First visit to the dentist

Mention the word ‘dentist’ these days and most kids smile! Jennifer Kernahan reports. There’s an apocryphal story in our family about the little brother, the dentist, the tooth extraction and the blood…!

Many of today’s adults could probably match such torture-chair stories with their own version, embellished of course as the years have worn on, but none the less traumatic to this day. Then they have children of their own and have to face their own worst fear – taking their kids to the dentist.

But things have changed considerably since the dark days of the sixties and seventies – and modern dental practices with it. The best investment a parent can make in their child’s health is to start them on a lifelong habit of visiting the dentist for regular checkups.

A baby’s teeth start forming during the second trimester of pregnancy and it’s only a matter of time before the first of 20 deciduous (“baby”) teeth appears. That’s usually around six months of age, but sometimes not until near their first birthday. The next two years are a busy time as the deciduous teeth erupt, starting with the lower front incisors and finishing with the second molars.

Now is the time to set in place good oral habits. Even babies can get plaque – whether they’re bottle fed or breast fed and particularly once they start on solids. Start by wiping over the gums with a soft cloth and once teeth appear, use a soft toothbrush, paying attention to all biting surfaces.

A pea-sized amount of low-fluoride toothpaste need only be used once they’re old enough to spit it out. If children swallow the paste, there is a risk of developing brown spots on their teeth, called fluorosis.

The younger they are at getting used to the feeling of a plaque-free mouth, the easier it will be for you and them to continue good practices as they grow older.

There are several compelling reasons to make sure that baby teeth be kept healthy and cavity free.

• Baby teeth serve as spacers for the permanent teeth to come, maintaining correct alignment of the jaw and making sure there is enough room for the larger permanent teeth.
• Baby teeth play a crucial role in the development of speech.
• Poor oral care leads to periodontal disease, even in little kids. This can cause damage to the underlying jawbones and result in major problems for the permanent teeth…not to mention your wallet.
• If your child has a sore mouth, they will avoid chewy and hard textures in their food, limiting their nutritional intake.
• Dental pain and infection from neglected teeth is something you wouldn’t wish on any child, nor is having to undergo complex dental work or even extractions.
• Finally, the appearance and feeling of healthy teeth build self-esteem and confidence.

While it’s tempting to let your baby have a bed time bottle to help fall asleep, the long-term consequences are less happy. Baby bottles create a haven for bacteria and should not be used as a comforter with anything other than water. Sleeping with a bottle in the mouth can create a condition called nursing caries (cavities), or nursing bottle caries.

Milk and/or juices may pool around the baby’s mouth and gums. Bacteria then converts the sugars present to acids which attack tooth enamel, inevitably leading to tooth decay and cavities. A similar problem is often seen in children who are weaned from the breast much later than usual, especially when they are allowed to fall asleep while suckling.

Lactose - milk sugar - can produce decay when it's allowed to stagnate on the teeth during sleep, when saliva flow slows to almost nothing.  Constantly sucking on a day-time bottle full of fruit juices will also create great damage to your baby’s teeth. Instead, teach your toddler to drink from a handle cup by the age of 12 months.

The First Visit

The Australian Dental Association recommends that children should first visit the dentist by the ages of 12 –18 months. These days, dentists want the visit to be non-threatening, stimulating and satisfying to a child’s natural curiosity. They and you should leave feeling happy about the prospect of a return visit.

Check with your dentist whether he is comfortable dealing with very young children or ask around friends for recommendations. There are also paediatric dentists who specialise in the care of children’s dental health. As with any parenting issue, it’s about exercising common sense and following your gut feeling.

Be really careful about the language you use when talking to your child about going to the dentist.  As a parent you can unwittingly transfer any adult hangups you may have developed about dentists and dentistry if you are not careful about the words and feelings you express.  This can create real problems for your child. Be positive about going to the dentist, and never, ever, make threats about what the dentist might do.

Once there, the initial visit is a familiarisation process for your child. The dentist will welcome you in and should talk to your child in child-friendly language. Their manner should be patient, gentle and understanding of children’s developmental stages.

Then they might show your child the features of the consulting room such as the chair, the light and the instruments like the mirror and probe, and let them touch to see how it will feel on their fingers. This lets little kids realise that it won’t hurt their mouth.

Next, it’s time to go for a ride on the chair, in Mum’s lap if they want and the dentist will ask if you have any particular concerns at this stage. Now is the time to mention the dummy, thumb sucking, lolly addictions or any other teeth-unfriendly habits of note.

The dentist’s main objective will be to count the number of teeth, check for any early signs of decay or gum sensitivity, the state of teeth enamel and the spacing and the location of your child’s baby teeth. They’ll also be interested in the teething history of your child.

Lots of dentists have soft toys or finger puppets to distract and amuse their young patients while this is going on – the idea is to introduce them to a professional handling of their mouth, while avoiding any unpleasant associations! Some even have a TV mounted on the ceiling and tuned to children’s channels, or soothing pictures of dolphins or familiar cartoon characters.

