From zero to twenty……. teeth

In the first article of this series in the last issue, I covered dental care matters for the expectant mother. In this article I will cover the main dental issues for the first three years of life or so (when your baby should have twenty teeth). It would be impossible for me to cover every topic in such a relatively short article, when whole books have been dedicated to less but I will provide answers to the most common questions that are asked of me in practice by new mothers and fathers. I will also add a little information about what to do in the event of a dental accident.

When should I start brushing my baby’s teeth?
As with almost every other area of development it is as well to establish good habits as early as possible in the child’s life. That being the case, as soon as your baby’s first teeth begin to appear (usually the lower front teeth), you can start by rubbing a soft brush over them. At this sort of age your baby will probably be putting just about everything in its mouth and it shouldn’t be too much trouble to get in there with a soft toothbrush. The reason your baby puts everything in its mouth at this age is that the touch sensation of the lips is more developed than it is in the fingers and hands and it is thought that babies do this as a method of recognition as much as anything else.

Should I be giving fluoride drops or tablets to my child?
It would be possible to write a whole article on this question alone. An internet search on the topic supplied 13,300 references and a quick flick though some of them seemed to show that you could find evidence both for and against what is becoming a more emotive topic.

Very briefly, fluoride helps to prevent tooth decay both by strengthening the structure of the tooth surface during formation and secondarily through the action of the saliva. However, there is unequivocal evidence that too much fluoride in the diet during the formation of the teeth can cause an unattractive discolouration known as mottling. This is in addition to the disputed claims of fluoride as a toxic agent.

As dental adviser in my house, (my wife actually makes all the decisions) I have recommended that fluoride supplements are NOT used for our two children (currently two and four years of age). The advice is based on three criteria:

1. Use of fluoride is only one of the three main tools in the fight against tooth decay – the others being a diet low in refined sugars and a good cleaning regimen. Once the other two are in place, less reliance need be placed on the action of fluoride.
2. I estimate that our children get sufficient fluoride though their normal diet and through the ingestion of fluoride containing toothpaste.
3. We are not really “pill” people in our house.

Fluoride supplements should only be considered if the fluoride content of your water supply is less than 1 part per million. In Jersey, the water supply is not naturally fluoridated to this level and fluoride is not added by the New Waterworks Company. (I understand that there are no plans to do this in the foreseeable future).

What drinks should I give to my child?
Mother’s milk and water are the best. After that the most important piece of advice is to avoid drinks with a high refined sugar content. If your child isn’t too keen on water alone, I would recommend well diluted fruit juices (at least four parts water to one part juice). Although fruit juices do contain natural sugars which can cause decay, and although they can be mildly acidic they are not as damaging as refined sugars (particularly sucrose) especially if they are well diluted.

Additionally and almost as importantly, the regularity and timing of drinks can be important in the cause and/or prevention of dental decay. A condition known as “baby bottle decay” is much less common now than it once was. It described the severe damage through dental decay to the baby’s front teeth as a result of sugary drinks (original Ribena was one of the main culprits). The damage to the teeth was so bad that it appeared as thought the teeth were actually coming through already decayed. The reason for the severe damage was that the delivery of the sugary drink almost continuously through the bottle meant that the teeth were constantly bathed in a fluid high in refined sugar.

Note:- “Ribena Toothkind” is a relatively new product which has been endorsed by the British Dental Assocation. Although I wouldn’t give it to young babies, it certainly is better for the teeth than original Ribena.

At what age should I take my child to the dentist for an check-up?
This very much depends on the individual child. I have performed successful examinations on children as young as 18 months and been wholly unsuccessful with others as old as five years. It is probably better to start sooner rather than later even if the dentist is only able to manage a quick look at the teeth. Speak with your own dentist to establish his or her preferences but the following guidelines may be useful.

1. If your child is comfortable and confident with adults other than parents and grand parents.
2. If there are older siblings, it may be useful to have the examinations all at the same time with the baby going last after he/she has seen the others survive this strange event.
3. If you are able to clean your child’s teeth successfully with a toothbrush (If your baby won’t let you get in to have a look they are unlikely to let the dentist have a look)
4. If you suspect a particular problem with your baby’s teeth – particularly black or brown staining which isn’t removed by brushing and seems to be getting worse.

Which toothpaste is best for my child and should I be using mouthrinses?
Use a toothpaste which contains fluoride - almost all do. Kiddies toothpastes are slightly different form normal preparations as they will have a lower fluoride content as well as being more pleasantly flavoured. My experience is that the children will often simply eat the toothpaste off the brush, not brush their teeth and then ask for more toothpaste. You should not be using more than a smear of toothpaste on the brush head because of the potential problems of mottling mentioned earlier.

I am not a fan of mouth rinses, particularly at an early age. Even if the child is able to manage the task of rinsing and spitting they are unlikely to hold the mouthrinse in their mouth for any significant length of time and it is unlikely to give any benefit. Time spent rinsing your teeth with a mouthwash would probably be better spent doing some more brushing.

What should I do if my child falls and damages his/her front teeth?
Damage to the front teeth become much more common when the baby begins to stand and walk about. Because the lip will often be cut at the same time, the bleeding of the lip, which is often quite dramatic, will often make the situation appear worse than it really is. If you can see damage to the teeth, if they are displaced or knocked out, you should really try and get to a dentist as quickly as possible (hours rather than days). A situation such as this is just about the only one where I would try and perform a dental examination (of the particular problem) with an unco-operative child. What can be achieved in term of repair will very much depend on the severity of the problem and the age of the child. However, you should be reassured to learn that damage to baby teeth in this way rarely causes damage to the adult tooth which is developing in the gum underneath the baby tooth.

Occasionally, a child will knock a front tooth and appear to do no damage to it. However, over the next several weeks the tooth may start to grey and you may notice a gum boil developing underneath the lip above the tooth. The greying is caused by the same process as the blackening of the skin by a bruise. Unfortunately, unlike a bruise, the greying is permanent. If the gum boil appears, it may well be preceded by a period of discomfort when your child will not want to bite anything vaguely hard with his/her front teeth. If you notice these changes, a visit to your dentist is really recommended as any advice should be tailored to the individual.

I hope that the foregoing is helpful. Again should there be any burning questions that you would like answered please contact me via e-mail nickohare1@ aol.com and I will include them in the final article.

Nick O’Hare BDS MFGDP(UK)