Teeth – they’re a lifetime investment

Growing pains don’t just happen in the legs of children and the hearts of parents. They also occur in the mouth. By simply growing, many children have to deal with tooth problems for no other reason than the jaw and teeth don’t match in size. But growing up also leads to behavioural and dietary changes that can create problems with teeth. It’s this combination which prompts many parents to take their children to the dentist. 

The resounding opinion of dentists is that it is better to take a child to the dentist before any work is required. This allows the dentist to establish a relationship with the child and dispel any of the family myths, particularly the horror stories that liken a dentist’s surgery to a war zone.

Melbourne dentist Dr Peter Henderson says he has seen children who have endured hours of horror stories from siblings, parents and others and are traumatised by the time they reach his surgery.

Educating children about the role of the dentist should go hand and hand with teaching them about oral hygiene. Filling a cavity in the tooth of a traumatised child is an unpleasant experience for both child and parent and can be just as bad for the dentist. Dr Henderson likes to see children twice a year once they have all their first teeth.

It may mean they require no significant work for several years, but when that time comes, they are relaxed about the visit. Importantly, the dentist can detect cavities, developmental anomalies and other teeth problems, as well as gum diseases caused by oral bacteria.

The message is clear, simply tell your child at a very early age what role the dentist plays in maintaining their health. Don’t play it down and don’t beat it up.

Many parents leave the first inspection of teeth to the pre-school and school dental services, which vary from state to state. For example in the Northern Territory the Children's Dental Service provides dental care and dental health education for primary and pre school children in school based clinics.

In Victoria, child dental services are provided through the School Dental Service (SDS). Some child dental services are also provided at the Royal Dental Hospital of Melbourne (RDHM) through its General Dentistry Unit. The dentists visit the school every one or two years. Most states also provide a dental check for children before they begin school. To access this service contact your maternal health or community health centre.

But teeth problems can and often do start much earlier than school age. Diet can play a major role in oral health, and providing healthy foods for snacks can reduce your child’s risk of tooth decay. Dr Henderson has filled a cavity in the tooth of an 18-month old child.

Many problems cannot be prevented, such as crowding of the teeth, but they need to be monitored from an early age so referral to an orthodontist can be made if necessary.

Dentists are seeing more cavities in the teeth of young children now than they did a decade ago. There has been no research done to determine the cause of this increase, but theories are circulating.

Dr Don Wilson, an Adelaide dentist who chairs the Australian Dental Association’s Oral Health Education Committee, has seen the increase in his own practice and believes it is an issue the association will pursue.

The introduction of fluoride into drinking water in many parts of Australia in the 1970s reduced tooth cavities significantly. But things are changing and Dr Wilson believes there are a couple of possibilities, including:

• Changing diet with children regularly eating and drinking many things that are not good for their teeth or overall health.
• Reduced exposure to fluoride. Many children now drink a range of fluids throughout the day, ranging from juice, milk, cordial, soft drink and bottled water, which contain no fluoride. Fewer children are drinking tap water, which contains the fluoride. Many families have filters on their taps and certain reverse osmosis filters draw out the fluoride. Tank water, common in rural areas, and increasingly found in urban properties, is not fluoridated. In Brisbane, where the tap water is still not fluoridated, the decay rate in 12-year-old children is double that of children in areas where the water is fluoridated.

Drs Henderson and Wilson believe parents need to have better control of their child’s diet in order to reduce the risk of decay in a child’s teeth. If parents allow children to eat high sugar foods from the time they are very young, it will be a difficult pattern to break once school lunches and television advertising come along.

Dr Henderson agrees that the media pressure on parents to buy the high sugar snacks for their children is enormous, but resistance will pay off, or save money, in the long term. Unfortunately, he said many snack foods that are advertised as healthy for children, are not. Instead, he says snacks for school lunches and at home should include foods such as cheese, fruit, raw vegetables and ham.

Dr Wilson believes we should still be cleaning our children’s teeth until they are about 10 years old, despite their keenness to do it for themselves. If parents are in doubt about the efficacy of their young child’s teeth-cleaning technique, then buying the inexpensive plaque disclosing tablets at your pharmacy will put you at ease or alarm you.

A child can chew the tablets, made from vegetable dye, after they have cleaned their teeth. The pink dye clings to any bacteria left around the teeth and this can also be a real eye opener for the independent child who thinks they are doing a perfect brushing job. It is important to remember that a perfectly plaque-free tooth cannot get tooth decay.

Dr Wilson recommends parents clean their child’s teeth by standing behind them and brushing back and forth (for baby teeth), up and down and around for the older teeth. Once the adult teeth develop and gaps close, using floss is a good way of dislodging food from the cracks.

‘I think to clean their teeth you work the bristles in and get the food out any way you can,’ Dr Wilson says. ‘I have had to go through this myself and I know it is difficult, but you can turn the teeth cleaning ritual into a game by saying ‘your turn, my turn’. It is worth it. My experience with my own children is that they come to like the feeling of well-cleaned teeth.’

