"Parents, don't let your children brush their teeth on their own"

Interview with Dr. Chantal Kengo, Specialist Pediatric Dentist

One of the main causes of tooth decay in children is poor oral hygiene, more specifically inefficient brushing of teeth. What happens when we let our children do the brushing on their own? Find out from Dr.  Chantal today.

You see a lot of children and parents every day. What do most parents say when it comes to brushing their children's teeth?

During consultation, parents would often say "My child knows how to do it", "My child does not want me to brush his/her teeth" or "I want my child to be independent." Most parents allow their children to brush their teeth by themselves. What happens then? The child does a very poor job of cleaning his teeth, and ultimately, the end result is cavities.

What do you recommend parents when it comes to their children's oral hygiene?

Every child is different but in general parents should brush their child's teeth until they are about 5 to 8 years old. Remember that it is very important that parents continue to supervise their children's brushing until the age 10 to 12. This is to make sure that they're doing it thoroughly. Brushing should be done for two minutes minimum twice a day.

What if the child insists on brushing on his own?

Brushing is a skill. Like many skills, it take years to learn it and be good at it. Young children usually do not have the manual dexterity to brush or floss properly. If your child wants to do it by himself, let him! It's a great way for him to practice but ALWAYS make sure that you brush his teeth before or after he's done it for himself. For older children aged 10 to 12 years, make sure that you supervise them. Be there when your child brushes his teeth and make sure that your child is doing it well. Reinforce whenever necessary.

Do you still see many cases of tooth decay in children?

I see a lot of cases. In fact, although tooth decay is preventable, the World Health Organization reports that around 60 – 90% of children around the world have tooth decay.

What other advice can you give parents?

Aside from proper oral hygiene and regular checkups, one other main thing that parents should focus on is their children's diet. I suggest a diet with very minimal intake of sugar to help protect your child from cavities. If you must give your child some sweets, give a small serving along with a main meal, or have a “Sweet Day”, one day in the week where your child can enjoy some sweets. Parents should also be wary about juices. Juices, even those labelled fresh or sugar-free, are loaded with sugar and acids. Limit juices and encourage your child to drink more water instead.

Is a Root Canal Treated Tooth Susceptible to Decay?

By Dr. Kavita Tarale, Specialist Endodontist

The only difference between a normal tooth and a root canal treated tooth is the absence of nerve supply and blood supply to the root canal treated tooth. And hence, there is no sensation to hot and cold food.

However, teeth that have had root canal treatment are at a risk of formation of tooth decay and gum disease, just like any other tooth. And if allowed to advance, either of these conditions can ultimately lead to tooth loss.

I have noticed that some of my patients think that since when a crown is done, very little or no original tooth structure is visible above the gum line, there is no chance of tooth decay on that tooth. A crown is connected to a natural tooth underneath it and because of this, decay can form around the edges of a crown.

Dr. Kavita Tarale, BDS, MDSSpecialist Endodontist

With proper care, root canal treated teeth can last life time. Root canal treated teeth tend to dry out, become brittle and can break. With a filling and crown, the tooth can be protected against breakage but not against decay. Proper brushing and flossing along with regular dental checkups can help prevent decay as well as any gum problems.

Dental decay or caries is an infectious disease caused by specific bacteria. But just having the bacteria present in your mouth does not mean you will develop decay. Other factors must be present. What are those other factors?

The most important other factor is sugar. When you ingest a meal with lots of simple sugars (this includes candy and sugary sweets, but also food with large amounts of sucrose), the bacteria consume those sugars. Upon consumption of those sugars, they release acid. That acid goes on to attack the mineralized part of teeth and weaken them. Over time, the hard enamel shell of the tooth is dissolved which leads to cavitation.

This decay process can occur on any surface of the tooth regardless of whether the tooth is vital (tooth with nerves and blood supply) or non vital (tooth that no longer has access to nutrients and blood flow). Hence, good oral hygiene practice at home along with a regular dental checkup is mandatory to maintain a healthy oral cavity.

