How can pharmacists encourage good dental hygiene among infants and children?
Written by Dr Madelaine Jackson, Dentist of the Year 2022, Cosmetic Dentist of the Year 2022, Best Aesthetic Dentist 2021
Instagram @DoctorMadelaine
As a mother of two children aged 5 and 7, I understand and appreciate the need for more health professionals to understand more about Dental hygiene; it’s important as a Dentist and as a parent.
Tooth decay, an almost entirely preventable disease, remains the single most common chronic disease of childhood and the number one reason for childhood hospital admissions. The Oral Health Foundation (OHF) prioritises improving oral health for all, to ensure young people are given the very best start in life by providing them with the means to have a healthy mouth.
Tooth decay is largely the result of not brushing teeth twice a day with a fluoride toothpaste and consuming too much sugar. Many people believe baby (deciduous) teeth do not matter because they will be replaced by the adult teeth, however deciduous teeth play a crucial role in a child’s emotional and physical wellbeing. Children need healthy teeth to eat nutritious foods, speak clearly and smile brightly. Deciduous teeth are essential for the proper development of adult teeth, acting as a spacer, guiding the permanent teeth into position. If lost prematurely, results in crowding and malocclusion.
Children are losing crucial days of their education each year due to rotting teeth, as well as suffering pain, sleepless nights and missing out on doing the things they enjoy the most – which is being a child!
Not to mention time taken off work by parents and carers.
Children begin to lose their teeth around aged 6-7, with the last being lost around age 12-13. This is too long for a child to be subject to pain and discomfort. Often, it is not possible to restore decayed teeth in children, and extractions are required under general anaesthetic.
Acting to prevent tooth decay doesn’t have to be complicated or difficult, it can be structured around educating caregivers so we can create good habits from the outset. Prevention is better than cure; and pharmacists are in a unique position to provide oral health advice, a cost-effective intervention that can save money in the long-term and reduce the number of children needing time off school because of tooth decay.
Call to Action
Achieving good dental health for all children requires a whole system approach. At the frontline of healthcare, pharmacists have a substantial role in influencing behaviour to improve the oral health of children. Pharmacists are positioned to give accessible professional oral health advice, in a friendly, comfortable atmosphere as recommended by the OHF. The key aim is to promote and protect people’s oral health by improving their diet and oral hygiene and encouraging them to visit the dentist regularly.
Key points for keeping deciduous teeth cavity-free:
• Brush twice daily with a fluoride toothpaste
• Limit sugar
• Visit the dentist regularly
Risk Factors for Tooth Decay
Tooth decay is a result of the destruction of the hard tissues of the tooth by acids produced in the mouth when bacteria in dental plaque metabolises dietary sugars. Repeated and prolonged acid attacks will eventually cause the tooth surface to weaken and a cavity to form which may lead to pain and infection. The risk of tooth decay increases in more deprived areas where the imbalance in income, education, employment, and neighbourhood circumstances affect the life chances of children’s development.
Studies show children are more at risk of developing tooth decay if they are
• Eating a poor diet
• Brushing their teeth less than twice a day with a fluoride toothpaste
• From deprived backgrounds
Encouraging Good Dental
Hygiene
Pharmacists have the opportunity to engage with members of the community who are caregivers of babies and young children to advise on good dental health. With an aim to improve the oral health of all children and reduce the oral health gap for disadvantaged children. Pharmacists are a good source of information to advise on caring for oral health, and to recommend the most effective products for individual needs. Recommending a range of oral health products such as toothbrushes and fluoride toothpastes.
Tooth Brushing
Daily application of toothpaste to teeth reduces the incidence and severity of tooth decay in children. To maximise prevention of tooth decay, children should brush their teeth at least twice a day with a fluoride toothpaste. Children in more deprived areas are less likely to brush their teeth at least twice a day.
Caregivers of babies should be encouraged to clean twice daily from the day the first tooth appears, using a soft baby brush, with a smear of fluoride toothpaste. All children should brush twice a day with a fluoride toothpaste, last thing at night and at one other time of day.
Adult toothpaste is perfect for the whole family, children under 3 years old should use a smear and 3-6-year-olds a pea sized amount; Kids toothpastes are great but adult toothpastes are better; my kids love being minty fresh.
There is no need to rinse after brushing, the first few occasions may feel intense for the kids but it is only reducing the fluoride. Avoid eating and drinking for at least one hour after brushing. Electric toothbrushes can be introduced from age 3. Toothbrushing should be supervised by an adult until at least age 7.
Dietary Advice
The pharmacist has a vital role to support the education being given in the dental practice by reinforcing healthy eating messages, with a reduction in and frequency of sugar consumption.
For babies:
• Bottle fed babies should be introduced to a free-flow cup from 6 months and bottle discouraged from 12 months. Do not give the baby a bottle overnight, the milk bathes the teeth causing tooth decay
• Milk and water are the only healthy drinks
• Only milk or water should be given in bottles
• Avoid adding sugar to foods or drinks
For all children:
Give healthier eating advice routinely to promote good oral and general health. Eat a nutritious diet and limit snacking. The main message is to reduce the number of sugary foods and drinks
• Reduce the quantity and frequency of foods and drinks that contain sugar
• Juice has no real place in a child’s daily diet
• Administer sugar-free medicines where possible
Practical advice on how to limit sugar intake with food and drink:
• Water and milk are the only safe drinks
• Looking out for ‘hidden’ sugar in foods and drink
• Eat whole foods
• Breakfast cereals are notoriously high in sugar, double check the labels to what extent
• Avoid adding sugar or jam to foods, most foods already have sugar in them so more is not needed
• Deserts and treats only on special occasions, everyone likes a treat, just in moderation!
Food Myths
• ‘No added sugar’ is not the same as ‘sugar-free’
• Sugar-free often contain sweeteners, that can also cause tooth decay
• Many health foods snacks such as cereal bars and dried fruits have deceptively high sugar levels
• Fruit juices and smoothies are high in ‘free’ sugars
Dental Attendance
A significant proportion of the population are not currently registered with a dentist, which makes the pharmacy an important source of accessible oral care advice.
Children should see a dentist by their first birthday, to familiarise with the dental setting and for professional oral health advice. Getting children used to the environment from an early age will prevent fear in the future. Keeping primary teeth cavity-free also ease the fear and discomfort children might feel if the dentist needs to treat or remove a decayed tooth.
A dentist can be a fun and exciting place for kids, tell them about the adventure they will go on, excite them about the machines and dental chair, and more importantly there us a strong chance they will leave with a sticker to show off to their friends!
Oral Health in the Community
I am passionate about oral health and have been involved in a local health initiative to deliver oral health education to school and nurseries. Last year I visited a local pre-school and provided oral health education for 3-4 years. We did a fun-based lesson on the importance of keeping teeth clean, going to the dentist and limiting sugar. I brought with me a puppet, ‘Doug the Dentist’ to demonstrate tooth brushing technique and different types of manual and electric toothbrushes.
I gave all the kids a free pack to take home which included:
• Toothbrush
• Toothpaste
• Toothbrushing chart
• Stickers
I’m proud of the education I provided and hope to make further visits to this year.
The key is creating health habits at home that will improve long term dental health.
Tooth decay can have a serious impact on children’s physical and emotional health, and extractions at such a young age can signal a lifetime of poor oral health ahead. We need to work together to protect our children from this devasting but preventable disease. Pharmacists are uniquely positioned to offer oral health advice for parents and caregivers of young children to promote good oral health to children in the community.
