Dental Care for Your Child : Dr. Maha Alsarheed
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Dental Care for Your Child

Care of the mouth is an important aspect of maintaining the health of children. Neglect of teeth and gums results in unnecessary pain and injection and may cause permanent disfigurement. Teeth are necessary for proper chewing of food. In addition the treatment your child is receiving for the underlying medical disorder may be seriously complicated by the need for dental treatment.

  • The Cause of Dental Decay and Gum Disease
  • Control of Diet
  • Tooth Brushing (Removal of Plaque)
  • Fluoride Supplements
  • Dental Care For Children With Mouth Blistering
  • Dental Care for Oncology Patients
  • Care for Children with Heart Problem

The Cause of Dental Decay and Gum Disease

Many thorough research studies have shown that dental decay and gum disease are the result of a complicated interaction between the body’s resistance to infection ( host resistance ) and the bacteria (germs) that cause dental caries (decay), and gingivitis (gum inflammation).

Despite these complicated interactions dental researchers have shown that three simple measures, if carried out conscientiously, will prevent dental disease almost completely.

These three measures are:

  1. Control of diet.
  2. Thorough tooth brushing
  3. Careful use of fluoride supplements.

In addition your dentist can apply fissure sealants (a plastic shield or coating) to permanent teeth at the back of the mouth. This is easy to do provided that your child is sufficiently cooperative when he or she sits in the dental chair to have treatment.

Control of Diet

The role of diet in dental decay revolves almost completely around the fact that any sugars entering the mouth are used by the germs on and around the teeth to form acid. The germs adhering to the teeth are in a jelly-like mass stuck closely to the tooth surface. This holds the acid on the tooth surface causing dental decay. Eventually, usually after several months, there is so much calcium lost from the tooth surface that a hole appears. The germs then invade this hole and continue to burro deeper into the tooth finally causing infection of the nerve and abscess formation. Such infections are potentially very serious. At the very least they are distressing and can be very painful.

In the hole is caught at an early enough stage it can be filled with silver amalgam or in the case of anterior teeth a white fluoride rich filling. If the child is un-operative the usual alternative is to arrange for a dental anesthetic and to take out the badly affected teeth. This can sometimes create difficult problems when it has to be dovetailed with the other aspects of the child’s medical treatment.

The simplest way for dental decay to be prevented is to have rigorous control over the amount and particularly the frequency of sugar and sugar products eaten or drunk by the child.

In general terms this means that the best advice is to avoid sweets and sweet things between meals. With some effort on the part of the parents this is easily achievable. The special advice given to the public by the Health Education Authority is :

  1. to avoid sweet things as far as possible to avoid the development of “sweet tooth”.
  2. to cut down the frequency of eating sugary foods.
  3. to try and limit sweet eating.

The best way to achieve all this is to cut out between meal snacks, and to limit sweet eating to only one day a week for example, a Friday.

These guidelines are all very well for healthy children but many of the patients with special needs are placed on special diets. Some of these are necessary to keep the children alive, and some are necessary to help built up the strength of the children to make them feel better. This creates enormous difficulties for some of the patients as there is a genuine conflict between the advice normally given by the dentist to prevent dental decay, and the dietary advice given by the dietitians to keep children healthy.

It is clear that for children on these special diets the medical needs must over-ride the needs of preventive dentistry, nevertheless, some effort can be made in partnership with the dietitian to modify the diet to reduce the risk of dental decay.

Tooth Brushing (Removal of Plaque)

Tooth brushing and tooth cleaning are an important part of personal hygiene and are essential for the maintenance of healthy teeth and gums. The object is to remove all plaque and debris from the tooth surfaces and gum margins each and every day. Good tooth brushing and tooth cleaning is a skill that needs to be properly taught. To do this the patient should be seen by the Dental Surgeon or Dental Hygienist on a regular basis until a satisfactory standard has been reached. The teaching requires that the pale usually colorless Bacterial Dental Plaque is revealed by staining with a red dye known as a Disclosing Tablet or  Solution. This dye can be used in the dental surgery or occasionally at home under parental supervision. The frequency of brushing is always recommended as two times a day although some patients are only able to manage once a day.

