Kids' Dental Health Essentials

As parents, we all want to set the foundations for lifelong good dental health in our children. We chatted with Inner West Mum and dentist Dr Nitu Gupta of Drummoyne Dental Surgery about some of the essentials of kids’ dental care. Nitu enjoys practising all areas of dentistry but has a particular interest in working with children.

When will my baby begin teething?
The average age for the first baby teeth to come into the mouth is 6 months old. The first teeth to appear are usually the lower front teeth. You may notice your baby drooling a lot (much more than you ever thought possible!); some will start getting nappy rashes, cry and have a low-grade fever. Some babies can be quite miserable, while others take it in their stride and the parents barely notice their teeth have come through.
The thing to remember is that this is an average age, and it’s not set in stone. I tell my patients to give or take 6–12 months. That is, if your baby doesn’t have any teeth at 12 months, don’t panic – they’re on their way!

What do you suggest for teething discomfort?
Some options include cold cucumber pieces (under supervision so choking isn’t an issue), teething rings (you can chill these by putting them in the freezer), or a wet face cloth (chilled in the freezer for 20 minutes) to rub along their gums. Bonjela works very well for some kids, and others prefer to chew on your/their fingers. A baby brush can also help, which is a little silicone finger sleeve with soft bristles, which most babies like. If bub has a low-grade fever (usually while drooling a lot, off their food, and with redness around the mouth), then age-appropriate children’s paracetamol can really help.
Most adults forget how painful teething can be, until they get their wisdom teeth when they are suddenly reminded. If your child is in pain, don’t be too hesitant with providing them with some pain relief. Also chat with your dentist about this.

When should you start brushing your child’s teeth?
Once the teeth erupt (appear) in the mouth, use a wet, soft cloth, e.g., a face washer, to wipe the teeth. You don’t need to use a toothbrush or paste at this stage.

How should you brush your child’s teeth?
Unfortunately for many, tooth brushing is a battle. I had this battle with both my boys until they were 18 months old, by which time they got it that brushing their teeth was not negotiable. Young children will just chew on their toothbrush, which is okay. This gets the child used to holding and using the toothbrush, but it does need to be followed up with one of the parents brushing the teeth.
Effective tooth brushing is a complex task requiring a lot of dexterity, which young kids just don’t have. Get your child to help you brush your own teeth, play games, sing songs. There are tooth brushing apps you can use, and sometimes it’s just a case of giving them a ‘tooth brushing cuddle’ (i.e., lightly restraining them) and being patient, waiting for them to open wide and getting in there quickly when they do. It’s not always easy, but there are some techniques that can really make a difference, which your dentist can show you.

Should my children be using toothpaste with fluoride in it?
Yes, depending on their age. Some people seem to have very strong opinions about not using fluoride but unfortunately in most cases, this isn’t based on any critically evaluated science. A lot of research has been done for many years, all around the world, and water fluoridation is one of the most successful, cost-effective public health solutions we have. Dental decay is an entirely preventable disease (other than with developmental conditions) and one of the best things for growing, and adult teeth, is fluoride. There is fluoride in the Sydney water supply, but this alone is not enough to protect our teeth. A fluoride containing toothpaste, used daily, is so important for us and our children.
The current guidelines for fluoride use are:

0–2 years: no fluoride toothpaste
2–6 years: low-dose children’s fluoride toothpaste
6 years+: adult toothpaste

Now, these are guidelines that apply to most children, and there are always exceptions, so chat to your family dentist about this.
The major brands (Colgate, Oral B, Macleans) have started introducing toothpastes with age guides, e.g., 0–3, 2–4, 4–6. 6–9 years, etc., but this is largely marketing. If you’re not sure about which toothpaste to choose, ask your dentist.

When should your child have their first dental check-up?
Ideally a child’s first check-up is around 2 years of age. This allows us to check to see if they have the right number of teeth in the right place, if there are any developmental issues, if there is any pathology (such as decay), and discuss dietary issues and oral hygiene with the parents.

Any tips for making children’s first dental check-ups as smooth as possible?
Absolutely. Bring them early in the morning, as kids cope better with new things earlier in the day. Don’t wait until later on when they’re possibly tired or hungry, as it will be harder for them to adapt to new people and environments.
Also, if they have an older sibling, bring the younger ones along so we can use the older sibling for modelling and the younger kids get an idea of what happens and what to expect.
In our surgery we make kids’ appointments really fun: we play with the kids, build up rapport with them and when they are comfortable, then have a look in their mouths. Dental surgeries can be weird places with strange equipment, so it’s about normalising things.
Lastly, if you’re anxious about dental treatment, do you best to not project this onto your child. Kids pick up on their parents’ emotions; if you’re casual about their appointment, chances are they will be too. If there’s a parent or grandparent who’s not anxious, then get them to bring your child as it helps with a smoother appointment.

How often should your child have dental check-ups after that?
This depends on the child and their level of risk of dental decay. For most children, a yearly check-up is enough. Your dentist will assess your child’s risk and tell you how often they need to be seen.

How can tooth decay in children be prevented?
A number of factors contribute to decay. Firstly, children should only be drinking tap water and plain milk – not cordial, juices, flavoured milk or soft drinks.
From 2 years of age they need to be using a low-dose fluoride toothpaste and having their teeth brushed twice a day. The child should brush their own teeth, followed by an adult. After their teeth have been brushed at night, they should have only tap water – if they do eat or drink anything more, then the teeth should be brushed again.
Monitor what your child is eating, and how often. Be wary of ‘healthy snacks’, e.g., bliss bars or balls or dried fruits, as these have a lot of sugar in them. It’s also ideal if kids aren’t grazing all day, i.e., they’re having 3 meals and 2 healthy snacks a day, although I know this isn’t always practical. If you’re not sure, talk to your dentist for specific advice regarding your child.

At what age do you suggest children begin brushing their teeth independently?
This depends on many individual factors, e.g., the child, their level of manual dexterity, motivation, rates of decay, habits, etc. Typically I recommend assisted brushing until 8 or 9 years of age. Again, this is something I assess at check-ups, and guide parents on based on their child.

If your child breaks a tooth, what should you do?
Dental trauma affects 25 per cent of people in their lifetime, i.e., 1 in 4 people will suffer trauma to their teeth. This statistic applies worldwide, regardless of race, socioeconomic status or educational background.
The best thing to do with a broken tooth is to see if you can find the broken part, or whole tooth, pop it in some milk and get to your dentist asap. There are a huge number of types of trauma that can happen with our teeth, and the management is varied. The longer trauma is left, the more complications can occur.

Cover image © anyka/123RF Stock Photo