Dental advice for children 0 - 4

Children 0-4

Introduction

Baby teeth are important for eating a healthy diet and speaking clearly. They affect a child’s appearance and willingness to smile and they keep the space for the permanent teeth. Care of baby teeth should begin even before the first tooth erupts. The time when babies get their first primary teeth (milk teeth) varies. A few are born with a tooth already through. Others have no teeth at one year old. Most get their first tooth at around six months, usually in front and at the bottom. Most have all their primary teeth by about two and a half. There are twenty primary teeth in all, ten at the top and ten at the bottom.

The early months are the best opportunity to influence what a child will enjoy eating and drinking. Dental decay is caused by sugar and it is not just the amount of sugar in sweet food and drink but, perhaps more importantly, how often there are sugary things in the mouth. Toothache is distressing for the child and the family. The pain may affect other aspects of their daily living: problems with eating, sleeping, concentration and behaviour and may result in young children having teeth extracted under general anaesthetic.

Diet

Sugar is the main cause of tooth decay. Breast milk is the best form of nutrition for infants. When breastfeeding is not possible, a cows’ milk formula is the preferred option. However mothers who have been advised by their GP or other health professional to feed their baby soya-based infant formula, should continue to do so. Soya-based infant formula contain sugars that can cause tooth decay, so it will be particularly important to be careful about caring for the baby’s teeth once they start coming through. As children grow up they can learn to enjoy a wide variety of foods. There is no need to ban sweets and biscuits but they will do less damage if they are eaten after meals or saved for a specific treat time.

It is not only important that good dietary habits are established at home, but in other settings where the child may spend part of their day. Nurseries and Pre-schools should be health promoting settings and should provide a positive example to children and parents where good dietary habits are encouraged. Birthdays are about making a child feel special and playgroups and pre-schools should try and celebrate without sweets or cakes. A written policy on healthy eating avoids misunderstandings and introduces new parents to the rules of the group. The policy may cover what snacks and drinks the group serves and whether or not parents may bring snacks and how the group celebrates birthdays.

Children's Drinks

Drinks other than breast milk and infant formula contribute little to nutrient needs and if consumed in excess or between meals, they are likely to reduce appetite for more nutrient dense drinks and foods. Cooled boiled water can satisfactorily quench thirst. ‘Early childhood caries’, previously referred to as ‘nursing bottle caries’ usually affects children’s front teeth. The teeth appear brown or black in colour and may be decayed right down to the gum level. Decayed front teeth will spoil a child’s appearance until the second teeth come through at about 7 years of age.

The prolonged contact time between sugar in the drink and the teeth is well recognised as a cause of early childhood caries. The risk is increased if the feeding bottle is used to comfort the child, especially at bedtime or when in a cot or pushchair. If sugar sweetened drinks are given to younger children, they should be very well diluted, taken preferably at meal times only and drinking times should be kept short. An open cup or beaker should be used, never a bottle. It is important that babies and young children have enough to drink to prevent constipation and a child’s normal fluid intake should ideally be plain water or milk. Babies should drink from a cup as soon as they are old enough to hold one which is usually by the time they are 6 months old. It is recommended that water and milk are the main drinks offered to young children at this age. Bottle feeding should be discouraged after the age of 12 months.

Dummies

Using a dummy for long periods of time after the first teeth have come through can cause a gap between the top and bottom teeth. Using a dummy during waking times, can also make toddlers dribble a lot giving them a sore chin. Dipping dummies in sugary foods can cause tooth decay. Sucking of dummies or fingers may displace permanent teeth if the habit is not given up before the second teeth come through. Use of dummies should be restricted to sleep times from about 12 months of age.

Sugar free medicines

Sugars in medicines may also cause decay. Many paediatric medicines, including those sold without prescription, have sugar free alternatives. Clinicians should prescribe sugar free medicines and parents/carers should request them. Pharmacists should be encouraged to stock and recommend sugar free alternatives to the most commonly used prescription and general sale medicines.

 

Tooth brushing

Regular, twice daily, tooth brushing with a family fluoride toothpaste can be introduced as soon as the first tooth appears. This gives the teeth the benefit of fluoride protection as soon as they appear in the mouth. It is important to teach a child to accept a toothbrush and toothpaste and fit into the other normal routines like bath time, bedtime and washing.

A small, soft toothbrush should be used, with just a smear of toothpaste, increasing from the age of about three years, to a small pea sized amount for children under seven years. A gentle and systematic approach should be used with the aim of cleaning the outside, inside and biting surfaces of all teeth, including the back ones when they appear, usually between one and two years of age.

Younger children are often happy to brush their own teeth but lack the manual dexterity to do so efficiently. Parents or carers should supervise or assist with brushing until the children can do it effectively, usually by the age of seven years. However, some children need supervision beyond this age.

The regular use of a family fluoride toothpaste is recommended. However, care should be taken to ensure younger children do not eat toothpaste directly from the tube or swallow excessive amounts from the brush. Children should spit out and not rinse after tooth brushing.

Visiting the Dentist

Everyone should visit a dentist. Children and young people up to the age of 18 years should see the dentist at least once per year for a dental check-up or more frequently if recommended by the dentist and children especially may need to be seen more frequently.

The dentist can give advice from birth. Dental treatment is free for all mothers during pregnancy and up to when you child is one year old. Dental treatment is free for all children up to the age of 18 years.

Teething problems

The eruption of teeth contributes to the development of biting and chewing and increases the child’s ability to explore different food textures. The term ‘teething’ is usually used to describe the troubles associated with the eruption of the primary teeth, which may occur at any time between 5-6 months and two and a half years of age.

One of the first features that parents notice is that the baby is salivating and dribbling more than usual, and the cheeks may be flushed. The baby may be restless and will not go off to sleep, presumably because of the discomfort the teething is causing. This is usually accompanied by the child having an urge to chew on hard objects. Giving the child something to chew on usually helps and various teething rings are available which can be cooled in the fridge. Teething should not be relieved by the use of a dummy dipped in any sweetened liquid. If pain is severe, then sugar-free paracetamol may give relief.

Unfortunately, the onset of teething coincides with the child having increased susceptibility to many infections. This is why in the past, teething has been blamed for illnesses from gastro-enteritis to convulsions. The early signs of serious infections may be dismissed as ‘teething’, instead of treatment being instituted. Therefore, if children who are teething appear to be unwell with a raised temperature or gastro-intestinal disturbances, they should be referred to their general practitioner for investigation.