The best design of toothbrush is now well established as Multituft. The size of the toothbrush head and the number of rows of bristle are features of each individual manufacturer’s design. Good examples of design are the Oral B brushes, Sensodyne brushes and Colgate own manufactured product.

It is important to remember that many young children do not have sufficient manual dexterity to clean their teeth properly.

The change in ability comes at about seven years of age. Nevertheless many older children will need some help from their parents. Children with physical or mental handicap will also need special help. Sometimes the help can be limited to modification of the handle of the toothbrush to enable a disadvantaged patient to grip it properly. You should see your dentist about this as it may need the help of a dental technician.

Many patients and parents ask about the advantages of an electric toothbrush. This is like comparing an old fashioned carpet sweeper with an electrically operated vacuum cleaner. It should be borne in mind that the tooth brush head still needs to be manipulated in an active way. The effectiveness of its use should be checked with your dentist.

Whichever design and method of toothbrush is used a suitable toothpaste is needed to get the best cleaning effect. In addition modern toothpastes have fluoride in then, which helps prevent dental decay. The proprietary toothpaste seen in supermarket and high street chemists are almost always suitable. The secret of success is to stick to the well established brands or supermarket’s own brand.

Dental Floss

This is waxed silk thread that is pulled gently upwards and downwards between the teeth to remove dental plaque from the area of the tooth and gum where the toothbrush bristles are unable to reach. To be effective it has to be used every day. Before it is used it is important to ensure that as much tooth cleaning as is possible by tooth brushing has been carried out conscientiously. Once this has been done the floss can be used although it does need to be monitored by the dentist as over enthusiastic use cause damage to the gums.

Chemical methods of Controlling Plaque

The only method known to be effective is the use of a solution of 0.2% chlorhexidine gluconate (Corsodyl mouthwash). A measure is supplied in the cap. Approximately 10 ml of solution should be measured out and a few milliliters at a time gently and thoroughly rinsed around the mouth for 60 seconds. This should be done morning and evening. This disadvantage with the technique is that it causes staining of the teeth. The stain needs to be removed by scaling and polishing which is carried out by the Dental Hygienist every few months.

An alternative method of administration, especially for those children with extremely sore mouth (e.g. epidermolysis bullosa or bone marrow transplant patients during chemotherapy ) is a spray with a long plastic nozzle. It is easy to direct the chlorhexidine to areas of difficult access.

Fluoride Supplements (Fluoride Drops and Tablets)

Fluoride is an effective way of preventing dental caries, often up to 50%, when used every day. For children with chromic medical disorders it is most effective if used from birth in the forms of drops or tablets. The amount to be administered by the parent depends upon the age of the child and the amount of fluoride present in the water supply.

Recommended Dosage of Fluoride (F-) Drops and Tablets
(milligrams of fluoride per day)

 

Age (yrs)

Level of F in Water Supply
(parts per million)

Less than 0.3

0.3 – 0.7

More than 0.7

Less than 3

0.25 mg

0 mg

0

3-6

0.5 mg

0.25 mg

0

6-12

1.00 mg

0.50 mg

0


This is the new range of recommended dosages. You may find that the label on your bottle is slightly different. You can follow the ‘old’ dosages if your wish but we would prefer you to use these. The method of administration is quite simple. Drops are used for infants and small children and tablets which can be sucked or chewed for older children. If it is more convenient the drops can be used for older children especially if there is any physical or mental disabled.

Fluoride Toothpasts

This is probably the most widely used method of administering fluoride. It is easy, simple and safe. The toothpaste should be used sparingly: only a measure the size of pea should placed on the toothbrush. The fluoride in the toothpaste prevents up to 30% of dental decay. There is no reason why the toothpaste and supplements cannot be used on the same patient.

Fluoride Mouth Rinses

These are normally confined to use in children with excessive amounts of dental decay or where there is a significant change in the mouth as a result of illness or treatment, such as poor salivary flow after radiation treatment for a tumour. They can be used daily or weekly, both regimens giving similar levels of reduction in dental decay.

Daily Fluoride Mouth Rinse 0.05 % Sodium Fluoride

A measured 10 ml to be rinsed around the mouth daily after toothbrushing, for a total of 60 seconds.

