Dental decay - what is it and how to prevent it.

Hi

This time we are looking at what happens if we get decay. Next time we will look at fillings

Today we are going to focus on dental and how to prevent it.

What is decay?

Decay is the break down of your tooth surface by acids in the mouth. They can come from bacteria and food. It breaks down the hard enamel layer and gets inside to the softer layer of tooth where it lets  bacteria in to produce more acid and break down that material rapidly.

Decay can be painless to begin with. If caught in the early stages, it can be treated by the dental team and the tooth can re-mineralise, heal itself, and become strong again.

Another great reason to visit the dentist regularly.

IF YOU WAIT FOR TOOTHACHE OR UNTIL YOU SEE A HOLE IT IS ALMOST ALWAYS GOING TO BE A BIG AND EXPENSIVE THING TO DO!!

How to prevent decay

The best thing we can do is look after our teeth and not let decay start.

Top tips for this are:

1. Brush your teeth for at least 2 minutes twice a day. See my previous blog on how to brush with an adult toothpaste that contains fluoride.
2. Watch when you eat sugar and acid. Keep it to meal times and try to drink water only between meals and not choose sugary 
3. Have the biting surface of your back teeth fissure sealed - covered in a protective coating to help stop decay starting.
4. Chew sugar free chewing gum after eating to help neutralise acids or finish a meal with a small piece of cheese.
5. Clean in between tight teeth as food can get trapped and cause decay there.

To learn more about dental decay have a look at  The Dental Health Foundation's website

Mhari works a team of dental health and prevention experts at Gentle Healthcare.

Smile! Good oral health - the primary years

Hi

We are now looking at children's oral health from around 7 years old until 12, focusing on tooth loss.

Tooth-brushing
Most children will be brushing independently by 7. A good way of knowing they are ready is to not stop supporting their teeth cleaning until they can tie their shoe laces themselves (yes I know, even when they learn they still make us do it!) This varies from child to child and if they have dexterity issues - like my autistic son did, then help them out a bit longer to ensure the teeth are being properly cleaned. (Look at the last 2 blogs for toothbrush tips)

The recommended brushing routine is once before bedtime and one other time of the day. If brushing first thing in the morning then always do it BEFORE BREAKFAST. Always use a pea sized amount of adult toothpaste and spit out but don't rinse after brushing.

Use disclosing and sticker charts
We can't be there every time they brush, especially in that tornado that is school run time. But we can help out by ensuring they are brushing for long enough - see my previous blog - and by carrying out regular spot checks. Using disclosing solution and a reward chart for at least a few years can cement good habits that will last a lifetime.

Wobbly ones
Wobbly teeth are fun, funny, annoying and sometimes painful towards the end. It takes around 8 weeks for a tooth to go from wobbly to falling out. That is an eternity if you are 7!!

We start to lose teeth around age 6. If your child starts to lose teeth before age 4, or if your child reaches 8 and still hasn't lost one, then bring it up at your 6 month check up with your dentist. 

My daughter Josie was 7 years and 4 months old when finally the first one came out. That is a long wait for the tooth fairy!

Usually baby teeth fall out in the order that they came in with the two bottom middle teeth first to go, followed by the top two in front.

Goomy smiles are normal 

There can be similarities to bugs bunny when those first permanent teeth poke through. The bigger new teeth can look giant-sized in that still-little mouth, but your child will grow into them! Permanent adult teeth also tend to look a little yellow beside the super white baby teeth, and they’ll look jaggy on the edge when they first poke through, but will be worn smooth by chewing.

What happens to create the wobble
The root of the tooth reabsorbs - disappears - in preparation for the new tooth coming up into position and that is when it starts to wobble. 

Kids tend to go one of two ways on this:

1. They hate the sensation of the movement, feel it is uncomfortable and avoid eating on that area and touching it too much.

2. They are fascinated by the movement and wobble it, chew on it and fiddle with it a lot. Sometimes baby teeth fall out on their own by getting stuck in food.

Number 2 children tend to shed their wobbly teeth with little problems and love showing you the slightly bloody gap after.

Number 1 children are likely to shed at a slower rate and need a bit of encouragement towards the end when it is really wobbly.

