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Info Bites



Bed-time and the bottle

The bed-time bottle can be a cause of serious decay as sugars from the milk, juice or other sweetened liquids collect around your baby's teeth as he or she sleeps.

These sugars quickly turn into plaque and form acid that will dissolve your child's enamel.

Children form routines and a child that is already used to having a bed-time bottle might need to be weaned off their usual drink – gradual dilution of their drink with water can help the child adjust and eventually they should get comfortable with receiving only plain water at bed-time.

Understanding Flouride

Fluoride works in two ways. Firstly, on the unerupted developing adult teeth in your child and secondly, on the teeth that have already erupted into the mouth.

Your child's adult teeth start to form at birth. Fluoride, when incorporated, will help in the formation of strong healthy ‘adult' teeth. In Singapore, our water is fluoridated and drinking tap water is a good way of fluoridating teeth. Toothpaste is also a good source of fluoride for teeth that have just emerged in the mouth. However be sure that your child is able to expectorate (spit) before starting to use fluoride toothpastes because excess fluoride, when ingested, can cause discolouration or fluorosis of the adult teeth during development.

The crowns of the adult teeth are especially vulnerable when being formed in the first 3 years of life. A smear of fluoridated toothpaste is all you need.

The benefit of good dental health outweighs the risks of fluorosis in youngsters who are very susceptible to decay or whose medical condition could become compromised should their teeth become infected from decay. Children in these groups will require additional applications of topical fluoride by the dentist.

British researchers over the last 2 decades have had strong evidence that effectiveness of toothpaste is dose related. Low fluoride children toothpastes (containing 200-550ppm fluoride) are ineffective at preventing caries. Their recommendation is that toothpaste should contain at least 1000ppm fluoride for optimal prevention of caries.

By comparison, regular toothpastes contain 1000-1500ppm fluoride, homecare fluoride gel range from 1000-5000ppm fluoride.

TOP TIP: use toothpastes with at least 1000ppm fluoride.



Fissure Sealant

On the chewing surfaces of the back teeth are deep pits and grooves called fissures. These are so narrow that even toothbrush bristles cannot clean them. Food can collect and bacteria can live in large quantities in these areas. As a result tooth decay often begins here. Fissure sealant forms a protective coating over the tooth. Sealants are most effective when applied as soon as practical – after eruption of the tooth (especially molars, followed by premolars and occasionally, the upper lateral incisors). They are bonded directly to the tooth enamel and do not require drilling or local anaesthetic.

Diet and Sugar

It is important to keep the frequency of sugar contact in your child's diet low. Sugar can be found in most foods and drinks and limiting the number of times a day your child has sugar (for example at meal times only) means less chance of decay. Sugar and acid in between meals in the form of candies, cookies, dried fruit, fruit juices, flavoured milk and formula milk should be avoided.

Sweetened treats and candy cannot be avoided completely but should be rare and if possible, limited to special occasions. In between meals, savoury snacks could serve as an alternative (sandwiches, quiches, cheese or nuts). Water and plain fresh milk are better alternatives to juice or soft drinks. Even diet drinks, which do not contain sugar, are detrimental as the carbonated gas in fizzy drinks will erode the tooth enamel.

Brushing and Flossing

Thorough teeth brushing is essential before your child goes to bed at night. The parent should do this until the child has developed enough dexterity to clean their own teeth properly. Supervision is advised until 7 or 8 years of age to ensure good cleaning. Use of plaque disclosing dyes is a fun way to show up areas that have been missed.

Most young children are not very good at flossing; however a primary site for decay is between "baby" molars. Parents need to help the child floss between all baby teeth that contact tightly before bed.

What to do in an emergency
with accidental injury to teeth

Injury to a tooth is always going to be a traumatic experience for your child and for you. Here are a few tips on what to do whether you are at your child's rugby match or at home.

Remember that you should first check for fractures to facial bones; serious injuries to the face or head may need hospital attention before you can attend to your child's teeth.

Taking control

It is critical to stay calm and move quickly – locating the tooth or fragments will allow the dentist to try and save the tooth.

Permanent teeth

a. With dislodgement or avulsion of a permanent tooth, if possible, try to replant the tooth in the gum immediately and hold it in place.

Remember to handle the tooth by the crown and not touch the root as you check for damage to the root. DO NOT clean the tooth under running tap water.

Preserving and transporting the tooth

It is essential that you keep the tooth moist, if you are unable to replant the tooth, the child's own saliva as a transport medium is actually one of the best options available till you get to a dental office. Your child can keep the tooth under his tongue or tucked within the cheek.

If your child is too upset and/or swelling/bleeding makes this too difficult, you can transport the tooth in glass of milk or sterile saline e.g. eye drops.

A plastic wrap serves as a last resort.
b. With fracture of a permanent tooth, the retrieved fragment may be bonded back to your child's tooth.

Baby teeth

If it is a baby tooth that has been dislodged, DO NOT try and replace it into the gum as this might damage the underlying permanent tooth. Reimplantation is not recommended in this case. Take the tooth to the dental office so that we can check if the whole tooth has been dislodged and that fragments are not left behind in the socket.

TIP Get to the dentist ASAP if unsure

The sooner you get to the dentist the better the chance your dentist will have of reattaching and saving the permanent tooth.



From infancy through to teenage years

Infants

Your baby should make their first trip to the dentist by their first birthday or shortly after his or her first tooth appears (usually at the 1 year mark).

Before teeth erupt: It is best to clean your baby's mouth and gums with a soft cloth after each feed (read about avoiding the bedtime bottle).

After teeth erupt: A combination of a damp towel and a child's toothbrush should be used to clean baby's teeth twice a day.

Pacifiers: Remember never to dip a pacifier in sweet syrups and that your child should be weaned off the pacifier early as this lessens the chances of developing crooked teeth.

From your child's pre-school to teenage years Kids Dental World recommends coming in for a routine checkup twice a year, these sessions will encompass preventative recommendations and cleaning but also importantly, we will advise parents and children on proper dental hygiene practices.

Below are some of the more age-specific areas that we will work with parent and child on:

Preschooler

Between the ages of 1-3, your child will need your help to brush and floss. During this period, we will work with you to ensure that proper techniques are used and that the development of your child's milk teeth is healthy and normal. We will also advise on types of food to be encouraged and to avoid.

Children 3 years and younger are most susceptible to tooth enamel defects caused by swallowing fluoride toothpaste – either use no toothpaste or just a smear of toothpaste on the brush. Encourage your child to spit out the toothpaste afterwards.

School-aged kids

With brushing and flossing, close supervision is advised through to the ages of about 7-8; while this may seem tedious, your child's first adult molars will erupt inconspicuously in the back of his mouth, developing the right practices will stay with your kids for life.

During this period, we will also look at the need for a sealant to prevent cavities – particularly over the chewing surfaces of your child's back teeth.

As your child ventures into contact sports and other physical activities, it is important that you help them understand how important a mouth guard can be.

Teenagers

Hunger pangs during growth spurt makes them look for snacks; both tooth decay and gum disease risk increases as a direct result of your teen's diet – high frequency of teeth contact with sugar and starch contribute significantly to this problem.