What are the hidden causes of tooth decay in small children?

This article first appeared in maternity & infant, October/ November issue, and after watching Sugar Crash on RTÉ earlier this week, I thought I’d post it here.

Why is dental decay in kids on the increase in Ireland, and why is nobody telling parents that waiting for primary school screening is not advisable?

Paediatric Dentist Dr. Rose-Marie Daly explains why decay is on the rise, what the direct causes are, and what parents can do to prevent problems. There’s advice on how soon to brush a baby’s teeth, why it matters at all when we’re talking about milk teeth, tips on brushing teeth of reluctant toddlers, and first-hand experience from mum of three Lucy O’Connor.

Brushing our three-year-old’s teeth is the nightly chore that my husband and I try hardest to delegate to one another. Like most small kids, mine wants to brush his own teeth, and sometimes it’s tempting to give in. After all, they’re only milk teeth – what harm can it do? Actually quite a bit, it turns out. Unfortunately, and perhaps surprisingly, problems with children’s dental health are on the up.

kids' dental health - andrea mara

“Anecdotal evidence suggests that cavities in children are on the increase,” says Dr. Rose-Marie Daly, a consultant paediatric dentist at the Bon Secours Hospital Tralee, Co. Kerry. “According to a number of regional surveys, approximately one third of children have experienced decay by the age of three.”

The last available published research is from the North South Survey of Children’s Oral Health in Ireland 2002. It showed that 55% of five-year-olds in non-fluoridated water areas, and 37% of five-year-olds in fluoridated water areas had tooth decay.

“It’s our most common chronic childhood illness,” says Dr. Daly, “More common than asthma.”

So why, in twenty-first century Ireland, is tooth decay in kids on the rise?

Fluoride avoidance – using filtered water, or low-fluoride toothpaste – may be contributing to this increase, along with the consumption of “no added sugar” drinks, which parents assume are a safe option.

There’s also a lack of awareness about how early children should have a check-up.

“The majority of parents think children don’t need to see a dentist until they’re in primary school,” explains Dr. Daly.

“This is probably a hang-up from the screening provided by the HSE dental service. Unfortunately the evidence shows that by second class, a lot of damage is already done. It’s important to emphasise that state funded dental services for children are school-based. Other than an entitlement to emergency care, the service for preschool children is completely under-developed. It could be argued that this vulnerable cohort are being discriminated against.”

In fact, children should visit a dentist when they first get teeth, or at least by the time they turn one.

Causes of dental problems

juice - office mum

Dietary and feeding habits are a major factor – babies feeding at night from bottles after teeth have erupted, and children sipping fruit flavoured drinks throughout the day.

Grazing between meals is a problem too. With five “meal moments”, and twice-a-day brushing, saliva can control the acid produced by bacteria during meals. But more than five “meal moments” means normal saliva may not cope.

Different types of bacteria can cause decay – bacteria can be passed by parents to children through normal day-to-day interaction, or sharing brushes.

Tongue-tie can mean children are unable to remove food particles from their teeth, and teeth with deeper fissures and grooves may be prone to decay, especially the molars.

What can we do?

The quickest fix is to cut the juice. There are between two and five teaspoons of sugar in every glass, and children don’t need juice in their diets; giving them water is much better for their teeth.

Establish a good tooth-brushing routine. And yes, this is hard, especially with babies and smaller children (see panel for tips.)

Book a dental appointment. This is the biggest hurdle to overcome, because it’s ingrained in many parents that it isn’t a necessary step – they’re waiting for the primary school screening.

Consider fissure sealants: this is a plastic resin placed into fissures and grooves on back- and sometimes pitted front-teeth, to block out bacteria and food. This protects teeth from developing cavities by about 40%.

Parents often wonder how soon they should start brushing a baby’s teeth. “It’s important to clean a baby’s teeth as soon as the first one comes through,” says Dr. Daly. “When a baby is feeding from a bottle the teeth become bathed in the liquid. Formula, cows milk, juices and breast milk all contain sugars that can cause decay. The teeth are especially vulnerable at night when the mouth is a little dryer. This can lead to ‘early childhood caries’ – an aggressive condition that spreads quickly and always affects multiple teeth. This can lead to very small children requiring extensive dental treatment. It’s identifiable by brown, yellow or white spots on the teeth and parents should always seek professional advice if they notice any of these signs.”