How to help
If a wobbly tooth is being bothersome to your child, you can encourage them to wiggle it gently to help it come out faster. Don't be tempted to help out and pull it before it’s ready. Really tugging before the root has been shrunken away can lead to breakage of the root making it prone to bad bugs or an infection. If the tooth is still there after 8 weeks then check it out with your dentist — it may need to be pulled, but by a professional.This does not happen often.

Teething goes on...and on.... 
It took up to three years for your child to get all their baby teeth, it takes around another 16 until they have all her permanent ones. The big chewing teeth at the back - molars - come in in stages as the jaw develops. First molars around age 6, second molars around age 12, and then third molars (wisdom teeth), which come in between the ages of 16 and 20. Not everyone has wisdom teeth and your dentist will tell you if this is the case. Eventually your child will have 28/32 teeth that with proper care will last a lifetime.

Next time, what to do if  you need a filling. 

Mhari is a hygienist in an oral health practice. 

Pre- school and junior years

Hi

We are now looking at the child from around 2 onward. Most children will have all of their 20 deciduous - baby - teeth by around 3 years of age. 

http://dentalcarematters.com/baby-teeth-order/

They will really develop a sense on independence and it can be tempting to give in to their demands to brush their teeth themselves. 

I highly recommend letting them have a go, but we should be supporting cleaning until around 7. A good guide for the individual child is that they can brush their own teeth when they can tie their own shoelaces. It is about good dexterity so both require skill and concentration.

What we can do as parents and carers is work with them so when they are ready to fly solo on brushing they really know what they are doing.

2 minutes brushing time
There are lots of ways you can reinforce that it takes 2 minutes to really brush the mouth well. You can get a 2 minute egg timer, great visual for short attention spans, or use a high tech version with the Brush DJ app.

You can also get toothbrushes that have timers in some form. Electric brushes are safe for use once the child is able to stay fairly stationary while you brush. Most companies recommend around age 4.

How to brush

http://www.eschooltoday.com/tooth-care-for-children/brushing-and-flossing-your-teeth.html

The key to good brushing well is starting at the back on one side and, using small circles touching tooth and gum, brushing all the outsides, then the insides, then the bits we chew on. Then you move on to the other arch - top or bottom - whichever you haven't done yet. 

If you move from one area to the other with no pattern you are more likely to miss some spots.

Check how you are doing

Using a disclosing solution to show up the bad germs is great for you as an adult brushing but also really helpful for the children learning how long and well they need to brush to get all that dye off. 

Use and adult toothpaste - a pea size, and spit out at the end of brushing but don't rinse.

This time starts to get tricky for us in terms of diet as they are often at a nursery or some form of childcare. 

Again there are things we can do to protect the teeth and keep sugary foods to a minimum.

• Drinks are water - don't offer juice 
• Avoid dry fruit as a snack - loaded with concentrated sugars
• Same with juices, the amount of sugar in them is quite a shock, there is a great sugar smart app for this too
• Keep sweet things to mealtimes

Losing teeth  

Teeth become lose and fall out making way for the adult teeth to come through. This can start as early as 4 or as late as 7 or 8. It can get tricky to brush when the teeth are lose as it can be tender for the child so go slow and be gentle. 

They can sometimes get a little smell as the tooth really starts to wobble and this is totally normal and nothing to worry about.

Visits to the dentist

We are so lucky that NHS dental check ups and treatment are free for all children and it is so important to go regularly. Every 6 months for a check up is normal. By the time you can see something is wrong, it will almost always mean treatment for the child.

Us dental people can prevent, and put a stop to decay if we get a chance to look in regularly. And that usually means no drilling or filling simply using varnishes and other medical treatments.

So don't delay, book your child in today! 

Next time, Primary Years, how to get your wobble on, and what to do if they do need a filling.

Thumb sucking and soother dependency - how to move on without (too many) tears, tantrums and sleepless nights

Hi

I have had a lot of interest about this subject and many people looking forward to seeing what options are out there. 

It can be seen as one of the hardest things to do. 

Soothers and thumb/finger sucking provide a way for the child to settle themselves and provide comfort without the aid of a parent. Many babies find their thumb in the womb - think of the cute scans you have seen - and it is a natural reflex action. Then young babies use it to pacify themselves and toddlers use it as a security reflex as they grow and develop. 

