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How to protect your child's teeth

Children should go for regular dental checkups every six months.



If your child insists on having sweets, then give your child the whole box of chocolates to eat at one go.

This is the advice from a consultant in dentistry for children. A bit radical perhaps, but the truth is if you allow your child to snack all day instead of eating sweets at one go, it would be like bathing the child's teeth in acid round the clock, and this can only lead to dental decay.

Datuk Dr Low Teong, consultant orthodontist, consultant in dentistry for children and dental surgeon, says diet, regular checkups and good oral hygiene practices will help children maintain good teeth.

Even if they brush their teeth three times a day, but snack on chocolates, sweets and biscuits all day long, there is a high risk of cavities developing.

“Dental decay is a very simple process. When you take sugar, the bacteria in the mouth will act on the sugar and produce acid. The acid will demineralise your tooth. When you have a meal, the acid level will go up. When you stop eating, even assuming you don't brush, the saliva will clean off the acid and it will go back to the normal pH and nothing will happen. Even if there's a little bit of demineralisation, there is a natural process of remineralisation.

“But if you keep snacking on sweet things then you are literally bathing your teeth in acid around the clock.

“Therefore, what you eat is very important.

“The solution is not to give up sweets completely. I always tell my patients that a kid that grows up without sweets hasn't grown up naturally. If you have a box of chocolates, after dinner, give them the whole box. Let them finish it then encourage them to go and brush their teeth. So that they are not continuously taking the sweets all day long,” he says.

Another big problem is the nursing bottle syndrome where a child is sucking on a bottle all day long. This is very damaging to the child's teeth if there is a sweet drink or even milk in the bottle, because even formula milk has got some sugar in it. It is the equivalent of sucking on a sweet all day.

Many years ago, the pacifier was considered detrimental to a child's teeth development. This myth has been debunked today.

Dr Low explains: “When I was a dental student, we had a whole chapter on it. But now, nobody cares because we now believe that if your teeth are not destined to stick forward, after you stop the pacifier they will return back to the right position. If your teeth are destined to go forward, whether you use the pacifier or not, or suck the thumb or not, it will go forward.

“Parents don't need to be worried about this.”

He emphasises the importance of diet, regular checkups and good oral hygiene practices. Although the number of children with dental problems seems to be reducing compared to 30 years ago, Dr Low says it is nonetheless important for parents to supervise their children and keep an eye on them when they brush their teeth because often children will do a quick job when brushing their own teeth.

He advises parents to bring their children in for checkups every six months. In fact, Dr Low says it is best to establish a family dentist concept.

That means, when the parents go for their checkups, they would bring the children along just to familiarise the children with the idea of visiting the dentist instead of only going to the dentist when the child is in pain. If you only take your child to the dentist when there is a problem, then the child will associate the dentist with pain and will not want to go for regular checkups.

Dr Low with a model of the jaw and teeth. The permanent set grows directly below the baby teeth.

“We always tell parents that the worst time to bring a child to a dentist is when they are in pain. Because they already know something terrible is going to happen. That is what creates a lot of bad adult patients. Then you have adults who are still scared to see the dentist.”

Any dentist will do for regular checkups. Dr Low informs that parents don't necessarily have to find a consultant who specialises in dentistry for children.

Below are some common questions answered by Dr Low on dental issues and children:

When should a child start brushing their teeth?

“Ideally they should start brushing the minute they know how to handle a toothbrush.

“Nowadays children are quite clever; they're learning to use the toothbrush early. But they may not do it as well so we always recommend that the parents either help them through it or take a wet towel to clean their teeth if they're still small.”

What type of toothbrush should they use?

“Ideally, get a soft brush. This is not just for children; it applies to adults too. When you rub two surfaces together one will wear out. If you use a hard brush, the brush will stay in tact, the tooth will wear away. If you use a soft brush your tooth will remain in tact, but the brush will wear away.

“And, it's cheaper to wear away the brush instead of the tooth!”

When should a child start using toothpaste?

“The general norm is at the age of two onwards. By that time all the baby teeth would all be there. Any earlier, we normally recommend to parents to use a wet towel and clean the teeth. Usually we recommend using toothpaste the size of a pea because you don't need a lot. A little bit is sufficient.

“Actually, the toothpaste is just to make the brushing process much more pleasant. Otherwise if you just brush with a toothbrush it's quite a boring exercise. The flavour of the toothpaste makes it pleasant. It needs to be toothpaste with fluoride. The colourful toothpastes are fine for children.”

What type of toothpaste?

“Any fluoride toothpaste is fine.”

When do the permanent teeth usually start to come out?

“At the age of six to seven the front teeth of the permanent set will start to come out and followed by those at the back until they are about 12 years old. After 12, then the other teeth, farther back, will come out.”

