Published by the Dental Health Foundition

www.dentalhealth.ie

It’s getting easier to make sure thatchildren have healthy teeth. There

are two reasons for this. Firstly,fluoride, found in the water childrendrink and in the toothpaste they use,has made teeth stronger. Butsecondly, there is a growingrealisation by parents that gooddental health doesn’t come about byaccident; that it requires animportant effort by parents andchildren to lay the groundwork froma very early age in order to createand maintain oral health which lastsall through life. This booklet iswritten to help you, the parent,follow a programme of appropriatesteps in preventive dental care forinfants and young children. Thegood habits started now will be oftremendous benefit to youngerchildren as they grow intoadulthood.

BEFORE BIRTH

About the fifth to sixth week ofpregnancy a baby’s teeth begin todevelop. During this time thenutrients that the baby needs comefrom the food that the mother eats.It is important that the mother has awell-balanced diet with anadequate intake of calcium,phosphorus and otherminerals and vitamins. It is equallyimportant that the mother does notneglect her own dental healthduring pregnancy. Regular dentalcheck-ups with increased emphasison brushing and flossing willminimise the dental effects ofhormonal changes that occurduring pregnancy.

INFANCY

At birth, the twenty primary (first)teeth continue to develop in thejawbones and some of thepermanent teeth begin their owndevelopment at this time. Thebaby’s front teeth (incisors) usuallybegin to come through the gumbetween the age of six to twelvemonths. Over the following twoyears, remaining teeth will grow sothat by the time the child is threeyears old the primary dentition isusually complete.

TEETHING

Myths have developed on thepossible side effects of teethingthrough the years. Many childhoodillnesses are incorrectly blamed onit. Some babies may have soregums, be irritable and may drool agreat deal but that should be theextent of effects. Any other signs ofillness should be checked out by aphysician. There is no magicalsolution to teething but allowing thebaby to chew on a clean, coldteething ring may bring relief.Ointments that numb the gumshould not be used unlessprescribed.

THUMBSUCKING

Babies get a lot of pleasure andsatisfaction from sucking things -including their own thumbs. There isno real harm in letting them suck theirthumb. Most babies will stop of theirown accord. You can expect childrento have given up sucking by the ageof 4 years. Thumbsucking is onlyreally a problem if children go onsucking their thumbs after this age assome children may push their teethout of shape. If you want to help yourchild give up sucking, remember thatsucking makes the child feelcontented and secure. Encourage thechild to do other things instead.

child’syour teeth

SOOTHERS

Not all babies need soothers or pacifiers. If youfeel your baby needs a pacifier it is important tomake sure it is of the correct design. Anorthodontic type is the most suitable. Only use itwhen absolutely necessary and wean your babyoff it as soon as possible. Otherwise it may havelong term ill-effects on the way your baby’s teethgrow. Never dip the soother into sugary liquid(honey, jams or syrupy medicines) to encouragethe baby to use it.

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nursing bottlemouth

It is important to ensure that your child hasa diet which contributes to rather thandamages the health of their teeth duringinfancy. It is important to realise that assoon as the child’s teeth appear they are atrisk of tooth decay. One of the mostcommon ways in which a child’s teeth aredamaged is to give the child a bottlecontaining sweetened liquids after the ageof one year, either as a pacifier during theday, or at nap or night-time.

Allowing the sweetened liquid to poolaround the teeth for long periods of timeproduces acid. This, in time, weakens andeventually decays the teeth. In severecases Nursing Bottle Mouth can develop. Itis a condition in which the infant’s teeth arealmost completely destroyed. Allsweetened liquids, soft drinks, sugaredwaters, juices, vitamin drinks (even milk),will cause this problem. A similar problemcan arise from giving the baby a sootherdipped in honey or sugar.

Generally babies will be able to use a cupat 6 months and they can usually beweaned off a bottle at twelve months.

A healthy mouth in a 3 year old child

Nursing bottle mouth in a 3 year old child

diet

Healthy meals and well planned snacks are importantto a child’s growth and development. Frequentsnacking on high fat or sugar containing foodsreduces a child’s appetite for the more nourishingfoods needed for proper development and will alsocontribute towards tooth decay. Start on the righttrack early by encouraging your child to eat a widevariety of foods in the recommended amounts fromthe Food Pyramid.