Weekly Fluoride Mouth Rinse 0.2 % Sodium Fluoride

A measured 10 ml to be rinsed around the mouth weekly, after tooth brushing, for a total of 60- seconds.

These two methods are very effective in preventing dental decay provided they are used conscientiously. They do require a considerable amount of co-operation from the patient, so are not suitable for handicapped patients.

Overall Strategy

Each child needs an appropriate combination of the above measures: diet control, tooth cleaning and fluoride therapy. Discuss this with your dentist who will advise you.

Dental Care For Children With Mouth Blistering
(Epidermolysis Bullosa) Special Considerations

We know that children with mouth blistering have special problems with diet and tooth cleaning.

  1. As regards diet you must follow the advice of your dietitian. 

    Then, if possible, follow the advice in this booklet about reducing the number of snacks and reducing the amount of sugar you eat. Have sugar free sweets if you want them.
  2. As regards tooth and gum cleaning, be careful not to hurt yourself by causing mouth blisters.

    Try using the Braun Oral-B Plaque Remover. This is the only electric toothbrush approved by the dentists.
    If cleaning the back teeth causes blisters, use it on the front teeth only!
  3. Make sure you use the fluoride supplements. These are more important for you than almost any other group of children looked after by the dentists.

    Use drops or tablets, whichever is best for you.
  4. If the dentist prescribes it, use the special Johnson & Johnson mouthwash with or without the pink sponges.
    This is the Yum flavoured Magic Mouthwash that combines Fluoride 0.05% and Chlorhexidine 0.05%.
  5. If you are old enough, use Sugar Free chewing gum after every meal for 15 minutes. Make sure that you DON NOT  swallow it. 
  6. Make sure you see the dentist regularly.

Remember: Prevention is Better Than Cure

Dental Care for Oncology Patients

The treatment for children with leukaemia or solid tumours often causes problems in the mouth. This is especially so for those who have irradiation.

Some infections some from the mouth so it is very important to achieve a high standard of dental care before treatment for the cancer is started.

Follow the advice and:

  1. See the dentist and have any cavities repaired or bad teeth extracted.
  2. See the hygienist and check that your toothbrushing is perfect. If necessary use the Braun Oral-B Plaque Remover. Make sure that your gums do not bleed when brushed. If they do, you need to brush them more carefully. At first they will bleed a little more but as the inflammation subsides, the bleeding will stop.
  3. Be carefully about diet, particularly between meal snacks.
  4. Make sure that you use Fluoride supplements; drops, tablets or mouthwash; whichever your dentist recommends.

Mouthcare During Therapy

During the most important stages of chemotherapy or chemotherapy / irradiation treatment, the mouth becomes extremely sore. It is at this time that you must be sure to keep your teeth and gums very clean. A new toothbrush is used every day. you will also need to rinse with Chlorhexidine (Corsodyl) 0.2% four times daily. If the mouth is very sore, a small foam swab may be used. If the skin in your mouth is painful, use Difflam spray coupled with painkillers such as Paracetamol. Occasionally intravenous diamorphine is needed.

Remember: Once your acute therapy is completed, make sure you see the dentist for an update on your care.

Care for Children with Heart Problems: Special Considerations

A history of heart problems is of special concern if dental treatment is required.

It is very important that everything possible is done to avoid the need for treatment by following the guidelines outlined in this booklet.

Restrict sugary foods and drinks to mealtimes. Watch out for syrupy medicines and ask for sugar free substitutes.

  1. Brush teeth and gums thoroughly two times a day.
  2. Use a fluoride supplement
    :- drops or tablets for young children
    :- fluoride rinses for older children
    (as your dentist which is best for your child).
  3. Take your child to see the dentist regularly so that fissure sealants can be applied to your child’s teeth.

Infective Endocarditis

We all have germs (bacteria) in our mouth. They are usually harmless but during some types of dental treatment these bacteria can get into the blood stream.

In some children with heart problems this can lead to them settling on the heart valves and causing Infective Endocarditis.

This is very serious so before you have any dental treatment you must tell your dentist so that you can be given antibiotics one hour before treatment (orally0 or immediately before treatment (intravenously).

Your heart doctor will give you a card which will tell your dentist which antibiotics to use.