10 tips on children’s oral health
Visiting the dentist from an early age is of extreme importance for children’s oral health, above all to prevent tooth caries during the development of permanent teeth. How often should children visit the paediatric dentist? Clarify your doubts about early caries, changes in the colour of teeth, fluoride administration, brushing, dental floss, among other questions.
1 – FROM WHAT AGE AND HOW OFTEN SHOULD A CHILD VISIT THE DENTIST?
The first appointment should be made when the first temporary (or “milk”) teeth erupt or, at the latest, until the child is one year old, in order to establish a preventive oral health programme, and intercept habits that may be harmful. Ideally, when good oral health is present, the child should be observed every six months. In situations of high risk of caries, this frequency should be reduced to intervals of three months.
2 – AT WHAT AGE DO THE FIRST TEETH APPEAR AND WHEN DO THEY STOP TO GROW?
On average, the eruption of the first teeth starts between 6 and 8 months of age, generally earlier in girls. At around 2 and a half and 3 years of age, the 20 temporary teeth will already be present in the oral cavity. Permanent dentition begins between the ages of 5 and 7, and can consist of 32 teeth, if the third molars (wisdom teeth) erupt, which does not always happen.
Earlier or later eruption is not necessarily related to a pathology, however, if a child does not have any teeth by the time they turn one year old, he/she should be seen by a dentist.
3 – WHAT DISCOMFORTS MAY BE RELATED TO THE ERUPTION OF TEETH AND HOW THE CHILD CAN BE HELPED?
The most common symptoms are: reddening gums, increased salivation, loss of appetite and change in nutritional habits, anxiety, difficulty sleeping. In case of fever, vomiting or diarrhoea, the child should be seen by his/her physician, as there may be another underlying cause. The child’s discomfort can be relieved by wiping the mouth 2-3 times a day with a wet gauze pad, or by using teethers and gels available in the market.
4 – WHEN TO STOP USING THE PACIFIER, BOTTLE OR THUMB/FINGER SUCKING?
Non-nutritive sucking habits (pacifiers, for example) should be abandoned by around 3 years of age, due to the possibility of self-correcting disharmonies in the development of the dental arches. As regards bottle-feeding, the habit should ideally be abandoned by the time the child is one year old. Some methods can be of added value, such as gradually diluting the contents of the bottle with water, so that after 2 weeks the child will only be offered water. another way is to gradually reduce the amount of fluid until the habit ceases, with the bottle being replaced, for example, by a cup with a straw or spoon.
5 – HOW TO PREVENT THE APPEARANCE OF EARLY CHILDHOOD CARIES?
Several measures are important in preventing caries lesions in early childhood: promote breastfeeding until, at least, 4-6 months of age, offer only milk or water in the bottle, and offer it to the child mainly during the day, and never when the child is sleeping. Do not offer sugary liquids in the bottle or pacifier, and as soon as the first teeth erupt, promote their hygiene with a gauze, a finger brush or soft brush, ideally after meals.
6 – WHAT ARE THE MOST FREQUENT CAUSES OF TOOTH-COLOUR CHANGES IN A CHILD?
The change in colour may have various causes. Thus, in addition to caries lesions, traumatic situations, disturbances in the formation of enamel and dentine, poor oral hygiene or extrinsic pigmentation of bacterial or food origin, for example, can lead to this type of disorder. The dentist is responsible for the correct diagnosis and possible intervention.
7 – SHOULD CHILDREN BE GIVEN FLUORIDE?
The administration of fluoride to children has been the subject of controversy. In view of the available evidence, and according to the recommendations of the Portuguese Directorate-General of Health, priority is given to topical applications in the form of toothpaste administered when brushing the teeth, as soon as they erupt. The pills and drops, previously recommended, will only be given after three years of age to children at high risk of dental caries. In this situation, the pills should be dissolved in the mouth slowly, preferably before going to bed. Health education actions should, as a priority, promote tooth brushing with fluoride toothpaste.
8 – HOW SHOULD CHILDREN BRUSH THEIR TEETH?
The way children should brush their teeth depends on several factors, but essentially on their age. Therefore, according to the guidelines of the Portuguese Directorate-General of Health, the following guidelines should be followed:
– 0-3 years old: brushing carried out by parents, from the eruption of the first tooth, 2x/day (one of which must be at bedtime), using gauze, a finger brush or a soft brush of an appropriate size.
– 3-6 years old: brushing carried out progressively by the child, duly supervised and assisted, 2x/day (one of which must be at bedtime), using a soft brush of an adequate size. The amount of fluoride toothpaste (1000-1500 ppm) should be similar to the size of the nail of the child’s 5th finger.
– >6 years old: brushing done by the child, duly supervised and assisted if the child does not have sufficient manual dexterity, 2x/day (one of which must be at bedtime), using a soft brush (or alternatively a medium one). The amount of fluoridated toothpaste (1000-1500 ppm) should be the size of a small pea, or up to 1cm of toothpaste.
9 – CAN CHILDREN USE DENTAL FLOSS?
The use of dental floss allows for the hygiene of interdental spaces and should be started as soon as possible, bearing in mind that, at around 8-10 years of age, children begin to have the necessary manual dexterity and autonomy.
10 – WHAT IS A DENTAL SEALANT AND WHAT IS IT USED FOR?
A dental sealant is a kind of “varnish” that is applied to the cracked surface of healthy teeth, with the aim of preventing the appearance of dental caries lesions. It is an effective resource in terms of prevention, but its application must be based on an assessment of the risk of caries and should not be an isolated measure, but integrated into a broader prevention programme. The application of dental sealant is generally indicated for permanent first and second molars as well as for premolars whose eruption period varies between the age of 5-8 and 11-14, respectively. Reapplication is indicated in case of partial or total loss of the sealant, maximising its effectiveness.