And boy are we grateful for these aids when we are trying to leave them for a rare night out, at nursery, or to sleep when they are restless. 

Then children start to teeth and the jaw develops and if they are sucking hard on the soother or thumb they can start to move the position of the teeth. Children who suck their thumb or fingers after age 7 years can develop an open bite which is a real pain to deal with later in life. Aidan was well passed that.

Most children naturally start to reduce their time with either the soother and thumb/fingers around about 2 years of age. They are so busy and active, and are in company of others that they tend to only really need them when they get tired or at bedtime. 

Somewhere between 2-4 they reduce it further and, easiest with the pacifiers, stop using them altogether. The majority of children who do continue tend to only do so in the comfort of their own home and in the evening. We should be supporting them stopping by age 4. Be careful of making it a "thing" as it can become a source of anxiety and control which can do more harm then good.

Tips for supporting the reduction and eventual stop of sucking between age 2 and 4:

Praise the positives, ignore the negatives 
Try to complement them when they are not using there form of pacifier and don't pick when they are tired to try to remove it.


Do a bit of detection, distraction and where possible, reduction and elimination. 
Children often suck their fingers and soother when feeling insecure. Removing the cause of anxiety, and comforting the child about the cause can really help.

We all love a good sticker chart!!!
Make it easy to get a sticker to start, "look your not using your dummy, have a sticker", then grow the goal "wow you went out to the shops and didn't suck your thumb once, well done, have a sticker" to finally "you didn't take your soother to bed last night, have a sticker". Remember stickers add up to a prize so even having that visible can help.  

Bin the soothers in a ceremony
Make a big deal that they are growing up and throwing away that symbol of being a baby. We threw the oldest boys out and had a wee party to celebrate, then went to the park (favourite thing to do at that age).

Top tips for those still thumbsucking at school age:

Been it, seen it, bought the T-Shirt
So you have read this so far and thought yep, tried all that. And not even a little bit near stopping. Do not fear, you are not alone. My lovely autistic boy is not easy to bribe or use rewards with so was still thumb sucking well in to secondary school - peer pressure has zero impact also. But we got there. Choose your time as it is usually us parents that cave and stop it from working.

Make it less enjoyable
The magic solution for us was to invest in a cool looking cover for the thumb. A lot of the sucking was subconscious, it had just become a habit. So we bought some great gloves, just for the thumb (I think you can get ones for fingers too) chose a holiday from school, and just made them wear it all the time. I checked once they were asleep that it was still on and they got a small toy for each night they didn't take it off. They didn't sleep to well the first 3-4 nights but it was fine after that. At the end of the holiday they got money - cold hard cash works well - because they hadn't sucked their thumb once. And the habit was gone.

Let the professionals do the work
The dentist and hygienist can encourage the child to stop sucking his or her thumb and explain what could happen to the teeth if it continues. You know they listen to everyone else apart form us!! 

Make a chill out routine for your child
Life is stressful, for us all. And children all cope differently with stress or anxiety. Try to talk a bit about their day, what was good, what was bad; give them a chance to share their troubles. Have a hard stop on electrical stimulation, tablet, TV, games, at least 1 hour before bed. A nice bath can really help them unwind and get relaxed. 

Tell them well done!
Remind them how proud you are that they are trying to give up something they love. Look how well we do with chocolate and wine!!(Or is that just me........)

I HAVE TRIED ALL OF THAT!!!!!!!!
Sometimes all the good planning doesn't work. Children are individuals.

So if the thumb sucking persists, talk to your child’s dentist or an orthodontist. They can prescribe a mouth appliance or advice on a medication with which to coat the thumb to prevent the thumb sucking. Don't try the old mustard trick. It is so painful and negatives hardly ever produce a positive result in there situations.

Please note this is general advice and not diagnosis so if in doubt go visit your dentist. 

Good luck!!

Next time - pre-school and junior school oral health.

Caring for your toddlers mouth - This is the way we brush the teeth, brush the teeth, brush the teeth......

Hi and welcome to my blog. So...moving up the age range, we go on to discussing caring for toddlers oral health.


