FAQs on Dentistry for Children by Liverpool Dentists

Are some children more prone to decay than others? If so what can you do about it?

Some children have more decay than others and are more susceptible to decay. This can be true of children in the same family. The only way we can tell is by the amount of decay present: those who have decay at the age of two are probably going to have more problems with their permanent teeth.

What can parents do about this?
These children would probably benefit from extra fluoride, which can reduce their susceptibility to decay by about half. Fissure sealing may also be recommended for children whose teeth are ‘at risk’. This involves painting a plastic coating on the permanent molars. It is particularly useful for teeth with deep groovesm,which cannot be reached with a toothbrush.

Meanwhile, limiting the number of times children eat sugary foods or have sweet drinks, and brushing effectively are the main weapons against decay.
Children under seven don’t have the manual dexterity or the mental application to brush effectively, so parents should do it for them. Technique is less important than the end result. What matters is that you reach all areas of the mouth. Use a small-headed brush with soft bristles. The shape and angle of the head aren’t important.

How Much Fluoride?
Advice to parents has changed in recent years. Whereas it was thought that fluoride worked best if given by mouth as drops or tablets, dentists now think that topical application, in toothpaste, is preferable. Most dentists today recommend supplementation only for children at high risk of decay – for example those with decay in their milk teeth. Children who aren’t at particular risk should get all the fluoride they need from toothpaste.

If a child has too much fluoride when the permanent front teeth are developing – around the second birthday – it can lead to the discoloration know as fluorosis. But working out how much a child is getting can be difficult. It’s the total intake – from supplements, toothpaste and the water you drink – that matters.

All water contains some fluoride (including bottled water), but you can’t tell how much, unless you call your water company to ask. If you live in an area with more that 0.7 parts per million of fluoride in the drinking water, don’t give your child extra fluoride.

Young children often swallow toothpaste and this can pose a problem. There is evidence of a connection between swallowing fluoride toothpaste and enamel mottling in children. It’s been suggested that young children may swallow up to half the paste on the brush, so children up to six who are caries-free should just use a pea-sized amount of low-fluoride toothpaste (around 500 parts per million). You can check the fluoride content of toothpaste in the list of ingredients – it’s listed as ppmF. Children over six, and those at high risk, should use a pea-sized amount of adult-strength fluoride toothpaste (1,000 or 1,500 ppmF), rather than ‘baby’ toothpastes, which contain less fluoride.

According to the latest evidence, it is best to spit out toothpaste but not to rinse. The more frequently children rinse and the more water they use, the quicker the fluoride is cleared from the mouth. Not rinsing means fluoride is retained in the mouth longer, giving better benefit.

The mottling caused by fluoride – fluorosis – is permanent, but there are ways of cosmetically whitening the teeth using micro abrasion, a crown or white filling material.

A slow-release fluoride implant developed by Jack Toumba at Leeds Dental Institute releases fluoride continuously into the mouth. The implant is made of glass, is about the size of a grain of rice and is attached by the dentist to the back tooth with dental cement. One study showed that after two years, children with this implant had 76 per cent fewer cavities then those without the implant. The device may be available in about five years’ time. It won’t completely eliminate cavities, but it’s expected to reduce them dramatically.

Contributed by Dr Jack Toumba

To Fill or Not?
A 1995 survey of pre-school children showed that only one in eight of those with decay had had a filling, a figure paediatric dentists find shocking. There is a widespread belief that baby teeth don’t have a nerve supply, and so don’t need to be filled. This is nonsense. If there is decay in baby teeth it needs filling, otherwise the decay will worsen and cause pain. Occasionally, if there is no pain and the tooth is going to fall out naturally within six months it can be left.
Mercury amalgam fillings are the subject of enormous controversy. Amalgam is a toxic substance and some experts are concerned that it may leak out of the fillings and accumulate in the body tissues. The Department of Health has advised that amalgam fillings should not be given to pregnant women. However, the evidence against mercury amalgams is not conclusive, and many dentists continue to use them.

Removing an amalgam filling can sometimes be more risky than leaving it in place because fine mercury particles are released during drilling.
It is hard to match amalgam for its longevity and its ease of application. In this practice we are using fewer and fewer amalgam fillings. The alternative materials are improving all the time.

Which Drink?
No drink other than milk or water is totally safe. Fruit drinks contain naturally occurring fructose which can cause decay in just the same way as added sugar.
But sugar isn’t the only problem. We’re also seeing more acid erosion of teeth, particularly in teenagers and young adults. Fizzy drinks – even diet drinks – contain carbonic acid, and orange, apple and grapefruit juice are also extremely acidic. This changes the acid/alkali balance in the mouth. The acid begins to dissolve the enamel of the tooth, the dentine is exposed and the teeth become sensitive.
The best way to avoid this decay is to keep a check on how often your child drinks and for how long.

If your child is going to drink juice or fizzy drinks, it’s better to have them with meals, when the mouth is producing plenty of alkaline saliva, which helps to protect the teeth from the acidity of the drinks. My advice is to restrict children to five ‘meal moments’ a day – three main meals and two snacks. At those times, children can eat and drink what the like as long as they are brushing twice a day with a fluoride toothpaste. The rest of the time, stick to milk or water. When they have a fizzy drink, give them a straw and make sure they drink it quickly.

Contributed by Dr Jack Toumba

10 Ways To Protect Your Child`s Teeth

Supervise under-sevens with tooth brushing. If they want to do it themselves, let them, but still do a final brush for them when they’ve finished.
Brush with fluoride toothpaste twice a day. Children over six can use an adult-strength formula.
Don’t let them rinse after brushing.
Only give juice or fizzy drinks with meals or snacks. Stick to milk or water at other times.
Use a straw for fizzy drinks.
Encourage your child to consume drinks as quickly as possible, rather than sipping them over a long period.
Limit sweet-eating to straight after meals, when the extra saliva created by chewing will help to protect the teeth.

If your child’s first teeth are already decayed:
Give fluoride drops, but ask your dentist’s advice first.
Take your child to the dentist so his teeth can be filled.
Ask about fissure sealing