The recent launch of the new National Oral Care Strategy, Smile agus Slainte, with the promise of free oral care for the under 6s at your local private dentist, has highlighted the need for young children to have regular oral checks.
So, when should you first bring your child to the dentist?
The answer is as soon as the first tooth appears! This will allow your dentist to check everything is developing correctly, and is an opportunity to get advice on oral care to keep your baby safe and healthy. This is the start of developing a “dental home “ for your child. Starting early means your child will have very few oral health problems and a trip to the dentist will be a normal part of their lives.
What will happen at your first visit?
Your dentist will check your babies mouth ( including the tongue for tongue tie), talk to you about your babies diet, and advise on how you should clean your babies teeth. Your dentist/hygienist may apply a fluoride varnish at this visit to protect teeth from decay. Fluoride is recognised as being very effective to prevent decay and can even reverse early signs of decay. Topical fluoride is very effective as a preventative measure and is easily applied without stressing your baby.
Milk teeth have a thinner layer of enamel than permanent teeth and are more likely to decay than permanent teeth. Thus we need to use every means, from limiting sugar intake, to brushing and the professional application of fluoride, to prevent cavities.
Causes of tooth decay in babies
Tooth decay starts when a baby’s mouth is infected by acid producing bacteria. Parents and carers can pass bacteria to babies through saliva. You can pass on your decay causing bacteria from your mouth when you lick a spoon before feeding to your baby. This also can happen when you “clean” your baby’s soother in your own mouth . The real problem is when you have active decay, or your oral hygiene isn’t as good as it should be. This means that your bugs will be shared with your baby. Make sure to keep your mouth really clean and have any decayed teeth treated so you don’t pass bugs on to your baby!
Nursing bottle decay
Tooth decay also starts when your baby’s mouth and tooth enamel is exposed to any liquid or food other than water for long periods throughout the day.
Remember, constant sipping on liquids through a bottle, especially at night, can cause tooth decay. We call this nursing bottle decay or baby bottle tooth decay. It doesn't just happen with fruit juice, it can happen even with milk (milk contains lactose, which is broken down to sugar) .
This can lead to infections and pain, and your baby may need to be admitted to hospital to have these teeth extracted under general anaesthesia. This is not the way to introduce your child to dentistry. Your child may manage to avoid extractions but may still be teased about bad teeth at school, which can also affect their confidence.
Every parent wants to avoid this. The rule is nothing only water or milk in the bottle. And only water at night once the first tooth comes through.
Start introducing a cup from 6 months of age and aim to finish with the bottle by aged one. Constant breast feeding during the night can also cause decay for your toddler and you still need to follow all the rules for good oral health.
Signs of dental decay
Decay may start as white spots along the gum line of the upper teeth. It's not always easy to spot which is why you need to take your child to the dentist, who can advise you.
How to prevent decay?
Start to clean your baby’s teeth as soon as they appear. Make it fun. You can sing to your baby as you clean their teeth with a piece of gauze, or with one a finger brush. There are many mobile apps available which you can use to make brushing fun.
Children learn best by copying their parents. How many children try using a razor because of watching Dad shave? If your children see you brushing and flossing, they will want to copy you. Move your night time brushing to do it with your young child. Then brushing and flossing becomes a habit and you avoid constant battles about tooth brushing.
Start using tooth paste containing Fluoride from age 2. A pea sized blob is perfect. A great resource, with videos and reward charts, is here www.brushmyteeth.ie. We recommend Biomin toothpaste for children from 2 years of age if living in a fluoridated area, and from the appearance of the first tooth in non fluoridated areas. You only need a smear of toothpaste. Biomin offers up to 12 hours protection. Remember not to rinse after brushing.
Besides pain and possible trauma with extractions, you also want to keep milk teeth healthy because these guide permanent teeth into position. If your child loses milk teeth early because of extractions, then teeth will drift and move out of place. This usually means braces later to correct the problem. Treatment can be more complicated at this stage as permanent teeth may come up in the wrong position due to loss of baby teeth.
Here are the steps to having a baby with a healthy mouth
Take good care of your own oral health even before your baby is born. It's important and OK to visit your dentist when you are pregnant. The healthier your mouth is, the less bacteria you will pass on to your baby. Whether you decide to breast feed or bottle feed, it's important to take good care of your baby’s teeth.
- Birth to 12 months - Keep your baby’s mouth clean by gently wiping with clean gauze or a finger brush.
- 12 to 36 months - 2 twice a day brushing for 2 minutes with a children's fluoride toothpaste , and 2 visits per year to your dentist.
- Limit juice to once a day with a meal.
- Juice should not be given to babies younger than 6 months. If juice is given to babies between 6 and 12 months, limit it to 4 ounces diluted half and half with water.
- For children aged 1 to 6 limit juice to 4 to 6 ounces per day.
- Never allow your child to walk around with or drink from a bottle or sippy cup for long periods.
- Water is the best drink!
- Limit food and drink to 3 meals and 2 snacks
Check if your water is fluoridated. If you have your own well, or are connected to a community group scheme, you may not have fluoridated water. When we see decay in young children, our first question is always about your water supply, and whether it is fluoridated or not.
Stop soother use by aged 4 – before any permanent damage to the teeth or lip and mouth development. Check to see if your dentist has a special “soother drop off box“ to make it easier for you.
My child already has decay. What do I do now?
Firstly, don’t worry and don’t feel guilty. It happens and the main thing is to deal with it and get the decay treated as soon as possible. If we catch the decay at an early stage, we can often do fillings at this stage. Young children are often excellent patients. Make sure your dentist likes treating younger children or, better still, find a paediatric dentist, who specialises in seeing young children.
Sometimes we use stainless steel crowns for baby teeth, instead of fillings (baby teeth are so small it can be hard to get fillings to stay. So the crown is like a metal coat over the tooth. This is where we find The Wand (for numbing teeth) to be really useful.
There's also a new treatment we can use if we see your child before the teeth have started to pain. We can paint a solution, SDF (Silver diamine fluoride ) onto teeth and place a GlassIonomer filling. This is done with minimal intervention and can successfully stop decay. However, the teeth may appear black, and there may be pain in the future.
If your child needs multiple teeth extracted, and needs to go to hospital—then talk to your child. Explain they will be put to sleep and when they wake up their bad teeth will be ready for the tooth fairy. It's important to talk about waking up –there's often a lot of talk about being put to sleep, and children can worry that they won’t wake up. The calmer your child is before the anaesthetic, the easier it is to get them anaesthetised and recovery will be better also.
Proposal to Introduce Fee Dental Care for Children under 6 - Smile agus Slainte
What do we think of the proposal to introduce free dental care for children under 6? We think it is something to aspire to in the future, but to fully implement it we need to raise awareness of oral health and educate parents so we're offering a preventative rather than a treatment based service. There's a great network of HSE children's dental clinics in all of our towns. We need to fully resource these to ensure all children have access to dental care and treatment. We don’t want a situation where HSE clinics are closed and children have no access to care in a private practice.
The proposals in Smile agus Slainte, particularly the implementation, raises a lot of unanswered questions and there's a lot of groundwork to be done before this becomes a reality.
In the meantime, we're considering introducing a limited free scheme for 1 to 6 year olds (children need to be decay free to start this program). Our goal will be to keep them like that. Message us on Facebook if you would like more details.