My last blog covered babies up until around 1 year. Once they get mobile things change dramatically!

New teeth

As mentioned before, infants teeth from around 6 months up until 18 months - 2 years. They have 20 baby teeth - us dental people call them deciduous. These teeth play an important role in the development of our jaw so it is really worth keeping them clean, healthy, and in the mouth until they are meant to fall out.

Thumb sucking and soothers

Many babies start to suck their thumbs in the womb. Two of my three did. The other had a soother from around 6 weeks. Make sure your soother is orthodontic and ideally BPA free. I will write another blog on how to get them off the dummy and thumb sucking soon!

Trauma

As soon as they start to walk, they start to bump into things and fall spectacularly! Both my boys damaged their front teeth as toddlers, one on a roundabout at the park, one on the door edge. And so I thought a few warnings and first aid tips would be useful for you.
They love to run at this age so don't let them run with any objects in their mouth and do not let them brush unsupervised. I have seen a few traumas from a pencil or toothbrush in the mouth when running and it is not fun for anyone.
If they do bump their teeth, four things could happen.

1. They chip or damage the tooth. If it is only a small chip it may only feel rough and not cause too much of a problem. Rhien was lucky and that was all that happened to him. If it is a bigger chip or fracture, it could expose a more sensitive part of the tooth and cause pain. Then it is a trip to the dentist to have some material put over the tooth area to stop the sensitivity.

2. They move the teeth in the mouth - this is what poor Aidan did when I was home alone with them first day back from hospital after having Josie. Nothing like a crisis to get you used to juggling 3! He was a thumb sucker - covered later -  so automatically sucked his thumb and pushed them back in to position. we had them checked by our lovely dentist and there was no visible fracture so we kept a close eye. They went grey - this happens if the nerve dies inside, not pretty but not harmful - and fell out naturally at the right time with no intervention. Again, always worth a trip to get checked out and reassured by the dentist.

3. The tooth comes completely out. This doesn't happen that often with baby teeth but if it does then the best thing to do is grab some milk and pop it in it and get to the dentist immediately. If the person is old enough, the best thing they can do is  suck on the tooth and try to place it back - gross but effective - as the tooth needs moisture from our mouth to stay alive. If that is not possible, milk is still good. Do not wash it or let the tooth dry out.

4. It bleeds. A lot. The mouth has a lot of blood vessels near the surface and this means that any injury usually results in a large bleed out quickly after trauma. Applying a little pressure with clean gauze or muslin can reduce the flow and stop the child being stressed by seeing that amount of blood. Using a little cool pack can help reduce the swelling that often comes with these types of injury.

The good news is the mouth is made of tissue that is really good at healing so it will be sore but will start to heal well within a week. Keep foods trauma friendly in that time, with no jaggy things.


Toothpaste

Current recommendations are that you use a smear (rice size) of adult toothpaste when brushing until the child is old enough to spit out the excess, then swap to an adult paste and a pea size amount. Don't teach rinsing after brushing.

Tooth brushing

So we should all be aiming to brush in the morning before eating and once again later in the day. The thought of this can fill a lot of parents with dread. It is like trying to wrestle a bag of cats while attempting to write neatly and perform a magic trick.

A great tool I mentioned before is the chewable brush and teether which lets baby have a go safely, but you still need to get in there yourself.

I found sitting on the floor, with the child between my legs and their head resting on my stomach, was the easiest way to get the job done. They have less wriggling room, are already on the floor (we all know the dead drop move the little ones do!) and you have a better view - a bit like the dentist or hygienist has in the dental office. I would hold their hands and sort of lock the head slightly and sing, and make a lot of distractions to get the job done. They would cry, almost always. Don't give up, they will thank you for not having holes in their teeth and won't remember it as a bad thing at all -at least that is what my 3 say. This lovely dentist Jenny shows you how to do it really well. In our high-tech world you could use an app like Brush DJ to play a tune on your phone to distract. This might be useful if your singing sounds like that bag of cats!

Toothbrushes

Now you have mastered the gentle headlock, it is good to know which kind of brush is easier for you to use. Up until around 3, it is best to use a manual or manual shaped brush like the baby sonic which has been designed for small mouths. When the child reaches pre school age - 3 onwards you have more options and I will cover that in the next blog.