Early Childhood Caries: A Major Health Concern

By: Dr.Carol Onyango DMD, MPH

1.        What is Early Childhood Caries (ECC)?

Dental caries is a chronic infectious disease caused by bacteria that breaks down sugar into acids which erode teeth over time. 

If a child under the age of six years old has at least one cavity, missing tooth due to dental caries or a filling on any baby tooth, then they are considered to have early childhood caries. 

If they are younger than three years old, and have a cavity on any tooth surface, then this is severe early childhood caries.

2.      What are the risk factors of early childhood caries?

Apart from poor oral hygiene, there are several risk factors that increase chances of getting ECC.  Young children are at risk of early childhood caries if their caregiver has high levels of the bacteria causing decay.  The disease can be transferred to the child through saliva for instance, when sharing utensils or cleaning a pacifier with the mouth. 

Other risk factors include a high consumption of sugar particularly between meals.  The most obvious foods that cause decay are chocolates, sweets, cookies, juice, sodas and so on.  However, sticky sweet foods such as raisins, dates and some dried fruit also increase the risk of tooth decay.  Some medicines given to children are flavoured with high amounts of sugar and this too may increase the risk of early childhood caries. 

Putting sweet drinks in sippy cups and milk bottles and/or allowing children to go to sleep with milk in a bottle increases the risk of developing ECC as well.

3.      What are the consequences of ECC?

The health of children’s teeth should not be minimised just because they are “baby teeth.”  When children have ECC, the resulting pain and infection can cause several major problems.  Most children are not very good at describing pain and parents may become aware of the severity only as a result of restless nights or poor sleep, poor eating habits and lack of concentration in school; all of which are very important for proper growth and development of the child. 

In addition, if ECC is left untreated for a while, the infection can become serious leading to high fever, admission into the hospital, emergency room visits and a much higher cost of treatment.  Children who have ECC are also more likely to develop caries in their permanent teeth if changes are not made early on.

4.      How can ECC be prevented?

a)      Mothers should make sure that they have a dental check-up and complete any necessary treatment to avoid passing on decay-causing bacteria to their children.

b)      Parents should also minimise saliva sharing activities such as cleaning pacifiers with the mouth and sharing utensils.

c)       Parents should bring their children to visit a paediatric dentist by age one to establish a dental home for their child.

d)      Oral hygiene is very important.  Parents should brush their children’s teeth at least twice daily with an age-appropriate toothbrush and fluoride toothpaste.  For children under age 3, a smear amount of fluoride toothpaste is sufficient while a pea-size amount should be used for children between 3 and 8 years old.

e)      Children at risk of getting early childhood caries should visit their paediatric dentist for professionally applied fluoride.

f)        Minimising consumption of sugar overall and also sweet snacks and drinks between meals.

g)      Minimising the consumption of processed foods that have high amounts of hidden sugars will also prevent tooth decay.

h)      Prevent putting children to bed with milk in a bottle and/or wipe teeth with a wet cloth after night-time milk feeding.

i)        Avoid putting juices and other sweet drinks in baby bottles and sippy cups.

j)        As children approach their first birthday, they should be encouraged to drink from a regular cup.

5 Things You Should Know About Fluoride & Your Child’s Teeth

By  Dr. Carol Onyango, DMD, MPH

1. What is fluoride?

Fluoride is a compound that contains the natural element known as fluorine. Routinely using small amounts of fluoride can help prevent tooth decay. Studies have shown that in places with community water fluoridation, decay rates have reduced by over 50 per cent and children grow up with fewer cavities. Where fluoride is not available in the community water, the use of toothpaste, mouth rinses and professionally applied gels and varnishes containing fluoride as the active ingredient is highly recommended to help reduce tooth decay.

Dr. Carol Onyango, DMD, MPH 
Specialist Pediatric Dentis

2. How does fluoride prevent cavities?

When sugar is broken down, it forms an acid which attacks and weakens the tooth enamel by causing the loss of minerals and creating cavities. Fluoride helps prevent this loss of minerals and encourages strengthening of the enamel in areas where cavities are just beginning to develop. Fluoride also affects the bacteria that help in causing the acid attacks on the teeth. When the use of fluoride is combined with a healthy diet and good oral hygiene, the risk for decay is reduced even further.

