You are clerking a young boy and you notice that he has lots of visibly rotten teeth. You’re shocked as he is is only 4 years old. You ask his mother about his teeth and she says,
“We always brush his teeth every day” .
“He doesn’t really eat sweets”.
You ask if she has taken him to see the dentist and she replies, “We can’t find any dentists who are taking NHS patients at the moment”.
This scenario is not unusual: around one-in-four 5-year-olds have dental decay, affecting, on average, three or four teeth. There is no substitute for seeing a dentist and getting a personal dental plan, but with a shortage of NHS dental appointments and the knock-on effects of COVID, it may be some time until the child is seen. This, added to the fact that children’s oral health has been found to deteriorate in hospitalised children, means that we should do more than advise a child to see a dentist.
A good place to start is to know the basic public health messages around oral health.
Here are some facts to help improve children’s oral health:
Brush teeth twice a day
Teeth and gums should be brushed twice daily for a minimum of 2 minutes. The most important time is last thing before bed due to the decreased saliva production at night. Saliva’s antibacterial properties act as a natural defence against bacteria, neutralise acid levels in the mouth and help wash away food remnants.
Spit, don’t rinse
After 2 minutes, spit the toothpaste out but do not rinse with water or mouthwash, as this will wash away the fluoride from the toothpaste. Leaving fluoride on the teeth helps protect them between brushing and maintains the fluoride concentration levels.
Don’t brush straight after eating
The pH in the mouth decreases straight after consumption of food leading to demineralisation of the enamel – wait 30 minutes after eating before brushing.
Check that you are using the right amount of fluoride
Toothpaste that has fluoride in it helps to keep the teeth and gums healthy. The amount of fluoride can be checked on the toothpaste label.
Try and keep food to mealtimes
Children are less likely to get decay if their teeth are given a rest from food and drink other than water between meal times. If children are snacking in between, consider the following less cariogenic snacks:
- Fresh fruits (choosing fruits that are low in acidity and sugar – like berries, peaches and apples)
- Cheese / dairy free alternatives
- Cucumber / carrot sticks
- Unsweetened or plain milk/yoghurt
Brush teeth together
All children should be supervised with their brushing until around the age of 7.
Change toothbrushes regularly
Your toothbrush should be changed every 3 months.
Avoid sugary medication
Advise parents to choose sugar free medicine options.
Take children to see the dentist early and regularly
Parents should be encouraged to take their children to the dentist as soon as the first tooth appears (around 3-6 months old), and all children should see a dentist by age 1. Children can see an NHS dentist for free up until 18 years (or 19 years if in full-time education). The time between appointments should be at most 12 months.
How to find a dentist
In the UK, families who do not have a regular dentist with a dental emergency can call 111, which will provide details of an urgent dental service. To find a regular NHS dentist, the NHS website has a link titled “search for an NHS dentist near you”, and there is a contact number for NHS England Customer Contact Centre if they cannot find a dentist accepting NHS patients. (https://www.nhs.uk/nhs-services/dentists/how-to-find-an-nhs-dentist/, accessed 5th October 2022).
Resources for parents
- NHS website: https://www.nhs.uk/conditions/baby/babys-development/teething/looking-after-your-babys-teeth/
- https://teethteam.org.uk/ – downloadable teeth brushing charts
- https://www.bspd.co.uk/Kidsvids – videos for children about teeth and visiting the dentist
- App: Brush DJ – plays 2mins of songs to help make teeth brushing more fun (no adds or in app purchases)
Health Education England (HEE), (2019) Mini Mouth Care Matters: A guide for hospital care professionals. V1. Available at: http://mouthcarematters.hee.nhs.uk/wp-content/uploads/sites/6/2020/01/MINI-MCM-GUIDE-2019-final.pdf
Public Health England (PHE), (2017) Delivering better oral health: an evidence-based toolkit for prevention. Third Edition. Available at: https://assets.publishing.service.gov. uk/government/uploads/system/uploads/attachment_data/ file/605266/Delivering_better_oral_health.pdf