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first with a damp cloth and eventually with a small toothbrush. Children should be seen by a dentist by their first birthday. If a dentist believes that a child is susceptible to tooth decay at this age, he or she may apply fluoride varnish to strengthen the enamel. Newly Erupted Adult Molars At around age 6 children begin getting their first permanent molars. The best preventive care at this time, in addition to regular dental checkups, is the application of sealants, which seal out decay-causing bacteria. It’s a good idea to repeat this preventive measure when the second permanent molars erupt around 12 years of age. Third Molars Eruption This is the last stage of the tooth lifecycle. If there is not enough room for “wisdom teeth” within a child’s mouth, they may crowd out earlier teeth or become impacted, which would require surgical removal. A dentist can advise a patient on whether there is sufficient room for these teeth or if they should be removed. Teeth are meant to last a lifetime. It is equally important to maintain good periodontal (gum) health to be able to support these teeth. Brushing twice a day with a fluoride toothpaste, daily flossing, drinking fluoridated water (or using appropriate fluoride supplements), eating a healthy diet and regular dental visits will make all the difference. Copyright ©2013 American Dental Association 10 Action for Dental Health: Bringing Disease Prevention into Communities can adversely affect dental health if eaten immoderately or without brushing. Tomatoes and citrus fruits contain acids that can harm enamel. Fruit juices, widely considered a healthy alternative drink, can have just as much sugar as soda. Dried fruits can stick to teeth, prolonging the damage their natural acids can inflict. A lack of certain nutrients also can make it more difficult for tissues in the mouth to resist infection. The ADA promotes a diet that is low in added sugar. The Association is lobbying Congress to reauthorize the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) with its nutrition education and obesity prevention grant program (SNAP-Ed) intact. The ADA also has been working with the USDA to update the nutrition standards for foods sold in schools. The most recent proposal would inherently prohibit sugar-added soft drinks and sport drinks from being sold in elementary and middle schools, and restrict their availability in high schools. School-Based Screenings Twelve states (as well as some individual school districts) require that parents show proof that their children have received basic dental exams or assessments before enrolling in public schools. (In most of those that do, there is no penalty for noncompliance.) The goal is to ensure that the dental status of incoming students is at least determined and, optimally, that children identified as needing treatment can receive it. These requirements can help catch oral disease at a point when treatment can save teeth. ADA policy encourages state dental societies to seek legislation requiring these screenings. The American Academy of Pediatric Dentistry also supports school-entry dental screenings. Many dentists consider these assessments to be the bedrock of preventive and early restorative care for children, but others remain skeptical about school-based screening requirements unless they are linked to available treatment. One former state dental director refers to them as “supervised neglect,” adding, “If you’re not offering treatment with [a screening] … then it’s just going to be a piece of paper telling parents what they already know. But if you have some sort of program that gets these kids treatment, or tells parents how to get treatment, then a screening requirement will mean something.” New York State schools are required to give parents a list of dentists who are willing to provide free or reduced-cost care, a measure that while not always successful, at least attempts to connect chronically underserved children with dental homes. The ADA defines a “dental home” as the ongoing relationship between the dentist, who is the primary dental care provider, and the patient, which includes comprehensive oral health care beginning no later than age one. Establishing dental homes for children, thus providing them with a treating dentist of record and a continuum of care, is critical to maintaining good oral health throughout childhood. Ultimately, every child should have a dental home, which will go a long way toward achieving a goal shared by the ADA’s Give Kids A Smile® program and the new Action for Dental Health campaign: eliminating cavities in U.S. five year olds by 2020. Maryland has so far taken the middle ground. “When we do the screening in schools we want to have a plan in place so that when we find that the children have some dental disease