white film over the tongue, inner surfaces of the cheeks, or roof of the mouth. It may be confused with milk coating, but unlike thrush, milk can be easily dabbed off with a cotton swab. Thrush is not harmful, although candida transferred to a mother’s breast may cause a local eruption of her skin.



Thrush can be treated with an antifungal solution such as nystatin, which your physician will prescribe. You can use an ordinary cotton swab or a device known as a toothette (which looks like a lollipop stick with a small sponge on the end) to apply the medication. Dip the toothette in the solution and gently scrub the affected areas inside the mouth. If you don’t scrub, the thrush will still resolve with repeated applications of the medicine, but the process may take longer. Be patient, because even with diligent efforts the infection might not disappear for weeks. (Don’t worry if your baby swallows some of the nystatin because it is not harmful.)

Some oral candida infections don’t clear with nystatin, or they return in spite of repeated treatments. An alternative treatment is one percent gentian violet, a dye that can be purchased from the pharmacist without prescription. Gentian violet is applied with a cotton swab to the inside of your baby’s cheeks twice daily for three days. Though harmless, it can stain everything in sight a vivid purple unless you are very careful with the swabs.



Canker Sores

Also known as aphthous ulcers, these small, painful sores appear inside the mouth, either singly or a few at a time. They may occur on the gums, inner surfaces of lips or cheeks, tongue, palate, and in the throat. They have a well-defined, depressed whitish center surrounded by redness. They may arise during an acute illness, although no specific virus or bacteria is known to cause them, or they may form in an area that has been traumatized (for example, where the inner surface of a lip or cheek has been accidentally bitten). They tend to recur throughout the lifetime of susceptible individuals.

The sores are usually preceded by burning, itching, or pain for a day or so before they actually appear in the mouth. They can be painful enough to interfere with eating; avoid foods that are hot, spicy, and acidic (such as citrus fruits and tomatoes). Cold foods, particularly liquids, are usually better tolerated.



There is no specific cure for canker sores, which will eventually disappear without treatment in 10 to 14 days. Over-the-counter analgesics such as acetaminophen (Tylenol and others) and ibuprofen (Children’s Motrin, Children’s Advil, and others) may relieve some of the discomfort. Check with your child’s physician about topical medications. If the sores persist for more than 15 days, the child should be seen by a physician.

Hand-Foot-and-Mouth Disease

This annoying but self-limited illness is caused by certain strains of a virus known as coxsackie. It affects infants, toddlers, and preschool children, most commonly during summer and fall, although it may be seen throughout the year. After a short incubation period of three to six days, small sores appear on the tongue and sides of the mouth. Small blisters may also develop on the palms of the hands, the soles of the feet, and occasionally the buttocks. Discomfort from the mouth, tongue, and throat is usually more pronounced than that coming from the hands and feet. Fever may accompany this illness.



Hand-foot-and-mouth disease will clear up on its own in five to seven days. Creams, ointments, or any other topical medications will not assist in the healing process. Antibiotics are not needed and should not be used unless a secondary infection is present. It is important to keep your child hydrated and nourished. A soft bland diet is best until the ulcers clear up. Citrus and tomato juice might cause stinging in the moth. Analgesic medications such as acetaminophen or ibuprotein may be used for pain.

Because this infection can be transmitted from one person to another through oral secretions, your child should stay home from day care or school until the illness has run its course.

Mouth Problems

Newborns can be born with a condition historically referred to as tongue-tie, in which the frenulum, the piece of tissue connecting the tongue to the floor of the mouth extends too far forward. Parents may notice a dimple on the tip of the tongue as the child grows. Doctors used to snip the frenulum at birth, but this is an uncommon procedure now. Most children with this condition suffer no significant consequences. However, if tongue-tie seems to cause feeding or speech difficulties, you should talk to your child’s physician about treatment options.

About one in 1,000 children is born with cleft lip or cleft palate (or both), a defect in the development of the central part of the lip or palate (roof of the mouth). The cause of this condition is unknown, but it occurs during weeks seven to twelve of pregnancy when the middle of the mouth fails to form properly. It is seen more commonly among Native American and Asian infants and least frequently in African-Americans.



Cleft lip and palate are not life-threatening conditions, although their appearance may provoke anxiety or other negative responses in adults or older siblings. The bonding process between parent and child may be impaired as a result, but it is very important that these infants receive all the cuddling, cooing, and other signs of affection that all babies need to thrive. (It is equally important not to overcompensate by becoming overly attentive to the child with the defect, and in so doing, deprive other children at home of time and attention they need.) While some infants with this problem are able to breast-feed easily, others have sucking difficulty and require a specialized soft nipple. Depending upon the extent of the problem and the timing of surgical repair, speech development and socialization may be affected.

Because of the breadth of problems associated with cleft lip and palate, caring for an infant with this condition usually requires an experienced medical team consisting of a plastic surgeon, ENT specialist, pediatrician, dentist, orthodontist, and speech therapist. A psychologist and/or social worker can help the family work through emotional and practical issues, both before and after the corrective process. The good news about cleft lip and palate problems is that they are surgically treatable, a process that may begin as early as nine months or as late as eighteen months.

Future siblings of a child with cleft lip or palate are in higher risk of being affected. If the parents are normal and no other siblings have it, the risk of cleft lip or palate occurring again is about 2 percent. If either parent or sibling is affected, the future risk could be as high as 7 percent, and if both a parent and a sibling are infected, the risk is 14 to 17 percent. Children with this condition may have associated problems such as congenital heart disease and spinal abnormalities. If your child has a cleft palate, don’t be alarmed if your pediatrician orders extra tests to ensure that he does not have other medical conditions.