Dominique Tillen looks beyond ‘brush twice a day’.
While there is much talk about children’s dental care this is often to the exclusion of younger members, particularly babies and toddlers. However, children who have learned to care for their teeth properly from a very young age are more likely to develop good oral hygiene habits that will continue as their adult teeth develop, and remain for the rest of their lives.
Though it is now recommended in the UK verylittle specific advice is available for infant and toddler oral care. Indeed, many dental health professionals report being at a loss as what to recommend.
Acknowledging different needs
The dentition of under-fives is developing through phases of toothless gums, teething and on to a full set of baby teeth. Each phase requires specific oral care to meet the developing dentition, behaviour and skills of the infant and young child. Recognition of this is important to help establish a more appropriate oral care routine and the use of products beyond the conventional toothbrush.
Toothless gums: clean gums every day
The majority of babies in the UK receive no mouth care until their first tooth has erupted; a period of six-12 months. However, keeping gums clean and in good condition can offer the following benefits:
- reducing the build-up of bacteria and preparing a healthier environment for new baby teeth
- avoiding gum infection, inflammation and associated pain during teething
- getting infants used to having their ‘teeth cleaned’ from a very early age
While some recommend cooled boiled water and a clean cloth, the use of xylitol dental wipes to clean gums has been shown to reduce the load of cariogenic bacteria in infants and significantly reduce the development of new caries. Parents have also reported being more satisfied with dental wipes over tooth-brushing and infants’ acceptance of dental wipes has been found to be higher.
Teething: brush from the first tooth and keep teething gums clean
During teething there is a need to continue to keep gums clean in order (to avoid gum infection, inflammation and pain), provide relief of teething discomfort and clean the new baby teeth. Many teething aids are not designed to reach back teeth nor clean gums and many mothers are familiar with toddlers chewing on conventional toothbrushes making it difficult manoeuvre them and clean teeth properly. New chewable toothbrushes have been developed to help clean both teeth and gums while providing a firm surface for teething toddlers to bite on. One unpublished study found that nursery-aged children who used a chewable toothbrush had fewer decayed teeth compared to those using a regular toothbrush. Another study showed that a chewable toothbrush was as effective as a regular toothbrush in plaque removal and had a significantly better effect on the lingual (tongue) side of the tooth.
A full set of baby teeth: brush twice a day, floss once a day
Children in the UK are rarely taught or encouraged to floss their teeth despite evidence that flossing reduces proximal caries in children and can prevent gum disease. In the US and Australia flossing is recommended once two baby teeth start to touch. Earlier introduction of flossing could help prevent caries, gum disease and develop improved oral hygiene habits to last over a child’s lifetime. For those who do not or cannot floss a new ‘FlossBrush’ with bi-level bristles has been designed to help clean both the surface and between teeth.
Preventing vertical transmission
The vertical transmission of decay-causing (cariogenic) bacteria is well known and practices that promote this such as sharing feeding utensils, toothbrushes and cleaning a dummy with the carer’s mouth should be discouraged. Research in the US has shown how the regular use of xylitol chewing gum by mothers provides a protective effect to the child by reducing vertical transmission rates.
Xylitol, a natural sugar that is very beneficial for oral health, has been hailed by the British Dental Health Foundation as the ‘biggest advance against cavities since fluoride’. Despite this few people in the UK are aware of Xylitol. Studies of children using 10 per cent xylitol-enriched fluoride toothpaste found they developed significantly fewer cavities than those children using fluoride-only toothpaste. Mothers should be encouraged to opt for children’s fluoride toothpastes and sweets which contain xylitol.
Conclusion
Given the high (40 per cent) decay rates in under-fives, the oral care routine of children (including infants, toddlers and younger children) needs to go beyond ‘brush twice a day’. Early years toothcare should encourage a broader range of oral hygiene practices such as gum care, advice on reducing behaviours that promote vertical transmission, the use of xylitol toothpastes and more appropriate dental care products as an adjunct to tooth brushing in order to help establish oral care routines and improve dental health from a very early age.
References available on request.