Keeping your children from the dentist

Young people's teeth are not as healthy as they used to be. So how can youhelp your children to keep them free of cavities? Louise Holden reports

How healthy are your children's teeth? If they're typical of young people's around the country they may have seen better days. Since fluoridation of water became standard in Ireland, in the 1970s, tooth decay has been in decline. It means a generation of parents has been spared the horror of premature tooth loss, routine extractions, multiple fillings and even surgery. But a new study reveals that the prevalence of tooth decay has stopped falling for the first time since the 1970s. Among five-year-olds it could even be on the increase.

Water fluoridation and fluoride toothpaste can do only so much in the face of poor snacking habits, high-sugar diets and reduced consumption of milk and water. Many Irish children and their parents seem to be doing their best to undo the good work of 30 years of fluoridation.

Dr Helen Whelton, director of the oral health services research centre at Cork Dental School and principal investigator in the first all-Ireland survey of children's dental health, laments the end of an era of consistent progress.

"Because of the great strides we have made in reducing tooth decay in children over the last 30 years we have been able to shift the focus of the dental profession from emergency treatment to comprehensive treatment and prevention. In the early 1960s, the typical 15-year-old had nine decayed teeth. Now that number has been reduced to two or three."

Although children are having no more fillings than before, nor, crucially, are they having fewer. Dr Whelton hopes further analysis of her data might reveal why. "I suspect that the decline of the school milk programmes has not helped," she says. "Children used to get a guaranteed serving of milk daily through the school. This carried the nutritional benefit of calcium, but it also meant that children were satisfying their thirst without risk to their teeth. Now parents are packing lunch boxes with packs of juice, and the sugar and acid is eroding and decaying children's teeth. Even pure fruit juice causes premature tooth erosion."

Although Dr Whelton is pleased that some drinks manufacturers are trying to reduce the sugar content of drinks marketed at children, she still believes that young people should be drinking only milk and water for optimal dental health. Schools that have fizzy-drink vending machines are not helping matters, she says. "Health is an intersectoral concern. Schools have an important role to play in children's health. I'd like to see tuck shops and vending machines offering high-sugar products reviewed."

Increasing importance is being put on keeping toddlers' milk teeth in good condition until they are replaced by their permanent successors. Many parents still feel milk teeth are not important, because they go the way of the tooth fairy before the onset of puberty. But decay and trauma in baby teeth do not auger well for the future.

"Besides the obvious importance of healthy primary teeth for eating, appearance and speech, primary teeth are also essential for guiding permanent teeth, which develop underneath, into their correct positions," says Breeda Maher of Dental Health Foundation Ireland.

"Early neglect or loss can result in a number of problems. If a child's primary molar tooth has to be extracted early due to severe tooth decay, then the guide for the permanent successor is lost. The space available for the permanent tooth can be reduced, resulting in a crooked permanent tooth." Irish parents spend enough time and money on orthodontic treatment to know the value of naturally straight teeth.

And cavities are not the only problem. According to the North South Survey of Children's Oral Health 2002, 24 per cent of 15-year-olds have probably accidentally damaged at least one permanent front tooth. This figure has not improved since 1984, and a large proportion of traumatized teeth remain untreated. Approximately one in 12 children in Ireland will have broken one or more permanent teeth before the age of 15. The most common teeth to be damaged are the upper central incisors. Damage can range from a small chip off the enamel to a fracture involving the dental pulp.

According to Maher, babies often damage their primary incisors learning to walk. The most common injury to baby teeth occurs when one of them - usually an upper central incisor - is pushed up into the gum.

"Due to the fact that these injuries occur following an accident during normal everyday activities, prevention is difficult. Wearing of mouthguards during organised contact sports will reduce the likelihood of fracturing a tooth.

"Also, children who have prominent upper incisors are more prone to damage, hence orthodontic correction is recommended. When a tooth is accidentally damaged it is important that professional advice from a dentist is sought immediately. In the case of permanent incisors which are knocked out of the mouth, the tooth should be stored in milk. The patient should be brought to a dentist immediately; the chances of successful reimplantation are considerably better if the tooth is reimplanted within 30 minutes of being knocked out."

Dr Whelton of Cork Dental School is puzzled by the number of dental-trauma victims who are not brought to a dentist for treatment.

"If your child chips his tooth, even slightly, it needs to be treated in order to safeguard the future survival of the tooth. Chips can be filled in easily and invisibly - get it seen to even if it's not causing any pain." She assures parents that, in emergencies, health-board dentists will treat children free of charge.

This generation of parents may have stopped viewing dental care as a health issue because water fluoridation, improved diet and our own parents' vigilance have spared us the nastier aspects of dental treatment. We've been free to concern ourselves with dental aesthetics because the basics were taken care of.

Complacency where our own children are concerned could bring us back to basics with a bump. Young people with dental problems experience tremendous pain and suffering, resulting in problems with eating, speaking and learning. School days are lost, serious surgical procedures can be called for - and a lifetime in the chair is the likely legacy.

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The best start

• You can start to clean a baby's teeth, using a clean damp cloth, as soon as the first tooth appears.
• As more teeth begin to appear, brush the child's teeth with a soft toothbrush and water. Do not use toothpaste.
• From the age of two you can start to use toothpaste, but use only a pea-sized amount. Always supervise children, to ensure that they do not swallow toothpaste.
• It takes three minutes to brush teeth properly.
• Never give babies juice or sugary drinks from a bottle: it bathes their teeth in sugar.
• Encourage drinking from a cup.
• Stop bottle-feeding by your child's first birthday.
• Never leave a baby with a bottle in bed: it leads to severe and rapid tooth destruction known as baby bottle nursing decay.

What's fluorosis?

Dental fluorosis causes discolouration of tooth enamel. It is a widely recognised side effect of ingesting fluoride of the type found in toothpaste and tap water.

As dental caries have declined, the incidence of fluorosis has increased. In the main, however, the condition attracts little public comment.

"Part of the next phase of our research will be to establish whether or not Irish people are concerned about fluorosis," says Dr Helen Whelton of the oral health services research centre at Cork Dental School. "We want to find out if the white spots caused by fluorosis are considered by the public to be an aesthetic problem."

Extreme cases of fluorosis are not caused by the common levels of fluoride in tap water and toothpaste. They occur when large quantities of fluoride toothpaste are ingested, usually by children. Dental practitioners are therefore trying to discourage parents from starting children on toothpaste too early.

Children under two should have their teeth cleaned using only a toothbrush and water. Children between two and seven should always be supervised when brushing their teeth.

Allow them to use only a pea-sized amount of fluoride toothpaste, and make sure they do not swallow large amounts of toothpaste.

And keep toothpaste tubes beyond the reach of children at all times.

Eating for teeth

• Fruit juices are an important source of vitamins in the diet. As they are acidic, however, they should be drunk only with meals. Frequent consumption can lead to enamel erosion and decay.
• If you want to give your children sweets, give them at mealtimes and avoid anything sticky. Chocolate or marshmallow is better than toffee or boiled sweets.
• Do not let your children eat sweets between meals.
• Avoid chewable vitamins: these are loaded with sugar. If you must give them to your child, do so just before a meal.
• Water and milk are the most tooth-friendly liquids.
• Cheese, fruit, raw vegetables and popcorn can be eaten between meals without undue risk to teeth.
• Watch out for hidden sugars: ketchup, coleslaw, soups and sauces can contain high levels of sugar.
• If your children get plenty of protein, such as meat, fish, eggs, cheese, pulses and lentils, at mealtimes they are less likely to come looking for snacks between meals.