A problem or a crisis
Harsha Kumar shares her thoughts on children’s oral care and on why parents need to be better educated about the crucial role they play in encouraging good dental hygiene
I’m sure we’ve all been faced with a patient who cautiously asks: “Baby teeth aren’t even important are they?” I’m incredulous, but always try to hide my disbelief, calmly explaining that baby teeth are important to their child’s health and development, and will impact their ability to chew, speak, smile, as well as provide the pathway through which permanent dentition will follow.
But how big a problem is children’s oral health in the UK? Firstly, I’d classify it as a ‘crisis’ rather than a problem. It is anathema to me that the most common disease in children in the UK is preventable. In February 2018, Public Health England Health Matters reported that a quarter of five-year-olds (24.7 per) have tooth decay, with on average three to four teeth being affected; so, that’s one in four children with tooth decay before they even start school.
The survey found that tooth decay was the most common reason for hospital admission for children aged between five and nine in 2012 and 2013 and more than 63,000 children aged 0-19 years were admitted to hospital for tooth extractions in 2014 to 2015 and this number was a rise of 3 per cent than the previous year!
Research has shown that in North West England hospitals 26 per cent of children had missed school because of dental pain and infection, and there is an average of three days of school that are being missed due
to dental problems. It was also
shown that 38 per cent of children had sleepless nights because of dental pain.
The NHS spends approximately £3.4 billion per year on all ages primary and secondary dental care. The BBC also publicised last year that more children are having teeth out in hospital in England –42,911 operations in 2016-2017, up from 40,800. That’s over 2,000 more operations in just one year. Dr Claire Stevens, aka ‘The Tooth Fairy’, an NHS consultant in paediatric dentistry, said that most of her patients were aged between five and nine, and that it is not uncommon to remove all baby teeth from a two-year-old because of dental decay!
So, what are the barriers to improving children’s oral health? As a hygienist, I feel that there is a lack of knowledge about oral hygiene in children. Many parents don’t even know that they are putting their children’s health at risk by not knowing the facts about dental care.
A lot of parents that I come across say that they didn’t even know when to start brushing their children’s teeth or when to start bringing them in to seeing the dentist. Some parents have even admitted to me that they didn’t think they ‘baby’ teeth were that important as they would fall
There are also some parents who say they find it too difficult to brush their children’s teeth or get the child to brush their own teeth as they are not compliant. There is also a lack of knowledge on the links between children’s diet and oral diseases, most parents know about sweets and chocolates causing rotten teeth (although a lot of parents don’t know about hidden sugars) but have no idea on acidic food and drinks.
I have two children, aged nine and four, and so I can relate to most parents and understand how difficult it can be to get your child to be compliant. My first-born was quite good and got along with brushing his teeth from a very early age and he now likes the routine including flossing and mouth washing. My second however was not so compliant; she found everything too ‘chilly’ or she’s always too tired or she’s just being stubborn and throwing a mini tantrum. When your child is being a mini terror, it is so easy just to give in! But It is so important to understand why we must persevere and ‘get in there’ to gain a good oral hygiene.
I follow the guidelines set out in PHE’s Delivering better oral health: an evidence-based toolkit for prevention, recommending that all parents or carers should be supervising children’s brushing until at least six years of age. I recommend to all my patients to monitor all children’s toothbrushing and to then go over them themselves until the age of 12 years. I recommend this as some children just cannot effectively remove all the plaque in their mouth themselves, especially when they have a mixed dentition. I do feel that more people are becoming aware of dental care and the role of the dental team and how prevention is better than treatment. However, the message needs to be way more widespread!
I recommend the following:
1. Brush as soon as your child has their first tooth! Starting them at such a young age helps in adapting a good regime and it teaches the child that this is the norm.
2. Brush twice a day with fluoridated toothpaste.
3. Brush every tooth and include the gum line too and then brush the tongue and cheeks too. Now this can be tricky especially at night times when most children become irritable and become too tired, therefore I recommend brushing after the child has finished their last meal of the day and one other time.
4. Supervise and monitor a child’s brushing until the age of 12 years old; this is because up until the age of 12 most children still have a mixed dentition and so may not brush effectively.
5. Encourage flossing at a young age but monitor the children when flossing. Again, every child is different so it is difficult to give a definite age at which they should start flossing but I would say roughly introduce flossing at age 8 and then make it a daily routine by the age of 12.
6. Mouthwashing at a different time to brushing helps cleanse the mouth and gives a healthy boost during the day.
7. Make brushing fun. Maybe introduce rewards, such as stickers or a treat for good brushing behaviour. Praise them even if their technique isn’t quite as good as it should be! Using disclosing tablets can help children ‘see’ the problem and make it a challenge to remove the plaque.
8. Give them knowledge. Kids are like a sponge and can absorb and retain so much information. Make the message relatable to the child’s age, i.e. you could describe plaque as a ‘baddie’ that needs to be ‘scrubbed away’, you’re then giving them a reason to want to brush their teeth.
9. Give parents and/or carers evidence-based written information and guidance, as messages can be so easily forgotten once outside the surgery. I use the Strong Teeth Make Strong Kids material developed by Oral-B in conjunction the University of Leeds. This gives me the confidence that the advice I’m giving is backed up by research,
and is designed to instigate behavioural change.
10. Dietary advice is also key. It’s unrealistic to expect parents to eliminate all sugary treats, but I encourage consumption to be restricted. I try to simplify the demineralisation and remineralisation of tooth enamel cycle, and explain that it’s better to have a treat with meal times than as a snack. Limiting fizzy and sugary drinks is a must and, should they consume these I always recommend a straw.
11. Where possible I encourage children to get an electric toothbrush, which may make brushing more easier and fun thus resulting in better plaque removal. Having a kids-themed electric toothbrush has made my children brush better. Children tend to love technology so it makes sense to bring this into the bathroom.
A good relationship between the dental team and parents and carers of children is essential to improve oral hygiene among children. To prevent oral disease, we need to spread the knowledge not the disease.
Every child matters.
Harsha Kumar is a dental hygienist and therapist in the East Midlands, treating nervous children for fillings and extractions. She qualified in 2012 from The University of Leeds. She practices four days a week at three different practices