Recent government statistics lay bare England’s dental crisis in young children: three in 10 children aged five have enamel or tooth decay.
In this survey of five-year-olds in England, the national prevalence of children with enamel and/or dentinal decay was 29.3 per cent. Regionally, this ranged from 23.3 per cent in the South West to 38.7 per cent in the North West.
Children living in the most deprived areas of the country were almost three times as likely to have experience of dentinal decay (35.1 per cent) as those living in the least deprived areas (13.5 per cent). There were also disparities in the prevalence of experience of dentinal decay by ethnic group, which was significantly higher in the ‘other’ ethnic group (44.8 per cent) and the Asian or Asian British ethnic group (37.7 per cent).
It's no surprise then that some councils, such as Nottingham, are planning to add fluoride to the water supply. Figures from the government survey show that 34.2 per cent of five-year-olds in the city had obvious signs of dental decay with the average number of teeth affected by decay in Nottingham's five-year-olds being 1.3, while in England the average is 0.8.
All water contains small amounts of naturally occurring fluoride, but at too low a level to provide any oral health benefits. Water fluoridation schemes raise it to 1mg per litre of water.
Fluoride force
Fluoride works to control early dental caries in several ways. It strengthens the enamel of the teeth, making them more resistant to decay. The antibacterial action of fluoride is due to the acidification of the bacterial cytoplasm through the formation of the hydrogen ion and the fluoride ion from hydrogen fluoride and the disruption of the bacterial metabolism by inhibiting vital bacterial enzymes such as proton releasing adenosine triphosphatase and enolase.
The use of fluoride lowers the pH. Bacteria will thus use more energy to maintain a neutral pH. Therefore, they will have less energy to grow, reproduce and generate acid and polysaccharides.
The World Health Organization recommends water fluoridation as an “effective and safe public health intervention”. Indeed, fluoridated water is currently supplied to 10 per cent of the population in England (including parts of Nottinghamshire).
However, while proponents argue that it is a safe and effective way to prevent tooth decay, there are also concerns about the potential health risks and ethical considerations.
Some studies have linked excessive fluoride exposure to various health problems. High fluoride levels can lead to dental fluorosis, a condition characterised by discolouration and pitting of tooth enamel. Opponents contend that water fluoridation may not be the most effective way to prevent tooth decay. They say that the benefits of fluoride can be obtained through other means, such as brushing with fluoride toothpaste. Moreover, some studies suggest that the decline in tooth decay rates observed in fluoridated communities may be due to improved oral hygiene practices and dietary changes rather than fluoridation itself.
Good habits
Indeed, what is undoubtedly key to the prevention of caries in children is the establishment of a good oral care regime from the get-go (hand in hand with limiting the consumption of sugary drinks and snacks). Brushing should start as soon as the first deciduous tooth breaks through, using just a smear of fluoride toothpaste (with a fluoride level of at least 1,000ppm). Children aged three to six years can use a pea-sized amount of toothpaste (that contains 1,350ppmto 1,500ppm) and always under the supervision of parents or carers.
From the age of seven children should be able to brush their own teeth and new elements introduced into their oral care routine to keep dental plaque and resulting cavities at bay, such as interdental cleaning.
Flossing, using conventional string floss, is a technique-sensitive process and can prove challenging for children still developing their fine motor skills. That’s where a Water Flosser may help (with supervision, of course).
The Waterpik Water Flosser is backed extensively with clinical research, proven to remove up to 99.9 per cent of plaque from treated areas. The Waterpik Water Flosser is easy to use and is needed for only a minute a day for improved oral health.
While water fluoridation can go some way to improving the oral health of young children in a community, establishing good oral care practices within the home/care setting from milk teeth onwards, can serve to optimise its benefits. Good habits formed young can make all the difference.
References available on request.