To clean a baby’s teeth, it’s fine to use whatever works – a wet facecloth or a soft toothbrush, and a lying down position may be best. It’s important to stay positive and avoid showing frustration. It’s recommended that until about the age of seven, parents continue to brush children’s teeth for them.

Effect on baby teeth

And how much of this matters, when we’re talking about “baby” teeth?

Quite a lot it seems. Dental problems with primary teeth – the “milk teeth” that start to fall out from the age of five or six – can be quite serious if left untreated.

“Decay in children can lead to disturbed sleep, pain, infection, facial-swelling, dental anxiety, increased risk of decay in adult teeth, and lack of confidence if the appearance of front teeth is affected,” warns Dr. Daly. “It’s the most common reason for preventable general anaesthetic in Ireland, and often requires specialist care and hospital admission.”

Edit: the next section relates to Halloween, as this was in the October issue of the magazine


Jelly Babies - Office Mum

Of course, all of this has particular resonance at this time of year, as children arrive home on Halloween night with bags and buckets of the very worst kind of sweets. But paediatric dentist Abigail Moore (paediatricdentist.ie) has some suggestions.

“Halloween is one of my most stressful times of year, both as a dentist and as a mum of two young kids – mainly due to the amount of absolute rubbish that children are exposed to from all angles. I don’t think we can change the customs of Halloween, nor would I want to, but here are a few Halloween tips for parents:

  • Jellies, toffees and lollipops are the worst things for teeth.  Apart from the additives and the poorer quality, they are sticky and long-lasting – ideal for rotting teeth.
  • Chocolate is a less harmful treat (in moderation of course!) as the texture is less sticky so it lingers for less time in the mouth.
  • Offer alternatives: fruit, nuts, crisps, stickers, or party bag fillers.
  • The longer teeth are in contact with sugary things, the more damage is done – the frequency of eating sugar is more important than the amount of sugar eaten – in other words best to eat all treats in one go rather than a little at a time.
  • Perhaps have a count up of sweets and assign scores.  Arrange to swap the sweets for something more desirable – Match Attacks, Lego mini figures and a Kinder egg.
  • Encourage children to drink water or milk after sweet treats. Sugar-free chewing gum can also be helpful as it encourages saliva flow that neutralises the acid of sugar.

And if your child is brushing twice a day, limiting the frequency of sugars between meals, and visiting a dentist regularly, Halloween isn’t going to cause a major problem. Especially if thoughtful parents help out by raiding the stash for themselves. Only to save the children from themselves. Of course.

Tips for encouraging good brushing habits in children:

  • Make a game of it – the food particles are hiding in between the teeth, and the toothbrush is a magic wand or lightsaber, tasked with attacking the food.
  • If your child enjoys the bath, try brushing teeth in the bath – she may be more relaxed.
  • Brush your own teeth at the same time – children love to copy what parents are doing – then take over to make sure the job was properly done (small children need to have their teeth brushed by an adult.)
  • Similarly, ask an older sibling to demonstrate.
  • Count the teeth one by one to make sure they’re all done.
  • Play or sing their favourite song when their teeth are being brushed.
  • Using an electric toothbrush may help – it’s not necessary for dental health but might make it more fun for your child.
  • Name the teeth and list them off one by one – toddlers don’t like for anyone to be left out (this one could take some expert memorising on your part!)
  • Look in the mirror – concentrating on the mirror image helps some children to stay interested while you’re cleaning their teeth.
  • Don’t bribe, and don’t use the dentist as a threat.
  • And remember, change your child’s brush regularly. If the bristles aren’t standing upright replace it, as it won’t remove plaque after that.

Lucy O’Connor is a mum of three, HR professional, blogger at LearnerMama.com and founder of C-SectionMums.com

Lucy O'Connor - Office Mum

As a new mum, I had heard about teething – lots and lots about teething. But not so much about more general dental health. We got a stark introduction when I noticed that one of my five-year-old daughter’s teeth looked odd. We took a first trip to the dentist and found out that the tooth had crumbled. It had to be taken out, in pieces.

Roll on a couple of years and she woke with severe tooth pain. I checked her mouth and again noticed a tooth looking odd. Another dental visit followed – it turned out she had an abscess. It resulted in a week of antibiotics and eventual extraction of the tooth.

She is now back on track, but has space issues and may need orthodontic treatment. A very recent dental trip for my second child resulted in a completely clean bill of dental health. The overriding lesson: no matter how careful you are, you can have dental issues, but keep on top of them with regular checks and if a problem arises, get it seen to immediately.

maternity & infant - Andrea Mara

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