The Food PyramidThe Food Pyramid is a colourful guide to the foodsrecommended as part of a healthy eating plan. Mostof your child’s food should come from the bottomshelves of the pyramid with a smaller amountscoming from food groups higher up the pyramid.Foods at the very top of the pyramid should be eatensparingly. Because of the variety of foods on eachshelf of the pyramid, it is easy to choose foods your childwill enjoy from each shelf.

How to use the Food PyramidThe number of servings recommended for children from5 years is shown on the Food Pyramid. For younger

children, encourage them to eat a wide variety of foods,with most of their food intake coming from the bottomshelves.

Snack FoodsFor snacks offer children fruit, raw vegetables,unsweetened breakfast cereals, bread, milk, cheeseand yogurt, unsweetened juices or drinks. Try to limit tomealtimes, children’s intake of confectionery especiallychewy or sticky sweets, biscuits, cakes and pastries,high fat snack foods (e.g. crisps) sugar coated breakfastcereals and fizzy drinks.

Remember, foods containing sugar when eaten atmealtimes (with other foods) have a less damagingeffect on your child’s teeth than when they are eatenalone.

Snacking TipsIf children drink or eat snacks containing sugar, limit thenumber of times they take them throughout the day,• Food or drinks containing sugar (limit intake to

mealtimes) and juices should be taken quickly and

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&snacks

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not over a long period.

• Fruit and vegetables are ideal ‘tooth friendly’ snacksand can be given instead of sweets and confectionery.

• Milk, cheese and yogurt are high in calcium, amineral needed for healthy teeth. They are ‘toothfriendly’ and make good snacks.

• Read food labels. The nutrition label will tell you howmuch sugar a food contains. If there is no nutritionlabel then read the ingredients label. Don’t just look forsugar - often sugar can be called sucrose, glucose,maltose, dextrose, invert sugar syrup or corn syrup. Tryto choose infant foods with the least sugar content anddon’t add sugar to home-made baby food.

• Carbonated or fizzy drinks put the teeth at risk of enamel erosion.

FOOD PYRAMID

Food Pyramid servings above are suitable for childrenfrom 5 years of age

All children and young people should be active, at a moderate to vigourous level, for at least 60 minutes everyday

For smaller children, start with smaller servings (from the bottom shelf of the food pyramid)and increase as the cild asks for more. It is important that children eat according to theirgrowth and appetite

Taken from the Department of Health (2012)Your Guide to Healthy Eating and Department ofHealth and Children and Health Service Executive(2009) The National Guidelines on Physical Activity inIreland

Parents sometimes wonder whythere is growing importance beingplaced on keeping a baby’sprimary teeth in good conditionuntil they are replaced by theirpermanent successors. Manyparents still feel that the primaryteeth are not important becausethey are going to fall out anyway.Besides the obvious importance ofhealthy primary teeth for eating,appearance and speech, they arealso essential for guidingpermanent teeth which developunderneath, into their correctpositions. Early neglect or loss canresult in a number of problems. If achild’s primary molar tooth has tobe extracted early due to severetooth decay then the guide for thepermanent successor is lost. Thespace available for the permanent

primary teeth matterA SPECIAL WORD ABOUT THE

6-YEAR MOLARS

At about the age of six years,

your child’s first permanent

molar arrives in the mouth: the

6-year molar. Because it does

not replace a lost primary tooth

but comes in behind the second

primary molar, some parents do

not realise that it’s a permanent

tooth. So keep a watchful eye

out for these teeth.

(It is helpful if you are familiar

with the number and types of

primary teeth altogether.)

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tooth can be reduced resulting in acrooked permanent tooth. The possible complications causedby crooked permanent teeth areenough motivation for mostparents to take proper care of theirchild’s first set of teeth. It is alsoimportant to know that whenpermanent teeth start to erupt intothe mouth around six years of age,they should ideally enter a mouththat is healthy and free from toothdecay. For this reason the patternsof dental care established duringinfancy can determine the longterm health of the teeth.

