Avoiding Tooth Decay in Children

Welcome to Ask the Paediatrician’s Blog and the focus today is Dental Caries in children.
Many parents are worried about tooth decay even in young children. On the Ask the Paediatricians’ Facebook Group Parents’ Grand Round recently, a Paediatric Dental Surgeon of the Department of Child Dental Health, Lagos University Teaching Hospital, Dr Bukky Olatosi dealt extensively with the issue of Dental Caries in children, the cause, treatment and how to prevent caries. This is a blog post of this important topic. Read, learn and share!

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What is Dental caries?

Dental Caries simply means tooth decay. It is caused by specific types of bacteria which produce acids that destroy the tooth.
Normally we have bacteria in our mouth. These bacteria continue to build up on the teeth to form what we call plaque (the yellowish deposit that is seen on the teeth when they are not brushed).
These bacteria turn sugar and carbohydrates (starches) in the foods we eat into acids. These acids dissolve the teeth gradually to eventually form holes Which are too small to be seen at first. But they get larger over time.
This picture describes the role of sugar and bacteria in tooth decay.

Caries seen in children 6 years and younger is called EARLY CHILDHOOD CARIES, it has also been referred to as NURSING CARIES, BABY BOTTLE FED CARIES, COMFORTER CARIES and many other names.
This is how tooth decay progresses.

What are the causes of Early childhood caries?

1. Bacteria: When a baby is born the baby’s mouth is free of bacteria but begins to acquire it as early as 24hours after birth. One of the ways a baby acquires bacteria is by transfer from the mother or caregiver.
   That is why tooth decay is a transmissible disease. Mouth to mouth kissing of a baby, mother/caregiver placing baby’s spoon in their mouths, helping a baby to chew his/her food before placing in the baby’s mouth.

   

   Also sharing of feeding utensils, saliva sharing activities among children at schools and daycare centers. All these are possible ways of acquiring the bacteria causing tooth decay.

   

    

2. Poor feeding practices: Inappropriate use of feeding bottles, bedtime use of baby bottle containing sweetened drinks. Mothers please note “Do not give your babies feeding bottles containing carbonated drinks, chocolate beverages even milk to sleep”.This picture shows a baby sleeping with bottle containing milk. This type of feeding habit should be avoided.

   

   When an infant falls asleep with a bottle, or uses a bottle or sippy cup for extended periods of time, the sugar can coat the teeth. This causes the teeth to decay more quickly in such children. If you must give your child a bottle, fill it with water only. Teach your child how to drink from a cup around 6 months of age.
   The American Academy of Pediatric Dentistry recommend avoidance of sugar- containing beverages e.g juices, soft drinks, sweetened tea, milk with sugar added in a baby bottle or no-spill training cup.
   Avoid putting sugar drinks in baby feeding bottle. They also recommend that infants should drink from a cup as they approach their first birthday and infants should be weaned from the bottle between 12 to 18 months of age in order to prevent tooth decay.

3. Poor breastfeeding habit: We all know that breastfeeding provides the perfect nutrition for infants and this is a topic that has been discussed extensively at the ATP parents ground round however, frequent and prolonged contact of tooth with breast milk has been shown to increase the risk of a child having tooth decay.
   Also prolonged night time breastfeeding has been associated with an increased risk of Early childhood caries especially after the age of 12 months where the teeth have erupted.
   Another cause of tooth decay in children is high sugar diet, consumption of in-between snacks and beverages that contain sugar. It is better to give children healthy snacks in between their meals. Snacks such as fruits and vegetables avoid sugar acted drinks and fizzy drinks. You can blend their fruits and make it into juices but avoid putting it in bottles for infants rather use the normal cup.
   Encourage healthy eating habits, and limit sweets in general.
4. Poor oral hygiene: This simply means not keeping a child’s mouth clean – it can also cause tooth decay. Good oral hygiene practices has been discussed extensively on this platform so I don’t want to dwell too much on it, but as a reminder parents should start cleaning their baby’s mouth not later than when the first tooth erupts.
   Tooth brushing should be done for children under the age of 7 years by a parent twice daily, using soft toothbrush appropriate for the child’s age and fluoride containing tooth paste. In children under the age of 3 years, a ‘smear amount of fluoride containing toothpaste should be used while children 3-6 years should have a pea- size amount of tooth paste.

   

   Children 7 years and above should brush their teeth with the supervision of their parents/caregiver.

