Key learning points:
– Recognising when there is a problem with a child’s dental health
– Helping parents and/or guardians improve a child’s dental health and oral hygiene
– Understanding what a child’s daily dental routine should include
It is a staggering thought, but in primary schools across the United Kingdom around eight or nine children in every class will have already developed tooth decay. That’s approaching a quarter of a million children in each primary school year and around 3.3 million young people aged 0-14 years.
Many of these cases actually present themselves at a far earlier stage, with around one-in-three children starting school with visible signs of tooth decay. Given that tooth decay is an entirely preventable disease, along with the dangers that suffering with oral diseases can have upon their lives, there is a far greater need for developing and maintaining good dental health practice in children. Being at the forefront of the profession, we’re in a perfect position to make these positive changes and help improve the health of millions of young people around the country.
The first steps are the most important
Whether it’s their first tooth or their first visit to the dentist, a child’s early experiences of dental health can impact on the rest of their lives. If they have positive experiences then there is a much greater chance of them taking them forward into adulthood, however, the first encounter for far too many children is quite often a negative one.
Children exposed to adverse experiences are more than twice as likely to develop tooth decay and gum disease and suffer from conditions such as unfilled cavities, missing teeth and toothache, all of which can have serious implications for overall health.
That’s why it’s so important to teach children about their mouths and introduce them to good habits as soon as possible. Working with parents to develop a positive home environment is crucial for a child’s development in many aspects of their life, including their dental health. It is vital that we continue to offer support for families, individual parents and the children themselves, to ensure their upbringing is as comfortable and stress free as possible.
It is becoming increasingly important that screening for adverse childhood experiences in dental visits continues to be improved so future research can focus on reﬁning intervention plans and minimising dental health disparities. In addition to offering support to families, it is important that we work with nurseries and schools too. We all need to be more aware of how we can help to reduce the chances of a child developing poor oral health.
The implications of poor dental health
A healthy smile can be a great asset. Not only can it benefit us socially and help us with other things such as our careers and relationships, but it also has many more practical benefits. Our teeth have such an important role to play in our lives. They help us chew and digest food, they help us to talk and speak clearly and they also give our face its shape. Because of this, it makes sense to give our oral health the best care possible, and it all starts from childhood.
It is important to support children and their parents and help them understand about why good dental health is so crucial to their upbringing and share advice and guidance about how to improve and maintain it.
The consequences of ignoring their dental health could be disastrous. Numerous scientific studies over a prolonged period of time have shown links between poor oral health in adults and some major health conditions. This is especially prominent between gum disease and conditions such as diabetes, heart and lung disease and poor pregnancy outcomes. This highlights the importance of good dental care, particularly from an early age. By teaching children to build and keep up a good oral hygiene routine at home and visiting their dental team regularly, we can help reduce conditions such as gum disease and avoid the risk of other problems later on in life.
Noticing when there is a problem with a child’s dental health
Tooth decay in children is without question, the single most common childhood disease today. Almost a third of five year olds and half of eight year olds have dental decay in their primary/baby teeth while a third of 12 year olds and nearly half of 15 year olds have obvious signs of decayed teeth in their permanent/adult teeth.
Tooth decay happens when the enamel and dentine of a tooth become softened by acid attack after we have eaten or drunk anything containing sugars. Over time, the acid makes a cavity (hole) in the tooth. Tooth decay is caused by plaque acids that gradually dissolve away the enamel and dentine of the tooth. Decay damages our teeth and may lead to the tooth needing to be filled or even taken out.
These acid attacks can last for an hour after eating or drinking, before the natural salts in our saliva cause the enamel to ‘remineralise’ and harden again. It’s not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids (these are the ‘fermentable’ carbohydrates: for example, hidden sugars in processed food, natural sugars like those in fruit, and cooked starches).
There are a few ways to spot something like tooth decay. The first, and potentially most obvious sign could be a patient complaining of a toothache. Toothache is a sign that something is wrong and must be treated before getting any worse. It is painful and upsetting, especially in children, and the main cause is tooth decay.
Once the cavity has reached the dentine, the tooth may become sensitive, particularly when the patient has sweet foods and drinks, and hot or cold foods.
The toothache occurs as the decay gets near the dental pulp and it is important they are seen by a dental team straight away as the tooth is dying, and it may develop into a dental abscess if it is not treated.
A visual inspection should confirm whether the child has a cavity. The biting surfaces of the teeth and the surfaces between the teeth are most likely to decay, because food and plaque can become stuck in these areas but any part of the tooth can be at risk.
In most cases, visual examinations can uncover other areas of poor dental health in children such as:
· Cracked teeth.
· Loose or broken fillings.
· Mouth ulcers.
· Bad breath.
· Stained teeth.
· Gingivitis (early gum disease).
· Tooth loss.
· Dental erosion.
It is important that anything unusual in the mouth is referred onto the dental team.
