Article by Dr Martie Conradie, MBChB (UP), Diploma in Child Health (SA), Diploma in HIV Management (SA)
No baby or toddler will take responsibility for their dental health, even adults struggle. But this article might give you an interesting view on paediatric oral care, or maybe it will give you the motivation to have patience with a toddler refusing to brush teeth or making a fuss about using the toothpaste with the wrong picture on it.
Teeth usually do not become visible until babies are about 6-12 months old. Thereafter the first tooth starts breaking through and you have several sleepless nights trying to comfort a little one struggling to understand the discomfort. Most kids have their first full set of 20 teeth by the time they are 3 years old. From about 5-6 years these teeth start falling out one by one, and the tooth fairy (or mouse) might become a regular visitor for a few years.
Primary teeth fall out when the permanent teeth are ready to come out. By about 12-13 years old, most kids will have lost all their baby teeth and will proudly display a set of permanent teeth. Most people will have four wisdom teeth that appear in the back of the jaw when they are 17-25 years old and often these create so much havoc that they are rather removed.
To understand dental health, you have to know a little bit about what teeth are made up of.
The crown of each tooth is the part that is visible outside the gums and it is covered with enamel. Enamel is a very hard and shiny substance and acts as a tooth’s personal bodyguard. It is mostly made up of calcium and phosphate, like your bones, but it is stronger because of certain proteins and crystallites that form part of it.
Below the enamel, there is dentin. This makes up the largest part of the tooth and it is nearly as hard as enamel. This protects the innermost part of the tooth called the pulp. Pulp is where nerve endings and blood supply are found and is therefore the part that senses when you drink a hot drink, bite into ice cream or when you get a cavity. The pulp goes all the way down into the root of the tooth which is under the gum. The root anchors the tooth to the jawbone and is made up of cementum. About a third of a tooth is below the gums which is why you also have to keep your gums healthy.
Unfortunately, enamel is not invincible. It can chip or crack and its worst enemy is plaque. Plaque contains millions of bacteria from nearly 300 different species. The main culprit for poor dental health is Streptococcus mutans – it even sounds scary! It converts sugar and other carbohydrates into acids, and this eats away at your enamel. This is referred to as the cariogenic process.
Some risk factors for cavity development in children include the following:
The number one dental problem in pre-schoolers is tooth decay. Although the rates of dental caries have significantly declined among school-going children since 1970, the rates of caries in children of 2-5 years old have actually increased.
A few facts:
These are not comforting statistics and it is even worse in children from low-income families.
The good news is that cavities are preventable.
Except for the fact that a healthy oral environment in a child will promote healthy development of adult teeth, there are a few other reasons to take care of your child’s teeth:
Your child’s dental care starts even before birth.
Primary caregivers can transmit the bacteria which colonises a child’s oral cavity. Colonisation is inevitable but delaying it has been shown to be beneficial to oral health. Factors that influence colonisation include frequent sugar exposure in infants and habits that allow salivary transfer from mothers to infants. If a mom has poor oral hygiene, low socioeconomic status or frequently has unhealthy snacks, the risk of bacterial transmission to their infants are increased and it has even been shown that the infants in these cases test with high levels of Streptococcus mutans, even before their first tooth has erupted.
If a mom, even while pregnant, reduces bacteria levels in her own mouth it may delay the development of early childhood caries. Ways to do this include the following:
Here are a few tips:
Many of the tips for babies are also applicable to kids (and adults) too.
Here are a few more:
Losing their baby teeth will make your children feel really grown up, but you might be a little uncertain about what to do with a loose tooth if it is the first tooth you’ve ever had to manage. Once a tooth becomes “wiggly”, here are a few things you can do:
Okay, so your teenager probably will not allow you to brush his or her teeth. Chances are that they will brush quickly in the morning and at night to at least prevent foul smelling breath but keep telling them to take time to do it thoroughly and to floss. Also arrange their dentist visits when it is time.
If you are like me, taking your kids to a dentist might be low on the to-do list while there is no toothache. However, it should really be a priority, like I have learned the hard way. And if your little one does have a few caries, do not feel like you have failed your child, just try to follow the advice of the dentist and have them filled or consider the preventive options that might be available for you child. Preventing caries are much more cost-effective and time-efficient than treating them once they occur.
It is recommended by several paediatric societies that a child should visit a dentist by the time they are one year old or within 6 months after their first tooth erupts.
Infants and toddlers are not expected to be cooperative during an oral examination, so do not be concerned about what the dentist will think if they cry or move around. Dentists are usually well-equipped to manage kids.
A child who is taken for dental visits regularly is more likely to have a good attitude about oral health providers.
May your kids benefit from you taking care of their teeth and I hope there will be no toothaches in your future.