   This is the picture of a 4 year old child boy who presented in our clinic with Early childhood caries, his mother fed him with feeding bottle containing sugar drinks and he also slept with the bottle in the mouth.

   

   If the child has been brought earlier the child’s teeth would have been saved.
   How can we identify early childhood caries?
   Many times I have heard parents say they didn’t know when it started, it just appeared immediately the teeth started erupting. No it doesn’t just appear. It’s usually a process that if not attended to can progress fast destroying the teeth.
   It starts as a chalky white appearance on the teeth (usually starts with baby front teeth) that is the early stage then it progresses to brown spots on the teeth and then appearance of hole and destruction of the entire teeth leaving only the roots of the teeth in place. The description is shown in the image below.

   

Why do we need to protect baby teeth?

• After all said and done, since they will eventually fall out and be replaced by permanent teeth?
  Here are some of the reasons why we need to protect our children’s teeth.
• If a child has tooth decay that is left untreated, it can affect the growth, speech, appearance and self esteem of the child.
• Untreated tooth decay can lead to pain and discomfort which can also lead to infection.
• Untreated tooth decay can alter a child’s eating due to pain and this can prevent a child from getting the necessary nutrient required for growth.
• A child’s sleeping habit can also be altered due to severe pain from affected tooth/teeth, risk of hospital admission and subsequently there will be loss of school days and inability of the child to learn.
• Early childhood caries has been associated with reduced growth and reduced weight gain due to insufficient food intake that can meet the growth need of the child.
• Untreated tooth decay can also cause early loss of a child’s tooth/teeth which can lead to speech problem because one of the functions of the human teeth is speech, when a child’s teeth are lost early it can affect speech and pronunciation of words.
• Untreated tooth decay can affect a child’s self esteem, sometimes a child may not want to smile or talk publicly because of the way his/her teeth appears this can affects a child’s confidence if not look, if not looked into can continue till adulthood.

As simple as tooth decay may look it can lead to brain abscess (infection) and death. We do not pray for this. The good news is that early childhood caries( tooth decay) is PREVENTABLE!!!
PREVENTION IS CHEAPER THAN CURE!!

How can we prevent Tooth decay in children

1. Reduce the transfer of bacteria that cause tooth decay from your mouth to your child. This can be done by minimizing saliva-sharing activities.
   • Avoid the sharing of utensils such as spoons forks with your baby.
   • Do not chew your food and put it in the baby’s mouth.
   • Discourage a child from putting his/her hand in the mother/caregiver’s mouth.
   • Do not lick a pacifier before giving it to a child
   • Do not share toothbrushes.
   • The goal is to prevent or delay children as long as possible from acquiring the bacteria that cause tooth decay.
2.  Start cleaning your baby’s mouth not later than when the first tooth erupts
   • Tooth brushing should be done for children under the age of 7 years by a parent twice daily, using soft toothbrush appropriate for the child’s age and fluoride containing tooth paste.
   • In children under the age of 3years, a ‘smear amount of fluoride containing toothpaste should be used while children 3-6 years should have a pea- size amount of tooth paste.
   • Children 7 years and above should brush their teeth with the supervision of their parents/caregiver.
3. Bring your child to see the dentist as soon as the child brings out his/her first tooth. A child’s first visit to the dentist should be on or before the child’s first birthday. This will enable us to monitor the child for any sign of tooth decay and other dental problems that may be starting.
4. Avoid giving your child liquids, solid foods containing sugar frequently. Avoid sweets, chewing gum, fizzy drinks, biscuits, chocolates. If at all you must give it should be occasionally!
5. Avoid putting sugar containing drinks like tea, juices, chocolate drinks in baby bottle or training cup.
6. Do not put your baby to sleep with bottle filled with milk or liquid containing sugars.
7. ‘On-demand breast-feeding should be avoided after the first tooth has erupted and other dietary carbohydrates have been introduced.
8. Encourage your baby to drink from a normal cup not trainer cup as he/she are approaching their first birthday.
9. Infants should be weaned from the bottle between 12 to 18 months of age.
10. Regular visits to the dentist is important.
    If your child already has tooth decay no need to worry. It can be treated depending on how severe it is. The teeth can be restored(coated) with white dental material or it can be crowned(capped) to improve the child’s appearance and and improve the ability to chew and eat.
    In conclusion, tooth decay in children is preventable, if a child has tooth decay and is not treated it can lead to other complications.
    Following the pieces of advice in this blog post will lead to prevention of tooth decay in children.