Introduction

Most dentists are of the opinion that oral health care of infants and toddlers should begin before the first tooth erupts. Dental decay or dental caries can take place as soon as the first tooth erupts and gets exposed to the oral environment. Therefore it is important to ensure that teeth and gums are cleaned routinely to prevent the process of decay.

Teething

The first tooth erupts when the infant is 6 to 8 months old Eruption of the deciduous dentition is completed when the child reaches 3 years of age.The lower front teeth are the first to erupt, followed by the upper front teeth.With completion of eruption, there will be 10 teeth on the upper jaw and 10 teeth on the lower jaw.

First visit to the dentist

In June 2008, Oral Health Division,Ministry of Health Malaysia launched the programme for early childhood oral healthcare ‘Never Too Early To Start’ which recommends the first visit to the dental clinic when the infant is 6 months of age or after the first tooth erupts and no later than one year.

How does dental decay begin ?

Proper and continuous oral health care is important to ensure healthy gums, teeth and fresh breath. If teeth are not properly cleaned, a sticky, yellowish substance called plaque will form on the tooth surface.Plaque contains bacteria responsible for the acid formation.Bacteria acts on sugar from the child?s diet to form acid which attacks the enamel and dissolves it. This is the onset of caries formation. If not detected the caries will progress to the inner layer of the tooth and break it down to form a cavity.Bacteria in the carious cavity can continuously spread and infect the pulp tissues containing blood vessels and nerves.If this happens,the affected child will have toothache and the tooth will eventually become non vital or dead.Without further treatment, bacterial infection soon forms an abscess at the root tip and finally ends in ‘facial cellulitis’ when the infection spreads to involve the surrounding soft tissues.

What is the main cause of tooth decay?

Tooth decay can start as soon as a tooth erupts.Therefore it is important to prevent decay in your child.Oral health care in children begins with the parents or carers.They must be made aware that the main cause of tooth decay is from sugary food and liquid given to babies.The main factor that must be considered is the type of food, how often the food is taken and how long the food is in the mouth.

Liquids such as fruit juices, mother?s milk, cow?s milk, formula milk and carbonated drinks contain hidden sugar.If in cases when the teeth are not properly cleaned,plaque will form. Bacterial plaque will act on the sugar and produce acid that can cause tooth decay.

If your child has the habit of bottle sucking all day long, make sure that the feeding bottle does not contain sugary liquid or juices.Every time your child feeds on sugary liquid, acid will form in the mouth within minutes.If the sugary liquid is continuosly sucked, imagine how much acid forms in the mouth and the decaying process continues to take place for 24 hours.Parents must limit the intake of sugary juices to lunch or dinner time only.In between these times, try to feed your child with plain water or milk. Parents must try to avoid letting children sleep with feeding bottles in the mouth as this can lead to the pooling of milk or liquid in the mouth and cause tooth decay. If need to, try diluting the sugary liquid gradually over time to finally plain water in the bottle.

Controlling your child’s diet

Children will definitely like sugary snacks if they are exposed to it at a very young age. Taking snacks must be limited to certain times of the day or during certain occasions only, for example during lunch on alternate days or during weekends or at festive celebrations.If your child is used to your routine,you will find that children will keep to their promises and this will make dental care easier. To make it more effective, make sure your schedules are understood by family members and child minder You can substitute sugary snacks with healthier ones like fruits, vegetable snacks, crisps,nuts, curry puffs and so forth.

What shall be the Best Care for your child?

In caring for the deciduous dentition,it is important to know that the deciduous teeth act as space maintainers for the permanent teeth that will erupt.If the deciduous teeth has to be extracted early due to caries, the space meant for the permanent teeth will be lost and can only be recovered through orthodontic treatment.

Cleaning of baby’s teeth must be started as soon as the tooth erupts; even when the baby drinks mother’s milk or milk formula only.Apply toothpaste on a clean cloth or baby’s toothbrush and clean the baby’s teeth.When the molar tooth has erupted, you can start brushing with a baby’s toothbrush and use a smear of fluoridated toothpaste for a child below 3 years of age and a pea size amount for an older child. Do not forget to brush the tongue and gums where the bacteria is hiding and causes bad breath.Clean teeth twice daily, once in the morning and once before going to bed.Cleaning the baby’s mouth after each feed is advisable.

When can you allow your child to brush on his/her own? Your child is actually not able to brush his/her teeth properly until he/she starts schooling and begins to write. However you can let your child brush on his/her own if he/she is willing to do it.Make sure you check that they have done proper brushing. Praise the child if he/she brushes well. If he/she has not done it correctly, then teach them the proper way.

Use Fluoridated Toothpaste

Fluoride in toothpaste is good during tooth formation in children.It is a substance that prevents tooth decay through its action on the enamel making it more resistant to acid attack.A few states or districts in Malaysia get fluoridated water supply. You can check with your dentist. If you reside in an area where its water supply is not fluoridated, make sure your child use fluoridated toothpaste. If you live in a fluoridated area, it is advisable to use toothpaste that contains fluoride not more than 600ppm and use a smear or a pea size amount of toothpaste.This is because children like to swallow toothpaste rather than spitting it out.Ingestion of fluoride in a great amount over a long period can cause fluorosis. Fluorosis is a defect to the outer most layer of a tooth and can be treated.Mild fluorosis can present with fine white lines or patches on the enamel and may not be noticed.Severe fluorosis will cause notches and stains the enamel brown.

Use of Pacifier

Even though the use of a pacifier can pacify your child, continuous use is not encouraged.Most children stop using pacifiers naturally at the age of 2 to 4. However the frequency of using pacifiers must be reduced when the child reaches 3 years of age and completely stop at the age of 6 when permanent front teeth start to erupt.This is because pacifiers may cause the arrangement of your child?s teeth to be disrupted and not well aligned. If pacifiers are dipped in sweeteners, it can form caries much faster.Remember not to let your child bite on hard object as it can damage teeth and gums and also fracture the teeth.

Conclusion

Oral health care in infant and children must begin early and given priority. It requires knowledge, awareness, concern from all parties especially parents and carers.Healthy teeth will contribute to the development of healthy children who shall excel in future.