Children Oral care

Tooth decay, or dental caries, in children is caused by acid from plaque bacteria. In children under 6, when the baby teeth are affected, it is specifically referred to as early childhood caries (EEC).

Plaque is a sticky substance that can accumulate on the teeth thanks to poor oral hygiene habits and/or a high-sugar diet. Acid from the bacteria in plaque breaks down the minerals that keep the tooth enamel strong (demineralisation). Saliva and fluoride help to restore these minerals (remineralisation), but an excessive build-up of plaque means that the rate of demineralisation exceeds the ability to remineralise. A net loss of minerals occurs, the enamel is weakened, and the tooth starts to decay.

Early-stage caries in children begins inside the tooth structure and will present as a white spot, or incipient caries lesion, on the tooth. As the decay advances, spots may appear yellow/brown. When the decay breaks through the surface of the child’s tooth, a visible cavity will appear in the enamel. As the decay progresses, it can spread to the dentine and pulp of the tooth, and may lead to tooth loss.

Dental caries is one of the most prevalent childhood diseases, with an estimated 530 million worldwide affected by early childhood caries alone. All children can experience tooth decay, from the moment the first tooth erupts, but the following factors increase their risk:

- Lack of fluoride from water supply and toothpaste.

- A diet high in sugary foods and drinks.

- Unrestricted, at-will feeding, including breastfeeding, in infants and toddlers.

- Giving babies and toddlers bottles of juice or milk at bedtime.

- Inadequate oral hygiene due to reluctance, lack of supervision, or poor manual dexterity and motor skills.

- Crowding or spacing of the teeth during the mixed dentition phase.

Tooth decay can have a significant impact on a child’s wellbeing and quality of life.

In the early stages of caries, some children experience sensitivity of the teeth. Younger children and babies may not be able to communicate this to their caregiver, and white spot lesions are sometimes difficult to spot to the untrained eye.

Dental caries may go unnoticed until the child starts to show visible decay and cavities, at which point they might be experiencing pain and discomfort. The child may also be having difficulty eating, drinking, speaking or sleeping. At this point, the damage to the tooth is irreversible, and the child may have to undergo distressing and invasive treatment to restore the tooth.

Advanced dental caries can leave the inner tooth exposed, causing severe pain and distress to children and babies. At this stage, it may be necessary to extract the tooth, often in a hospital setting, which can be very traumatic for children.

The complications of childhood tooth decay can have social and developmental consequences too, with affected children missing school or social activities because of pain or treatment. Missing or decayed teeth can affect speech development and communication, and can make children feel self-conscious about their appearance.

Prevention is a priority in the management of childhood caries. Parents can prevent tooth decay by:

- Brushing from the first tooth.

- Encouraging twice-daily brushing with fluoride toothpaste.

- Supervising and guiding brushing in young children and toddlers.

- Keeping sugary foods and drinks to a minimum.

- Discouraging snacking between meals.

- Giving babies and toddlers bottles of water instead of juice and milk at night.

Using an age-appropriate fluoride toothpaste will prevent build-up of the plaque that causes tooth decay in children, and help to remineralise and protect the enamel against acid attacks. Before a cavity has developed, this can be sufficient to reverse caries.

In early-stage caries, or for children at high risk of developing caries, dentists may recommend more intensive fluoride therapies. They may administer a protective in-office varnish, like Colgate Duraphat Varnish, which coats the teeth with an ultra-high-fluoride solution for proven caries prevention in both primary and secondary teeth.

For children with permanent teeth, a sealant can also be applied to the molars and premolars. This fills the pits and fissures in the teeth, which can be especially prone to plaque build-up and caries development.

For children over 10, dentists may also recommend a prescription-strength fluoride toothpaste like Colgate Duraphat Toothpaste 2800ppm.

Once a cavity has developed, enamel damage cannot be reversed. The decayed tissue must be removed and the cavity filled. If decay has reached the pulp, a root canal or an extraction is usually necessary and will sometimes require a hospital admission.