Maintaining the full count of baby teeth until they fall out is important because it maintains correct spacing in the mouth, which will later be taken by an adult tooth. Overcrowded mouths and overbites are some of the problems that are difficult to prevent. They are also the ones that send a shudder through parents, who picture braces and big bills as soon as they see a prominent front tooth emerging.

Their fear is often unwarranted. Dr Wilson says teeth will sometimes look too big until the child’s face has fully grown. And not all mouths have to be perfect, though Australians seem to be following the Americans in their increasing intolerance of ‘imperfections’.

‘There is no doubt that the pressure on men and women to have perfect looking smiles is enormous. That pressure is felt by the school children and by the parents. So often it becomes an issue of the child’s self-esteem.

I will often say to a parent that I don’t think the child’s teeth need any orthodontic work, but often they choose to pursue that treatment because they don’t want the children to feel uncomfortable.’

In Australia about 40% of children will receive treatment from an orthodontist and 12-year-old Melbourne schoolgirl Eliza Leverett is among that number. Eliza has an 11mm overbite and two years ago her treatment began. She is soon to have a bite-jumper fitted which will re-align the jaw before braces are fitted in about 18 months. Her parents, Brendon and Ingrid believe they will have received value for money when the last monthly instalment of the total $5500 bill has been paid.

Ingrid, who has a small jaw, was not surprised when Eliza showed signs of an overbite at an early age and needed several baby teeth removed to make space in her mouth. Eliza and her younger brother, James, have not yet had any cavities.

Their younger sister, Jacqui, 7, had her first filling about a year ago. The Leverett children clean their own teeth, but are well monitored, as is their diet at school and at home. And the preferred drink at home is water!

“We feel the issue with her teeth and jaw could become a long-term health concern should they be left untreated, but the cosmetic improvement is still a secondary outcome for her,” Ingrid says.

By Rosie Hoban

Food and Teeth – the connection

If you ask anyone what is the most important thing you can do for healthy teeth, they would say brushing them. Then they may say regular visits to the dentist. Some would also say avoid sweets and others would say drink plenty of milk. So, which one is the most important?

Most Australians are much better at cleaning their teeth than ever before – they have the best brushes and flosses ever made and they have fluoride toothpaste. They may not all visit the dentist regularly but those who do know it is important for early detection of problems.

So why is it that some adults and children are getting decay and others aren’t? Well, the answer lies in what you eat, when you eat it and how long you take. This is what is called a person’s dietary habits.

The dietary habits include all activities that send substances past the teeth, either for a moment, such as drinking a glass of juice, for a moderate time such as eating a sandwich, or a prolonged time such as sucking on a boiled lolly. The parts of the food that affect the teeth are the amount of sugar or starch and the acidity of the food.

For example, soft drinks are very acidic. As well, many contain caffeine (see later). If you swallow one glass a day quickly, the teeth are able to cope. If you swish each mouthful around the mouth for a few seconds, you have a greater chance of harming the tooth.

If you drink 2 litres a day, in many small glasses, with swishing, your teeth will decay. As an adult, you may reduce the chance of decay by good brushing and flossing. But children aren’t good brushers so their decay risk is higher if they drink many soft drinks, especially in their baby teeth.

As another example, if you eat a carrot, you don’t get much of the carrot sticking to the teeth. Now imagine eating a sticky snack bar – it sticks to the teeth for a long time so there is more chance of decay.

So, how does decay happen? Sugars and starches are the favourites of some mouth bacteria. The bacteria take in the sugars and push out acid. While the sugars are there, acid is produced.

When the sugar intake stops, acid stops. If the sugars are there for a long time due to a person slowly sucking a mint or throat lozenge, there is plenty of acid. If it’s there for a very short time, so is the acid.

Then saliva plays an important part in watering down the acid to make it less harmful. So, if there is caffeine in the food (eg chocolate) or drink (cola drinks or caffeine-added ‘energy’ drinks), the mouth can dry up as caffeine is a diuretic (draws water out of the body). No saliva, no diluting and buffering the acids.

Drinking of water should be part of the dietary habit because water is the best thirst quencher and is good for the teeth. Drinking fluoridated tap water is known to lead to reduced decay because fluoride strengthens the outside of the tooth by making it repel acid attack.

But, there’s more. What about the acids we eat and drink? They are just as harmful if they are strong enough. Soft drinks are very acidic. Chewable Vitamin-C tablets are just powdered ascorbic acid – you are just grinding powdered acid into the tooth and so Vitamin C needs to be taken in other ways (powder in a drink or a swallowed tablet). Eating raw lemons is just plain dangerous.

Now take all these effects and think what it can do to a young, small child who is getting all these chemicals and sugars. That’s why a person’s dietary habits are so important.

Visit the ADA website for details of the ADA Freecall Hotline where you can talk to a dentist about dietary habits.

by Dr Don Wilson

Chairman, ADA Oral Health Education Committee

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 by Australian Family Magazine, July 2003. Updated July 2009.