How to take care of your child's teeth ?

Though we all are aware of the fact that prevention is better and cheaper than cure and it is prudent to take preventive measures in health care rather than curing once we are afflicted by the disease, we seldom apply that in our practice. It is good to see that people are oriented more towards preventive measures and have started to get regular health check up and dental check ups these days. Even the children are getting more care than they used to get in the past, may be because of awareness, availability of health care facilities, or rise in the economic standard of the households. People may not have idea about how they should take care of their child's teeth even if they are willing to. This short article attempts to address the concerns of such parents.

1. When should the first dental visit be?

This is a common question people are unsure about. When should they take their children to the dentist ? The first dental visit should be at around the time of eruption of first deciduous teeth (i.e. 6 months) and not later than 1 year of age of the baby. If your child has teeth since birth (natal teeth) or if a tooth erupts within one month of birth (neonatal teeth), that may traumatize the delicate gums of the opposite arch. You need to check that on your own and consult a dentist if necessary. If your child has got cleft lip and palate since birth, the repair should be done as soon as possible consulting a oral and maxillofacial surgeon.

2. Is it necessary to clean the oral cavity of my baby even when s/he has got no teeth ?

Yes. You should clean the gum pads of baby after feeding every time with a wet soft gauge or wet cotton. This will reduce the chance of bacterial colonization in the baby's oral cavity. As the immune system is very poorly developed at that stage, they are prone to frequent infections if not done so. You should not kiss the baby on the tongue which will transfer bacteria from your oral cavity into theirs. This may result in infection and the developing tooth germ may be affected (see: Turner's hypoplasia).

3. What are the reasons for getting caries in the tooth of children and what can be done to prevent that?

Dental caries is the demineralization of dental hard tissues (inorganic) and softening and decomposition of the organic part due to the action of acids produced by certain bacteria (mainly Streptococcus mutans). Dental caries is the most common disease affecting about 4-5 billion population of the world. Mainly foods containing sugar are responsible as the acid is produced by the fermenting action of bacteria on the sucrose and other disaccharides. The deciduous tooth of child are more prone to caries as they are not well matured and hence are easily demineralized.

To prevent dental caries, habit of vigorous rinsing of the oral cavity should be inculcated in the child after eating anything (particularly sticky sugary foods like chocolate, candies, biscuit, etc.). They should be facilitated to brush at least twice a day after meal with a fluoridated toothpaste. For very small child, who might swallow the toothpaste, non fluoridated toothpastes and toothpastes with fluorides in lower concentration are too available. Topical fluorides may also be applied in a dentist's office which will provide a long term protection (of around 3 months).

4. The children's teeth will fall and get replaced eventually, why bother even if they are decayed or are lost due to caries? 

All deciduous teeth (milk teeth) will have completed eruption by the age of 2.5 to 3 years, but the process of exfoliation of deciduous and their replacement by eruption of permanent teeth (succedaneous teeth) continues from seven to twelve years. If the primary tooth are lost too soon, and if there is a long gap between the exfoliation of deciduous tooth and eruption of primary tooth, the space is occupied by the adjacent tooth which drift towards the space and make it more narrower. Due to this, the permanent tooth supposed to erupt in that place might get impacted within the gums or might erupt irregularly in the arch causing crooked teeth. Besides, frequent dental visits may require frequent leave from their school which will affect their cognitive development. The child may be teased and bullied by their mates about the braces, about the caries they have and the child might be traumatized emotionally. Also, general growth and development may be affected due to malnutrition as the child cannot take adequate food due to dental problems.

It is believed that dental caries is a disease due to disorder in habit rather than due to the food taken. So, the child having caries in deciduous dentition is more likely to have caries in his permanent dentition too. Hence, dental care needs of a child should be given proper attention.

5. He won't listen to me when I say not to eat sweet foods and brush regularly. What should I do?

Small children don't know the consequences of eating sweets and not brushing. Their mental development is not so well developed that we can reason them into brushing or not eating chocolates. As they imitate us, we should be very careful to set an example and make the home dental-friendly. Will the child obey us if we tell him not to eat chocolates and he has seen us eat four big chocolate bars all by ourselves ? How much accessible is the chocolates and sugary foods for the child? Do our fridges and drawers always have some chocolate ? Even if we have to give them chocolates, we should give them just before taking meal only after they promise they will brush immediately.

 To encourage brushing, we can let them choose the color of toothbrush themselves and select the toothbrush that has small head and soft bristles. We should also brush along with them by playing their favorite song/rhyme. A habit developed in early childhood will remain lifelong.

With proper care at home and assessing the caries risk, consultation with a dentist should be done every 3-6 months as per the requirement.