Tooth decay:if it is caught early enough, the dental team will remove all the decay and repair the tooth with a filling. In the very early stages of decay, the dental team may apply a fluoride varnish onto the area. This can help stop more decay and help ‘remineralise’ the tooth. Sometimes the nerve in the middle of the tooth can be damaged and the tooth can become infected or form an abscess. If this happens, the dentist may have to remove the baby tooth, if it is an adult tooth, the dentist would normally carry out a root canal treatment to remove the dead nerve tissue to prevent further infection. However, if the tooth is so badly decayed that it cannot be repaired or root filled, the dentist may have to remove the tooth out.
Gum disease:the dental team will remove all scale or tartar from the teeth. The patient will also be shown how to remove plaque successfully themselves, cleaning all the surfaces of their teeth thoroughly and effectively. This may take a number of sessions with the dental team. A good oral care routine at home with brushing and interdental cleaning is the most important thing a patient can do to help prevent gum disease getting worse.
Cracked or broken teeth: when the child’s teeth are primary, then most likely the tooth will simply be taken out. If the child is older and a cracked tooth appears on their adult teeth, then there are a number of treatments available. Bonding to infill the crack, cosmetic contouring to smooth off any rough edges, veneers or crowns are all viable options.
How to help parents/guardians improve a child’s dental health
It is important to give parents and guardians’ simple and effective advice and guidance about how they can care for their child’s dental health at home. Helping to clean their child’s teeth should be part of the daily hygiene routine. Parents may find it easier to stand or sit behind their children, cradling their chin in their hand so they can reach their top and bottom teeth easily.
The following tips should be given to parents:
· When the first teeth start to appear, try using a toothbrush designed for children, with a small smear of fluoride toothpaste.
· It is important to supervise your child’s brushing until they are at least seven.
· Once all the teeth have appeared, use a toothbrush with a small head and soft bristles in small, circular movements and try to concentrate on one section at a time.
· Don’t forget to brush gently behind the teeth and onto the gums.
· If possible, make brushing a routine – just before the child goes to bed and at least one other time during the day.
· Remember to encourage your child, as praise will often get results.
The dental care routine
The daily oral hygiene routine is the single most important preventive measure we can instil in children to make sure they develop and maintain good dental health and stay clear of any potential oral diseases.
Parents and education workers need to be fully aware of how they can help to reduce the chances of children developing tooth decay and other oral diseases. There are three simple things that all dental care routine should involve:
Brushing:The best way to prevent any dental health problems in children is by helping them to brush their teeth thoroughly last thing at night and at least one other time during the day, with fluoride toothpaste. All children up to three years old should use toothpaste with a fluoride level of at least 1000ppm (parts per million). After the age of three, children should use toothpaste that contains 1350ppm-1500ppm. Encourage them to spit out the toothpaste and not to swallow any if possible, if they do not rinse after spitting the fluoride will remain in the mouth for longer and give them the best protection against decay.
Make sure the inner, outer and biting surfaces of teeth are brushed. Using ‘interdental’ brushes, or dental floss or tape, also helps to remove plaque and food from between the teeth and where they meet the gums – areas an ordinary toothbrush can’t reach.
Diet:A healthy and balanced daily diet is crucial for maintaining good dental health for children. It is important to keep any sugary foods and drinks to mealtimes only. Try to encourage them to drink milk and water instead of soft and fizzy drinks. A diet that is rich in vitamins, minerals and fresh fruit and vegetables can help to prevent gum disease while consuming low frequencies of sugar will help prevent tooth decay. If the children drinks fruit juices or squashes, make sure that they are diluted and using a straw will ensure that the acidic juice is in contact with the teeth is kept to a minimum.
Dental visits:It is also recommended that children should go to the dentist with their parents as soon as possible. Parents should then take them regularly, as often as their dental team recommends and certainly by the age of two and a half years, children should be having regular dental check-ups so that any budding oral health problems can be spotted early. This will let the child get used to the noises, smells and surroundings and prepare them for future visits. The earlier these visits start, the more relaxed the children will be.
Giving all children the best start in life is an objective all of us should aspire to achieve, for health professionals, schools and parents alike. By working together, being able to spot the early warning signs of oral disease and being able to give sensible dental advice, we can ensure young children everywhere receive the right information, delivered in an easy-to-understand way, which they can later adopt at home.
Teaching good habits and routines at an early age means they are more likely to be continued into adulthood. By instilling the importance of a healthy
mouth at a young age, we are not only creating good health for these children now, but the benefits will most likely continue far into the future.
· Health and Social Care Information Centre, Children’s Dental Health Survey: England, Wales and Northern Ireland. 2014.
· British Dental Health Foundation, Tell me About: Dental Decay. 2015.
· British Dental Health Foundation, National Smile Month: Our Oral
· British Dental Health Foundation, Tell me About: Children’s Oral Health. 2015.
· NHS Choices, Toothache. 2015.
· British Dental Health Foundation, Tell me About: Dental Care for Mother and Baby. 2015.
· British Dental Health Foundation, Tell me About: Teens Teeth. 2015.
· British Dental Health Foundation, Tell me About: Diet 2015
You are currently leaving the Nursing in Practice site. Are you sure you want to proceed?