Diet

Your toddler is an explorer of food at this stage and it is so important for them to enjoy. Almost all of them are grazers, I remember the half eaten rice cakes turning up in the oddest of places, and the cats used to follow behind them hoping for a dropped yoghurt pot.

Drinks - stick to water and milk - don't be tempted by juice - once you start it is really hard to get them to give it up. If they don't know it they won't miss it I promise.

Snacks - avoid dry fruit - super full of sticky sugar - try carrot or cucumber sticks, plain rice cakes - or with a little nut butter, or some cheese sticks.

Keep anything sweet to a minimum - again if they have never had cake they don't know they are missing out - and keep it to mealtimes. Reducing sugar consumption has such a huge impact on their overall health, not just the teeth.

First trip to the dentist

Believe it or not, dentists can be a really fun place for a small child to visit. And most of us dental people are keen to make it a great experience for them.

Book them in around 18 months - you can register them before that in case of trauma - and don't book them at the same time as you or another sibling. You know how short that attention span is! Usually the dentist will make it fun, about a ride in the chair, usually on your lap, and have a quick check over of the teeth while introducing them to a dental mirror and the surgery. Most surgeries have stickers or a balloon for the first visit so the child leaves feeling positive. Even if you are not keen on the dentist, take them. It is free, and one of the best gifts you can give them for life.

Next blog is about thumb sucking, soothers/dummies and the preschool years. I hope you find this useful and feel free to share with friends.

Let's start at the beginning - babies teeth

Hi and welcome to my dental tips blog. I have been in dentistry now for 25 years and prevention of dental disease through education is my passion. That doesn't mean nagging honest! I hope to produce useful dental information that will help the whole family.

So let's start with tooth care for babies.

0-20 in 18 months

Babies start to teeth at around 6 months old. They usually get the lower front teeth first, then the upper front teeth. By around two to two and a half, all 20 of their baby teeth (deciduous is what us dental people call them) have erupted. You should take them for their first visit at the dentist (free on the NHS) around 18 months to 2 years but it is a good idea to register before that in case of bumps to the teeth or mouth.

Teething

When babies are teething they tend to want to apply pressure to the area, chew on anything, they love a knuckle! Cool teething rings are good, and so are Bickiepegs or a decent chunk of carrot - not too small or it can be a choke hazard. Teething gel doesn't work too well, and there is not any evidence to say teething powders work, however some parents feel there is a benefit. Sugar free paracetamol can be used if the baby is really unsettled. Luckily it doesn't last forever, it just feels like it!!!

Cleaning those first teeth

 Usually the first time you know that tooth has broken through is when your little angel bites your finger and it really hurts! We now have to start cleaning that tooth every day at least once a day, ideally once in the morning and once in the evening. When the tooth is only part through the gum, you could use a piece of gauze or clean muslin cloth to wipe it. That is easier on you and your little wriggly baby who doesn't get the need for holding that head still one bit. You can get wipes with xylitol on them, thought to discourage the bacteria that cause decay in our teeth.

Then you can progress to a silica finger brush which is really easy to use and gets your baby used to brushing. Don't use any toothpaste as of yet as they can't spit it out, but once 4 or more teeth are through you can start a very small smear of infant toothpaste. As soon as your baby can spit, usually around 18 months, move them on to an adult paste as this is the best for their teeth.

Drinks

Don't be tempted to give your baby juice in their water as they wean, if they have never had it they will never miss it! Same with sweets, keep them off them as long as you can. I know it is not easy with older siblings and those full party bags. Best for drinking is plain water and milk and once that first tooth is in try to get them out of the habit of falling asleep on the bottle or breast at night. I am a mum of 3 and know that is not an easy one, so wiping the tooth after before you put them down will work if they are not ready to give up that magic sleepy bottle just yet. 

Let me mum!

As baby gets older Brushbaby do a great range and have a chew-able brush for baby from around 10 months to help with the teething of the back teeth. They can have a go themselves which starts to improve their dexterity ready to start learning how to brush.

I hope this was useful and feel free to share with any new mums. 

Next time - toddlers teeth.