Dental Care For Your Child - Blog Feb '12
This months blog is courtesy of Peter Doherty about the importance of dental care in childhood.
Dental Care For Your Child
A child’s first tooth is a milestone on their journey in life. Unfortunately it can be distressing when this is accompanied by the discomfort of teething. There are numerous terms used to describe the first set of teeth – milk, baby, primary, deciduous – but they all mean the same thing. A child’s first tooth (usually bottom front) typically erupts at around 6 months but anything from birth to a year is within the limits of normal. The remaining teeth appear in pairs up to about 3 years. Some of these teeth will not be replaced until age twelve so looking after them is vital for your child’s wellbeing.
Teething
The process of tooth eruption is often accompanied by teething, which presents as tender and swollen gums just preceding the appearance of the primary teeth. Occasionally the gum overlying a tooth may appear to have a blue tinge or appear bruised and this is known as an eruption cyst. Most resolve by themselves, but a persistent cyst would warrant a visit to your dentist. As teeth erupt it is uncomfortable and many children will experience restlessness, irritability, crying at night and drooling of saliva. They will often bite their lips, fingers or any hard objects to gain relief. The first port of call in dealing with the discomfort of teething would to give your child something to bite on, and cold objects bring the greatest relief. Refrigerated teething rings are best for this, impossible to swallow, reusable and easy to clean. Occasionally parents give their children biscuits or rusks instead and I can’t stress enough what a bad idea this is as they can cause tooth decay. If your child is particularly distressed and further pain relief is required the appropriate dose of Paracetamol suspension (eg Calpol) could be considered. If this is still of limited use the next step would be to try some teething gels containing Lignocaine (eg Bonjela Teething Gel) which help to temporarily numb the affected gum. Something to be avoided with young children is the use of the adult preparation of Bonjela. It contains a substance related to Aspirin which can in very rare circumstances be harmful to your child.
Toothbrushing
Tooth brushing is something which should begin with the eruption of the very first tooth. It is important to start this habit early in life and allows your child to accept it as part of their daily routine. Brushing twice a day is recommended, after breakfast and again last thing before bedtime. Parents often ask me which the best toothpaste to use is, and my reply is that the majority of the beneficial work done during tooth brushing is due to the mechanical removal of plaque (a thin film of decay causing bacteria) and food debris from tooth surfaces. As long as the technique used is good, reaching all tooth surfaces and carried out for two minutes twice a day, then the brand of toothpaste is largely irrelevant. However, when choosing a toothpaste, there are one or two things to watch out for. It is important to ensure that it contains fluoride (which helps fight decay) and that the amount of fluoride is correct for your child’s age. Infants under three years of age should use a thin smear of toothpaste containing at least 1000 ppm (parts per million) fluoride. Children between three and six should use a pea-sized amount of toothpaste containing 1350–1500 ppm fluoride (normal family toothpaste is fine if they like the taste). After brushing, children should spit out any remaining toothpaste but avoid excessive rinsing if possible to retain some of the protective action of the fluoride in the mouth for longer. Supervised or even assisted brushing up to age seven or eight may be required to ensure that the correct technique is followed.
Dietary advice
Diet plays an important role in maintaining the health of your child’s teeth. Sugar found in sweet food and drinks interacts with the bacteria normally present in the mouth to cause tooth decay. Most parents are aware of the usual food and drinks which are implicated in causing decay: chocolate, sweets, biscuits, cakes, fizzy drinks etc. There are a number of other sugar sources which as not as well known or perceived as healthier, but can in fact cause just as many cavities. These include certain breakfast cereals, dried fruit, honey, ketchup, fruit juices, dilute drinks, milkshakes, and flavoured water. Diet fizzy drinks may not contain sugar, but the chemicals which give the drink it’s fizz do cause erosion or wearing down of teeth. There are two ways of reducing the risk of decay from food and drink, the first is to limit the amount of sugar by switching to healthier alternatives, and the second is to limit the number of times sugary food and drink is consumed. If your children insist on eating sweets, they are best confined to directly after mealtimes as a treat. Snacks which are healthier for your children’s teeth include fresh fruit, raw vegetables, cheese, crackers, and plain popcorn. The best drinks to care for teeth are water and milk.
From six months of age children should begin to move from bottle feeding to a feeder cup, and bottles should be stopped by the age of one. Prolonging bottle feeding allows drinks to stay in contact with the teeth for longer periods of time and increases the risk of tooth decay. Using dummies or thumb sucking for a prolonged period can change the positions of the teeth and the shape of the mouth leading to prominent front teeth. It is very important to stop these activities at the very latest before the secondary teeth begin to erupt (age five or six) or these changes will become a permanent feature.
The first dental visit
The best time for a first dental visit is as soon as your child’s first teeth begin to erupt. This gives them a gentle introduction to their dentist and the surrounds of the dental surgery, and is also a wonderful opportunity to ask your dentist for any advice or have any burning questions answered. If there are any early problems with the teeth, gums or lining of the mouth they can be detected swiftly and remedied before they become something more serious. Personally, one of the most distressing situations to deal with as a dentist has to be seeing a child for the very first time and discovering that they have a mouth full of decay which could easily have been prevented if they had attended the practice at an earlier age. NHS dental care is free for children and most practices will happily see young children. If you have any misgivings about going to the dentist yourself then please don’t pass these on to your child. A trip to the dentist should be a positive thing, make it fun and explain how the dentist is going to see how big your child can open their mouth, count their teeth and look at how clean their teeth are. Modern dentistry is very much about prevention, and the younger the ideas here are instilled into our children the better.
Peter Doherty (BA, BDentSc, MFDS(RCSI))
Many thanks Peter!