Preventing Early Childhood Caries
What are high risk dietary habits?
Frequent and prolonged exposure of a child's teeth to food or drinks containing sugar increases their risk of tooth decay. The bacteria in the mouth act on these sugars to form acids which attack the tooth enamel. High risk dietary habits include:
What are some good dietary habits which should be adopted?
Why is oral hygiene important and how do I ensure good oral hygiene for my child?
Poor oral hygiene results in the accumulation of plaque on tooth surfaces. Plaque contains tons of acid-producing bacteria that contributes to tooth decay.
What is fluoride and how does it prevent decay?
Fluoride is a naturally occurring mineral found in soil, water, foods and teeth. Research has shown that fluorides are very effective in preventing tooth decay. Fluoride works in three main ways:
Types of fluoride
Most people get sufficient fluoride exposure from various sources, including fluoridated tap water and toothpaste, food and beverages. Additional sources of fluoride include mouth rinses and professionally applied fluorides.
Should my child use fluoridated toothpaste?
Fluoridated toothpaste containing a minimum of
1,000 parts per million (ppm) fluoride is effective in preventing tooth decay. Always supervise your child when using fluoridated toothpaste.
For children three years and above, a pea-sized amount of fluoride toothpaste should be used. A smear amount of fluoride toothpaste is recommended for children younger than three years old, and with a high risk of tooth decay.
(Left) Smear or rice-grain amount of toothpaste (Right) Pea-sized amount of toothpaste
Risks associated with fluoridated toothpaste
While fluoride toothpaste has great benefits in controlling tooth decay, it should be used judiciously. Ingesting excessive amounts of products containing fluoride during the formation of a child's permanent incisors (below age three) can lead to mild fluorosis of these teeth.
Fluorosis is an intrinsic white discolouration of the tooth structure, which forms in response to high systemic levels of fluoride. It disrupts the normal process of tooth mineral formation, resulting in areas of hypomineralisation (lower mineral content) which changes the colour of the tooth structure. Mild fluorosis appears as chalky white discolourations near the edge of the tooth, while severe fluorosis can result in brown discolourations. Mild fluorosis is common and generally harmless except for poorer aesthetics.
Fluoride toxicity occurs at a dose of 5mg/kg. The risk of fluoride toxicity resulting from ingesting toothpaste is very low as a child would have to swallow 50g of 1,000ppmF toothpaste (or 1/4 of a tube) to reach this dosage. A normal dose of toothpaste does not pose serious toxicity.
Parental brushing, close supervision and using an appropriate amount of toothpaste are important to minimise toothpaste consumption in children younger than six years.
What are fissure sealants?
Fissure sealants are resins bonded to the pits and fissures of teeth to seal them off from bacteria and food. There have been no reported adverse reactions to sealants.
The chewing surfaces of our back teeth contains deep pits and grooves (also known as fissures), where most cavities in children are found. Fissures are so narrow that you are unable to clean them effectively with proper tooth brushing and flossing. These form a conducive environment for bacteria to fluorish, often resulting in tooth decay.
Children who have deep pits and fissures on the chewing surfaces of their molars will benefit from sealants, especially if he or she has a high risk for decay.
How effective are fissure sealants?
Research shows that resin-based sealants prevent fissure decay between 11% and 51% as compared to no sealants, over 24 months and up to 48 months1. Sealants can last many years but may be damaged or lost through use, therefore they need to be maintained and checked regularly by your dentist. Lost or damaged sealants can be repaired easily.
How are sealants applied?
Sealant application is quick, easy and painless. No drilling of the tooth is required. The tooth is properly cleaned, dried and the sealant is painted on. A light is shone to harden the sealant, which forms a protective coating over the fissures of the tooth. Your child can eat immediately after sealant placement.
Does my child still need to brush or floss their teeth after having sealants?
Yes of course! Fissure sealants are only one part of decay prevention and only protect the biting surfaces of teeth. Good oral hygiene is still needed to remove plaque and bacteria from other surfaces of teeth.
Regular dental visits
Regular dental visits will enable your dentist to pick up signs of decay, defective restorations and infections in their early stages. This allows prompt treatment before dental problems become serious and require invasive management. Depending on his or her dietary habits and oral hygiene practices, your child's risk for decay will also change over time. Your dentist can recommend the appropriate preventive measures and advise on the frequency of follow-up reviews.
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