Children’s Dentistry

Keeping children’s teeth healthy is an extremely important part of our parenting role and can often be challenging to get right.

There are 4 basic principles to bare in mind when thinking about protecting children’s teeth:

1. Plaque is a build-up of bacteria on teeth that produce acid and causes tooth decay.
2. Sugar ‘feeds’ the bacteria causing them to produce more acid.
3. Fluoride in toothpaste changes the structure of enamel to make it stronger.
4. Fissure sealants help prevent decay in permeant molar teeth that erupt from 6 years old.

So no plaque= no tooth decay and no sugar = no tooth decay. It’s obviously impossible to cut out all sugar in the diet or eliminate all plaque but keeping sugar consumption low and plaque levels down by using a fluoride toothpaste with a good tooth brushing technique should eliminate any tooth decay. The main cause of toothache in children is tooth decay and can be very upsetting for both children and parents.

Top tips for preventing tooth decay

Diet

• Every time you eat or drink anything sugary, your teeth are under acid attack for up to one hour.
• The best time to eat sugary foods is mealtimes; rest teeth between to let them heal.
• Saturday sweets is a great way to limit sweet intake.
• Sugary foods are best eaten all at once and not saved through the day; the quantity of sugar is not as important as the time it is in the mouth for.
• Acidic foods and drinks can be just as harmful. The acid ‘erodes’ or dissolves the enamel, exposing the dentine underneath. This can make teeth sensitive and unsightly.
• Snacks are always a difficult one: try to stick to cheese, vegetables and fruit although try to limit how much dried fruit you give as it is high in sugar. Cheese on crackers, carrot batons, breadsticks, cucumber sticks, marmite sandwiches are all good examples that aren’t high in sugar.
• Try and avoid drinks containing sugars, including fruit juices, between meals. Give children water or milk instead. For babies, don’t add sugar to their drinks, or to foods when you introduce them to solids.
• It is also worth remembering that some processed baby foods contain quite a lot of sugar. Try checking the list of ingredients: the higher up the list sugar is, the more there is in the product. Generally anything ending in ‘ose’ is a sugar, for example: fructose, glucose, lactose or sucrose.
• Check that all medicines are sugar free.

Toothbrushing

• What toothbrush: based on very strong evidence which was done on electric versus manual toothbrushes the huge study strongly showed oscillating rotary electric toothbrushes to be superior at removing plaque Their ‘stages’ range is for ages 3-5 and junior brushes from 6-12. From age 12 an adult rechargeable brush can be used. The heads are specifically designed for children and it is important their dentist shows them how to use them correctly at a check up appointment.
• You tube has some great clips if you type in toothbrushing techniques for children  – great for motivation!

• Cleaning your child’s teeth should be part of their daily hygiene routine. You may find it easier to stand or sit behind your child, cradling their chin in your hand so you can reach their top and bottom teeth more easily.
• When the first teeth start to appear, try using a toothbrush designed for children, with a small smear of fluoride toothpaste.
• It is important to supervise your child’s brushing until they are at least seven.
• Once all the teeth have appeared, use a toothbrush with a small head and soft bristles in small, circular movements and try to concentrate on one section at a time.
• Don’t forget to brush gently behind the teeth and onto the gums.
• Spit out after brushing and do not rinse, so that the fluoride stays on their teeth longer.
• It is especially important to brush before bed. This is because the flow of saliva, which is the mouth’s own cleaning system, slows down during the night and this leaves the mouth more at risk from decay
• Electric toothbrushes are an important subject. All advice you receive from your dentist should be evidence based. A very large and powerful study was done on electric vs manual toothbrushes and the outcome was electric toothbrushes were more effective at reducing plaque. They are suitable from aged 3 upwards.

Fluoride

• Your teeth can get fluoride in a number of different ways, including from toothpaste, specific fluoride applications and perhaps the drinking water in your area. These can all help to prevent tooth decay.
• If you are unsure about how much fluoride you need in your toothpaste, ask your dental team.
• All children up to three years old should use a smear of toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a pea-sized amount of toothpaste that contains 1350ppm to 1500ppm.
• You can check the level of fluoride on the packaging of the toothpaste. Children should be supervised when brushing up to the age of 7. You should make sure that they do not rinse but spit out the toothpaste, and that they don’t swallow any if possible. This way the fluoride stays in the mouth for longer and will be more effective.

Thumbsucking and Dental Trauma

We are often asked if thumb sucking is really that bad. The answer is it depends on how much and how vigorously the child sucks their thumb or finger. This can be assessed at a dental check up. The effect is to push forwards the top teeth and make the arch of the palate deeper. With the top front teeth ‘sticking out’ they are more likely to get hit and damaged. Mouthguards are key in preventing trauma in children sports such as hockey, rugby and karate.

If trauma does occurs your dentist will often be able to fix it very successfully. Some key points should a child’s tooth be broken or knocked out.

• If the tooth is knocked out and is a permanent tooth, try and find the tooth, hold it by the top ’crown’ part and place it in saline or milk. If this is not available place it in the mouth between the cheek and gums. Phone your dentist immediately.
• Milk teeth are not re-implanted so keep them safe for the tooth fairy!
• If the tooth is broken try and find the broken piece and ring your dentist immediately, it may be able to be glued back on. An example from a Gwynne Dental patient is here:

When should I take my child to the dentist?

It is recommended that children should go to the dentist with their parents as soon as possible, just for the visit even if their teeth aren’t looked at. This will let them get used to the noises, smells and surroundings and hopefully a sticker! The earlier these visits start, the more relaxed the children will be. Intervals between check ups will be made according to risk factors contributing to the chances of decay; your child’s oral hygiene and diet and whether they are getting new decay at each visit.

When will my child’s teeth appear?

• First (or ‘baby’ or ‘milk’) teeth usually start to appear when your child is around 6 months old. All 20 baby teeth should appear by the age of 30 months.
• The first permanent ‘adult’ molars (back teeth) will appear at about 6 years, before the first baby teeth start to fall out at about 6 to 7. The permanent ‘adult’ teeth will then replace the ‘baby’ teeth. It is usually the lower front teeth that are lost first, followed by the upper front teeth shortly after. All permanent teeth should be in place by the age of 14, except the ‘wisdom’ teeth. These may appear any time between 18 and 25 years of age.
• All children are different and develop at different rates.