3. Is fluoride safe?

There is confirmation from clinical studies that fluoride use in the appropriate quantities for the prevention and control of tooth decay is both safe and highly effective. However, products containing fluoride should be stored out of reach of young children.

4. What happens if my child swallows fluoridated toothpaste while brushing?

To avoid ingesting excessive amounts of fluoride, always monitor children to make sure that they are using the correct amount of fluoride toothpaste for their age. This should be a smear amount for children less than three years of age and a pea-size amount for children aged 3-8 twice daily.

5. My child’s dentist suggests fluoride varnish? What is it for?

Topical fluoride is used and applied by a dental professional to prevent tooth decay. It comes in the form of gels, foams and varnish. Gels or foams are placed in trays and held against the teeth for up to 4 minutes while fluoride varnish is “painted” on teeth.

Image: American Academy of Pediatric Dentistry
Comparison of a smear (left) with a pea-sized (right) amount

World Oral Health Day 2016

It’s never too early or too late to start looking after your oral health. 

Sunday 20 March is World Oral Health Day. 

#WOHD16 #ItAllStartsHere

What Are the Potential Causes of Toothaches?

By Dr. Marwan Al-Obeidi, Clinical Head at Dr, Michael's Dental Clinic

There are many causes for toothaches. Carries could be primary, where the tooth has never been filled before (new decay) or it could be secondary, where it occurs below the fillings. It could also be caused by fractures or cracks of the teeth (patients who are grinding). Pain could also come from an impacted tooth. There are some case where the pain does not come from the tooth itself but from the gums around the tooth. Sometimes even nerve pain can manifest itself as toothache. That's why the dental checkups and visits are very important.

What You Need to Know About White Spots and Braces

Written by: Dr. Argiro Kechagia, Specialist Orthodontist

A very common problem that can occur while a patient has braces is the formation of white spots during treatment and it is always a bit disappointing to find that your teeth are marked with chalky white patches after your braces are removed.

But why?

Many believe that braces can cause these spots to appear, but in reality they are the result of plaque build-up just like any other form of tooth decay. These chalky patches, or dental decalcification, affect 24% of all teenagers without braces. That number jumps up to 50% in teenagers with braces. Although braces are not directly responsible for causing these white spots to form on your teeth, they can complicate the process of plaque removal. The white, chalky marks on the teeth appear when acids created by the plaque, remove minerals from the tooth surface and change the way it reflects light. Decalcification, most commonly affects the region between the gums and the brackets where plaque is most difficult to remove. So, braces do not cause white spots, bad oral hygiene does!

Can I prevent it?

Of course you can; and it is very simple, brush your teeth. Keep the plaque to a minimum. When you brush, be sure to focus on the areas that are obstructed by your brackets and wires, place the bristles of your brush underneath the wire. Finally, try to avoid having sodas and other foods that are high in sugar and acid, as these build plaque fast.

What if I have them already? Can I make them disappear?

1. The first step is to improve your oral hygiene with meticulous brushing in order to give some time (around 6 months) to the enamel to re-mineralize the affected tooth surfaces. All white spots improve some with time and minor ones may disappear altogether.
2. After 6 months our dentist can give you low concentration fluoride rinses and remineralization pastes that can be used in order to improve further the appearance of white spots.
3. Alternatively, bleaching, as it lightens the enamel, can make white spots to blend in better and actually improve as the effects of the bleaching wear off.
4. A newer technique, known as “caries infiltration,” involves injecting a liquid tooth-colored resin, which has optical properties closer to natural enamel, beneath the surface enamel in the area of the white spot. This makes the spot less opaque and more translucent like normal enamel.
5. For more severe problems, your dentist may perform microabrasion (removing superficial white spots), cosmetic bonding (replacing damaged enamel), or place porcelain veneers (covering badly damaged surfaces).

 Always remember that the best treatment is prevention.