Depending on their age, the dentist may show them and you, how to brush their teeth correctly and may want to chat to you about healthy meal and snack options. Finally, stickers and a novelty toothbrush and toothpaste are often employed to round out the successful wooing of your child!

Prevention, not pain!

Australian kids are lucky. The government policy of adding fluoride to tap water has meant that today’s generation of children experience far less cavities than their parents, but parents can’t afford to become complacent.

Cavities will still occur at a greater rate in the back teeth, which are hard to reach and clean effectively. That’s because the surface of these teeth contain pits and grooves, which can trap food and start the cavity process.

The use of fissure sealants is a major advance in preventative child dental health and your dentist will recommend these once the first permanent molars come in at around age 6 or 7. The tooth is thoroughly cleaned, then the sealant is applied as a liquid. It’s then set by bright light to form a tough, clear and protective plastic layer which bonds tightly to each molar.

Importantly, it’s a quick and painless procedure that means food can no longer accumulate and cause decay. Sealants can be applied to both baby and permanent teeth, but that’s not the excuse to go out and eat as many lollies as possible! They only protect the grooves in the chewing surfaces!

Ultimately a successful visit to the dentist should be a win-win situation all round. For parents, there should be a sense of partnership with your child’s dentist and for kids, a pleasant and non-threatening experience.

Over time, the payoff will be children who look forward to their regular checkups and can face future treatments, secure in the feeling that they know and trust their dentist.

“When you wake up in the morning and you get up out of bed, you brush your teeth…”

Theoretically, anyway. How do you get them to brush their teeth, let alone correctly…and sooner than once you notice that their teeth have turned an interesting shade of yellow?

It’s easy when they’re little. Before two, they lack the manual dexterity to brush correctly and should be supervised until the age of eight or nine, but no-one ever said you can’t make it fun.

• Young children are very oral and like chewing on a toothbrush, so it’s a good idea to make it part of playtime in the bath. Make sure you keep an undamaged toothbrush in reserve, just for Mum or Dad to use.
• For younger children, get them to brush teddy’s or dolly’s teeth, or let them brush yours.
• Let them have a go first, then you finish it off.
• Buy one of the many novelty toothbrushes available or better still, a child- themed electric toothbrush - some even play tunes at the end of the cleaning cycle (and dentists really do recommend them as far more effective in removing plaque and in promoting correct cleaning!).To get the most out of an electric toothbrush, your dentist will be pleased to give some instruction.
• Use disclosing tablets or fluid – kids love the gross-out pink result.
• Its ‘jiggle, not scrub’, ‘up and down’ not ‘sideways’ – make up silly chants to reinforce that notion.
• Laminate a 7-day chart for kids to tick off morning and night and  keep it in the bathroom.

Dental dos and don’ts

• Choose low fluoride toothpastes for young children and avoid toothpastes containing abrasives, as the enamel on young teeth is much softer.
• Floss, floss, floss – as soon as two teeth touch each other. If you aren’t confident in how to do this for your child, ask your dentist to show you.
• Be extremely careful of mouthwash, as many contain alcohol and the colour and smell can be attractive to young children. Keep it out of sight and out of reach.

Be aware that bottled water does not contain fluoride. Fluoride works by making tooth enamel – the hard white outside bit – more resistant to plaque acid, so kids need to drink tap water. Some high-level tap filters remove fluoride, too.

In most parts of Australia, fluoride tablets are not recommended by dental authorities unless your child does not have a normal intake of unfiltered tap water. Talk to your dentist if you have any doubts.

Healthy snacks are not always what they appear to be. While lollies are the obvious culprit in tooth decay, there others.

• Any sticky or gooey foods that adhere to teeth, like muesli bars or dried fruit and even peanut butter. Offer water with snacks and meals to help wash down food particles.
• Too much fruit! Fruit has natural sugars that can also erode teeth enamel, particularly some of the very sweet stone fruits. Surprisingly, it’s ‘how often’ that counts in tooth decay, rather than ‘how much’.

Instead:

• Offer cheese as a snack – it contains casein, which counters the effects of plaque acids.
• Cut down on the frequency of eating – children should eat 5 times a day only; breakfast, mid morning, lunch, mid afternoon and dinner. Between-meal nibbles increase the risk of cavities
• Offer dessert as part of a meal, rather than as a snack
• Offer only small amounts of fruit juices as a drink, no more than twice per day. Milk or water is safe for teeth and milk helps build strong bones and teeth.

By Jennifer Kernahan

Resources

Kid's Health Website – colourful and interesting site with information for parents, kids and teens on a wide range of health issues.

Save Your Smile website  – the dental zone dedicated to oral health

Virtual Children’s Hospital - from the Children’s Hospital of Iowa

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.
 

This article was first published in Australian Family Magazine, October 2002. Updated July 2009.