Q: My child brushes his teeth every day. We just went to the dentist and he has 5 cavities. How can this be? We use Tom’s of Maine toothpaste. I am a big believer in all natural products.

A: As a parent we always try to do the best thing for our children’s health. It sounds like you have been diligent in caring for your child’s teeth. Teaching him to brush every day and visiting the dentist for regular checkups is exactly what you should be doing. It is so frustrating when you do things right and your child still gets cavities. You are not alone in this. I frequently see parents who are in this situation. Let’s look at some reasons why your child is still getting cavities in spite of his and your efforts.

Firstly, let me say that I do not usually recommend toothpaste brands. I do however have to say that I see problems when children do not use a toothpaste containing fluoride (like Tom’s). I have written this column several times about the safety and effectiveness of fluoride when used properly. As long as a child can rinse and spit, there is no reason why he will get too much fluoride from toothpaste. Especially now that you know that your child is prone to cavities, I would switch to a fluoride-containing brand.

Secondly I would recommend that you choose smart snacks. Kids love sticky gummy fruit snacks like gummy bears , fruit rollups and raisins, but these sticky foods are big cavity producers! Likewise sugary drinks like soda and orange juice have high sugar content as well as acid, which helps cavities, form. So what is a smart snack? Cut up veggies and dip, cheese that is not artificial, and popcorn are all smart snacks. You can find lists of good snack ideas on the Internet.

Lastly, timing is important. Brushing after breakfast is a great way to start the day. Teeth are clean before school starts and usually stay clean until lunch. If you can do a quick brush after other meals it is great, but sometimes just not practical. Before bed is the most important time to thoroughly clean your teeth. Depending on the child’s age this may mean brushing for them, checking their brushing, or monitoring their brushing. The same goes for flossing. We all spend lots of time sleeping, so having clean teeth during that time will help keep them free of decay.

Of course regular dental cleanings and exams will provide education and help to spot dental problems early. It’s a great idea to have an open conversation with your dentist and hygienist about this subject.