By the time they are five years old, over 30 per cent of children in the UK have dental decay. In fewer than 10 per cent has the decay been treated and the tooth restored. When many teeth are decayed they may be extracted under local or general anaesthetic.
In some parts of the UK dental caries is particularly common. In Scotland, for instance, 14 per cent of children have had a tooth extracted by the age of five5 and dental surgery is the commonest reason for general anaesthesia.
Causes and risk factors for dental caries There are many risk factors for developing dental caries. There are SIX ways to prevent dental decay:
- Remove Dental Plaque. Plaque is the collection of microorganisms (bacteria) and other material around the teeth. Plaque can be removed by efficient tooth brushing
- Strengthen the Enamel. The enamel that coats the teeth becomes softened. It can be protected by regular tooth brushing and strengthened by using fluoride toothpaste.
- Limit Sugar Intake. The sugars in sweet foods and sugary drinks are metabolised to acids by the bacteria in dental plaque. These acids cause demineralisation or softening of the enamel. This process can be prevented by reducing the frequency of sugar intake to a maximum of four times a day.
- Avoid Food and Sweet Drinks at Night. Saliva in the mouth helps protect against tooth decay. During sleep salivary flow and swallowing decline, making clearance of material in the mouth less frequent. Food and drinks other than water should not be given to toddlers if they wake during the night.
- Avoid Prolonged Bottle-Feeding. Offer all drinks from cups not bottles. Prolonged bottle-feeding with sugary drinks or milk, particularly when a toddler is allowed to fall asleep with a bottle in his or her mouth, can contribute to dental decay and should be strongly discouraged.
- Avoid Grazing on Food and Drink. Frequent eating and drinking is associated with a build-up of plaque on toddler’s teeth. Food and drinks other than water should be restricted to three meals and two to three healthy snacks each day. Grazing on food and drinks should be strongly discouraged
Treatment of dental decay in toddlers is difficult because of their limited understanding and attention span. It is far easier to prevent decay than to treat it.
Parents should be advised to start tooth brushing as soon as their child’s first teeth erupt. They should use a small (child-size) toothbrush with soft bristles. Toothbrushes should be replaced every three months or sooner if the bristles splay. A child should go to bed having just had his or her teeth brushed. No drinks or food should be given after brushing.
Tooth brushing should be part of the daily routine to establish a healthy future lifestyle. Teeth should be brushed twice daily – in the morning and last thing at night. Fluoride toothpaste should be put onto a dry brush:
- Up to the age of three: a smear of toothpaste containing 1000ppm of fluoride.
- Over the age of three: a pea sized amount of toothpaste containing 1350-1500ppm or fluoride.
A dry brush is more efficient than a wet one, as the bristles are harder and there is less chance of bacteria accumulating. Brushing Babies Teeth One of the easiest ways to brush a toddler’s teeth is from behind. Comfortable and safe positions for the child are on the parents’ knee, sitting on a changing mat, in a baby chair / high chair or sitting in a pram or buggy.
Children should not be allowed to run around with a toothbrush in the mouth because of the risk of injury if they fall.
Note: Soothers, Pacifiers, Dummies If the toddler uses these, the parents should be advised to:
- Use an orthodontic soother / pacifier / dummy.
- Never dip it in anything sweet, for example, jam or honey.
The permanent teeth From around 6 to 13 years of age, the primary teeth are successively replaced by the next set of teeth, the 28 permanent or adult teeth. The first permanent molar emerges right behind the last milk tooth at the back of the mouth. It can be difficult to detect and clean, and the biting surface is irregular and extra sensitive to caries, so it is important to brush properly.
Parents should help the child to brush until the age of 10. A small child doesn’t have the manual skills to brush properly and cannot see the consequences of careless brushing. An older child may have to brush under your supervision.
Try to create a positive atmosphere around the brushing routine. It does not necessarily need to take place in the bathroom. You could just as well brush in bed or on the changing table (let the child lie on its back with the head nearest to you).
A little older child may sit in your lap, leaning the head on your arm. While brushing, use your finger to hold out the cheek to see and reach better.
When brushing is difficult All children sometimes refuse to brush their teeth. Try not to give up. Perhaps it is better to brush one hour after supper, when the child is not so tired, instead of waiting until bed time. Use your imagination – make up a tooth story or song, or fight decay (caries) with the toothbrush.
Always brush before bedtime Let the teeth rest between mealtimes. If your child takes medicine orally, always rinse with water afterwards. A good rule is to always go to bed with clean teeth. If the child often falls asleep before you get to brush, brush while the child is sleeping.
- Choose a toothbrush with a small brush head and gentle filaments.
- The handle should fit a small child’s hand, but also the adult helping the child to brush.
- Apply a small amount of fluoride toothpaste, the size of the child’s little finger nail, to the toothbrush.
- Brush the inside, the outside and biting surfaces of the teeth.
- Always brush in the same order, to make sure no tooth surface is forgotten.
- Place the bristles of the toothbrush along the teeth and gum line in a 45° angle.
- Brush with a slight pressure using small, circular movements.
- It is important to clean the gum line area, where bacteria easily build up.
Are plaque-‐disclosing tablets helpful? Plaque-‐disclosing tablets work by dyeing plaque either blue or red and can be very useful at showing you which areas of your teeth you’re not cleaning properly. As the staining can last for some hours, it’s best to use these tablets at bedtime or when you are not expecting visitors.