Central incisors

Central incisors

Canines

First Molars

Second Molars

Permanentfirst molars

First permanent molar

cleaning

The purpose in cleaning teeth is toremove the almost invisible layer ofbacteria that forms on every child’steeth regularly. This layer is knownas dental plaque and if it iscompletely removed off the surfaceof the teeth then tooth decay andgum disease can be prevented.Begin cleaning as soon as thebaby’s teeth appear in the mouth.

Initially do this by wrapping a pieceof gauze around a finger andrubbing the teeth and gums gently.In this way establish a cleaninghabit early and the baby willbecome accustomed to it.

When the baby’s molars (backteeth) appear around fourteenmonths, start using a small softtoothbrush with tap water. Fromtwo years upward you will onlyneed to use a little toothpaste –about the size of a small pea.Remember, toothpaste isn’tmeant to be eaten. Make sureyour baby or young childrennever manage to eat toothpastefrom the tube. Children up to theage of seven need help withcleaning their teeth - they cannotdo a proper job before this agethemselves.

Teeth which appear clean before disclosing

Note the plaque on the chewing surface.

Dental plaque is a colourless filmof bacteria that grows oneveryone’s teeth. A disclosingagent, which stains the plaque andmakes it visible, is a helpful aid toteeth cleaning. These agents comein both tablet and liquid form.Either chew the tablets or paint theliquid on the teeth with a cotton tip.Any colour remaining on the teethafter rinsing shows plaque. Cleanthis off with a toothbrush. Theseplaque disclosing tablets areavailable from pharmacies. Adults,as well as children, find this ahelpful exercise in cleaning teetheffectively.

A variety of tooth brushingmethods may be advised, yet, forchildren, over emphasis on adifficult technique may lead toconfusion. It is better in manyinstances to instruct the child justto remove all the coloured plaquefrom the teeth. If areas are beingconstantly missed then assist thechild to target the trouble spots.Brushing alone will clean three ofthe five surfaces of a tooth but toclean the remaining two surfacesin between the teeth, use dentalfloss. Hold the floss either betweenthe fingers or in a floss holder,bend it around the surface of thetooth to be cleaned and move it upand down a few times. Some olderchildren may find flossing difficultand like the child under seven dothe cleaning for them.

Children aged seven years and oldershould be encouraged to clean theirteeth and gums at least twice a day,using a small pea-sized amount offluoride toothpaste. A good rule ofthumb is before school and last thing atnight, just before bed time.

Good preventive dental care for childrenclearly begins in infancy by establishing ahealthy diet avoiding sugar snacks inbetween meals and an effective toothcleaning routine using a fluoridetoothpaste. The child’s first dental visit isideally at age one when the dentist canadvise on all aspects of infant dentalcare. After all, if parents begin gooddental habits early after the baby is born,it is more likely that the growing child willdevelop these habits and carry themforward into adulthood.

Holding the toothbrushbristles at a 45˚ angleagainst the gumline, movethe brush back and forwardwith short strokes - half atooth wide - in a gentle,scrubbing motion.

Use about 18 inches of floss,wind most of it around themiddle fingers of both hands.Hold the floss rightly betweenthe thumbs and forefingers.Use a gentle motion to guidethe floss between the teeth.

Brush the outer surface ofeach tooth, upper and lower.Repeat the same method onthe inside surfaces andchewing surfaces of allteeth.

Curve the floss into a Cshape and slide it into thespace between the gum andthe tooth until you feelresistance. Now, gently rubthe floss up and downagainst the side of the tooth.

Make sure to clean thechewing surfaces.

Repeat this procedure oneach tooth. Don’t forget thelast four teeth.

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Plaque stained by disclosing agent

Mouth GuardsWith the increasing popularity ofcontact sports, mouth injuries arebecoming more common. Toprevent many of these injuries, agood mouth protector is essential.Using one can dramatically reduceinjuries to the teeth, lips, gums andcheeks and in addition cushion theeffects of blows that wouldnormally result in head and neckinjuries.

There are many different types ofmouth guards and the type that ismost suitable will be apparent toyour dentist. The most importantfactor is to select one that will becomfortable enough to encouragethe child to wear it.