Do you have to help the baby teeth fall if the permanent teeth are coming up?

“You don't have to shake the baby tooth to make it fall out when the permanent tooth is coming up. Generally, the baby teeth will drop off by themselves. It's just a matter of time. But if the baby tooth is causing pain, then we suggest extracting it. Nowadays, extraction is very simple. But if there are no problems, leave it there. It will drop off by itself.

“The baby teeth do not cause the permanent teeth to grow crooked. If the teeth are going to grow crooked, they will already be growing crooked. It's got nothing to do with the baby tooth. The permanent teeth are just directly below the baby teeth. Taking out the baby tooth may not necessarily result in that tooth growing straight or in the right position.”

If the child has a tooth which is chipped, broken or decaying, do you need to see the dentist?

“One of the main functions of the first set or the primary teeth is to maintain the space for the permanent teeth to develop underneath it. So if you lose any of the baby teeth, especially the back ones, what happens is the teeth at the back tend to move towards the front of the mouth. Teeth naturally want to move forward on their own. So if there are no teeth there, the others will naturally move forward.

“Eventually when the permanent teeth are due to come out, the space is lost. Of course there are exceptions to that. That's why preserving the primary teeth is very important to maintain the space and for the permanent teeth to come out properly and aligned. Of course, the second reason why we would treat the primary teeth is if they are in pain, they cannot eat, or if there is abscess or an infection.

“If there is a chip and there's no pain, you still should come in to get it seen to and perhaps we will round off the edges because it might be very sharp. A chip can lead to other problems. It could affect the permanent teeth forming underneath. So, it's good to have it treated.”

What do you do if the child has sensitive teeth?

“Children should not have sensitive teeth. If it is painful, it can mean one of two things – there's a decay or there's a gum infection.

“So, then it would be painful when they brush. That is usually the case. But we don't get this often.”

If the child needs braces, what is the best age to have them treated?

“The best age is when all the permanent teeth are there. That means they don't have any more of their baby teeth. That's the best age – 12 or 13. But there are provisions to that. Sometimes we do treat them much younger than that. For example, if their lower teeth are in front of the upper teeth. We'd like to correct those cases when they are young.

“Sometimes we also have children coming in at nine years old and their front teeth are really sticking out and they love outdoor sports. If they fall, those teeth will chip or break. For those cases, we do treat them much younger.

“But by and large, if the child is quite happy and it's not really a problem, we leave them until they are 12 or 13.

“You can still put on braces when you're an adult. It's not really more painful. It's just that it takes a little longer. If you get your braces done when you're about 12-15, you're still growing then so the growth factor helps the treatment a lot. But once you stop growing you have to actually physically move the teeth along so the process takes a little longer.

“Braces are used for aesthetic reasons. That is the usual reason why people use braces. But there are also people who get braces done for functional purposes – sometimes, because of the jaw, the teeth are in the wrong position and they can't eat properly. Sometimes they might have lost a tooth a long time ago and the other teeth next to it have bent inside. Now they want to do something to replace that so we get it upright and do a replacement.

“By and large, appearance is the main reason why people come in to have their teeth corrected.”

Is it safe for children to have tooth whitening done?

“We don't recommend whitening of teeth for children, not until they become adults. Teeth comes in a range of shades. Where does the teeth derive its colour from? Mainly from the dentine underneath. So when the enamel is thicker the teeth are whiter. When the enamel is thinner, the teeth are a bit more yellow. That's basically what happens.

“I personally would not recommend whitener for children for the simple reason of who decides whether they like the colour of their teeth or not? The mother. But the child may not mind the colour. In fact, to be honest some of the perceived darker shades are quite nice.

“But if the child wants to do it then of course we will do it for them. Whitening is very safe because the whitener just bleaches the unlined dentine. But not many children ask for it.”

Is it okay for children to use sealants?

“Sealants are fantastic. We have been recommending sealants for years. Obviously when the permanent teeth first come out, especially when the surface is very irregular, a lot of food tends to collect between the teeth and that's when the decay starts. Once you apply a sealant you reduce the risk tremendously.”

Is it okay for a child to floss?

“Flossing is always good but the problem is in getting a kid to floss. It's not easy. But if you do it, it's good. These are good oral hygiene procedures – flossing, brushing.

“If the child can use it, then at any age they can start flossing.

“Of course, if they are young and the teeth are in good contact they may not have much food getting stuck.”

Can children or teenagers get implants?

“Implants for children and teenagers – it's not frequently done but if the need arises, it can be done. If they get an implant done when they are too young, some of the teeth will be shorter and some will be longer. But it's usually not done at a very early age.

“But I think in this day and age it's not necessary to replace teeth anymore. If they don't lose their teeth they don't have to replace them.”