Teeth care in children

Teeth development starts in utero. Teeth eruption generally starts around 6 months with central incisors, but can be as young as 3 months and as late as 12 months. The teeth and gums from this age are susceptible to decay called caries. This article discusses risk factors for early dental caries and provides some advice to protect the teeth.

What is Early Dental Caries ? 

This represents the damage to enamel from acids. Over time a thin film covers the surface of teeth called plaque. Plaque  contain bacteria which ferment carbohydrates (sugars) resulting in acid production. The acid wears away the enamel, and eventually breaks through and destroys the tooth itself. Plaque particularly thrives on simple sugars.

How To Recognise Dental Caries ?

The easiest place to see dental caries is by elevating the lip and looking at the surface of the incisors. Early changes are shown by whitish areas close to the gums as seen above. The example on the right is a severe case. This was a 2yo child who had been breast fed during the night constantly as a settling strategy until the age of 2 years. In addition during the day she was given juice in a bottle to constantly consume.

What Factors Contribute to Early Dental Caries ?

1. Early transfer of bacteria to an infant’s mouth. The bacteria strep mutans is the most potent and so avoiding transfer for as long as possible helps protect infant’s teeth
2. Constant exposure to carbohydrates – particularly during the night
3. Poor oral hygiene and lack of fluoride
4. Mouth breathing

What is recommended to avoid these factors ?

1. To avoid transfer of strep mutans, avoid using a parent’s mouth to clean dummies. Do not share utensils or containers.
2. Avoid frequent breastfeeding during the night. One quick feed is fine during infancy but after 12 months there should be no exposure to carbohydrates during the night.
3. Avoid bottle feeding to sleep. If this is too hard to stop, use water instead of milk.
4. Early hygiene practice. During infancy cleaning new teeth after feeding with a moist gauze. Introduce a soft brush but using water only as more teeth arrive. Do not share brushes with other children.
5. At 18months  start to use toddler toothpaste.  Water should be the only overnight liquid.
6. Avoid fruit juices, soft drinks, sweetened milks, particularly if they are sipped over a long period of time
7. Avoid simple sugars found in sweets and lollies except for ‘special occasions’. Avoid long lasting sweets such as lollipops. The time in mouth period is more important than the quantity of sugar.

What is the latest advice on cleaning teeth in children ? 

1. Up until 3 years use toddler specific soft brush and pea sized low fluoride toothpaste
2. Clean twice per day for 2 minutes
3. Help you child with the teeth cleaning until 7-8 years.

What if you feel early dental caries has started ?

• To a certain degree there is significant reversibility. Follow guidelines above, clean a toddlers teeth twice per day for two minutes.
• Book an appointment with a dentist who has paediatric experience.