Mouth protector in place

Mouth protector

The permanent teeth begin toappear in the mouth around age sixbut this can vary. First permanentmolars (6 year molars, see page 7)which appear at the very back ofthe mouth do not replace a firsttooth. Often they are missed withthe toothbrush. Because of thedeep pits and grooves in thechewing surface of these teeth,food tends to get caught and ifallowed to remain can quicklycause a cavity in that area. Toprevent this, identify the tooth assoon as it appears in the mouthand make a conscious effort toclean it using a small brush tocarefully clean the grooves.

Some six year permanent molarsthat are at risk may require fissuresealants. Here, a plastic coatingthat sets is placed in the groovesand fissures, protecting the surface

SealantsChewing surface before sealant.

Tooth protected by shaded sealant.

Injuries & traumasProbably one of the most upsettingthings - to parent and child - is anaccident on which a child’s tooth isfractured, displaced, or knocked out.

The majority of these injuries resultfrom simple accidents - minor fallswhen the infant is learning to walk andchildish pranks or accidents as they getbigger. You should bring your child tosee a dentist if they hurt their teeth and

the bleeding doesn’t stop, or if theydamage a tooth, or if they fall anddrive a tooth back up into their gum.Your dentist will be able to take an x-ray and decide if anything needs to bedone. Very often, all that is neededafter an injury is to keep a close eyeon the child’s teeth and gums for awhile, but you should check with yourdentist to make sure.

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from the effects of retained food.Although this is an excellent techniqueit is important to remember that thesealant protects the chewing surfacebut there are other surfaces that arestill vulnerable to decay. Otherpreventive measures may be taken:dietary control and tooth cleaning areessential, flossing is advisable and afluoride mouthwash may berecommended by your dentist.

Your child’sCrooked teeth before braces.

Braces in position

After tooth straightening

Orthodontics

Nowadays children like to go to the dentist. This isbecause dentists today can make a child’s check-upa pleasant experience, using a tell-show-doapproach for explaining what they are doing. It isimportant to be as positive about a trip to the dentistas possible, remembering that children will not beafraid oftreatment unless they hear it from someone.Keeping calm yourself will transmit confidence to thechild.

The recommended age for the first visit is age oneyear, although surveys show that on average,children first attend at age four years. The reasonsfor seeing children at age one include providingadvice on early infant practices in order to preventdecay, especially in relation to nursing bottle mouth;identifying cavities in primary teeth at an early stageso that they may be saved; recognising biteproblems early to improve the chances of successfultreatment; having a pleasant first visit rather thanattending with a painful tooth as a first experience.

dental visit1st

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Some children have problems withcrowded or crooked teeth or withincorrect bites. Sometimes theproblems are inherited, for example,missing teeth or extra teeth, whileother problems are caused by otherfactors such as thumb sucking orearly loss of primary teeth. It isimportant to check with your dentistat an early stage of your infant’s oraldevelopment so that emergingproblems can be identified andtreated at theappropriate stage.Early treatment can sometimeseliminate or reduce more extensivetreatment later.

Most orthodontic problems aretreated when the child has themajority of permanent teeth, from 10years of age upwards. The problemsof crowded, crooked or prominentteeth, for example, are usuallytreated with orthodontic appliances(braces) which can be either fixed(train tracks) or removable.

Straight teeth are easier to keepclean and less susceptible to toothdecay and gum problems.

Preventing dental decay in children

requires a combination of limiting

the harmful effects of sugary foods

and drinks on teeth, reducing the

presence of dental plaque by

correct cleaning and increasing the

resistance of the teeth by fluoride.

Fluoride works by making the outer

layers of the tooth, enamel, tougher

and thereby less prone to the

harmful effects of acid produced by

sugar in the diet.

In the Republic of Ireland, the

benefits of fluoride are available

from its presence in community

water supplies and fluoride

toothpaste. Your dentist can also

apply concentrated fluoride as a

preventative measure based on

individual clinical assessment.

Fluoride can reduce decay by up

to 70% when used in the correct

way. Check with your dentist

regarding the best advice for your

child.

Eat well duringpregnancy

Clean their teethfor them untilseven years old

Ask your dentistabout sealants

See a dentist earlyand regularly

Take care ofprimary teeth

Use fluoridetoothpaste from

age 2

Snack wisely

8Avoid nursingbottle mouth

Rules for a cavity free child

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