1. Looking after Children’s Teeth
A presentation developed by the Oral Health Promotion team for use at a postnatal or other targeted early year session. All the recommendations are based on guidance from “Delivering Better Oral Health- An evidence-based toolkit for prevention” - second edition by Department of Health and the British Association for the Study of Community Dentistry
Published 13th July 2009
Produced by the Oral Health Promotion Department part of Buckinghamshire Priority Dental Service

2. Who can do the most to help prevent tooth problems?
You can
Tooth decay and gum disease can be prevented
This session will help you understand how
Tooth decay and gum disease is preventable. This puts the onus on parents to take responsibility for their child’s oral health.
Starting good habits from the beginning is easier than trying to change established behaviour later.

3. Children need their milk teeth to:
Why do teeth matter?
Children need their milk teeth to:
Eat
Talk
Hold space for adult teeth
Develop face shape
Smile with confidence
Support their general health
The first teeth are important developmentally for a child's speech, eating and facial appearance.
They establish space in the mouth for the adult teeth, allowing the permanent teeth to grow and develop normally. Early loss of the first teeth can lead to overcrowding when the adult teeth appear.
They are also important for self confidence- children who lose teeth early from tooth decay are often very self conscious about their smile.

4. Today’s problem
Approximately 23% of 5 year olds in Buckinghamshire are affected by tooth decay *
this may became painful and require multiple extractions
treatment is often traumatic and may require a general anaesthetic
Buckinghamshire covers Aylesbury (25%), Chiltern (20%), South Bucks (21%) and Wycombe (24%)
By decay we mean they have teeth where untreated decay is present, or they have had teeth removed or filled due to tooth decay in the past.
*National Dental Epidemiology Programme for England:
oral health survey of five-year-old children 2012
A report on the prevalence and severity of dental decay

5. Dental decay
This picture shows a child who frequently snacked on foods and drinks which contained sugar during the day and at bedtime
Tooth decay occurs when the bacteria in dental plaque use sugars in the diet to form acid which then damages the hard tooth structure.
This softening of the tooth enamel and dentine can ultimately lead to a cavity (hole) in the tooth.
Children in Bucks as young as 2 or 3 years old are still having teeth taken out under general anaesthesia each week because of tooth decay.

6. Oral Heath is more important than you may think
– it has been linked to:
Diabetes
Stroke
Heart Disease
Lung disease
Dementia
Low Birth Weight
Premature Birth
Delayed Conception
The effects of poor oral health can impact on general health. The main cause of these links to other diseases is through gum disease but tooth loss itself is also a factor. Many of the causes of poor oral health also share common risk factors such as those causing obesity.
The aim is that these babies will not only keep their teeth all their lives but also remain healthy.

7. Regular check-ups are important
The dentist
To find an NHS dentist in Bucks log on to and type ‘find a dentist’ into the search box
Take your baby with you for your check-up
Children should ideally have their first visit by about 1 year old
Free NHS dentistry for children at school and pregnant women/new mothers until baby is 1 year old
Regular check-ups are important
Taking your baby with you to your check-up lets them get used to this new environment. The ideal is a visit for a simple check at about 1 year old but they should definitely have seen a dentist no later than 2⅟2 years old.
A new contract for dentists is being introduced next year (after May 2015). This will give the dentist an additional payment if they prevent dental disease for their patients.
Make sure you are registered (under the current contract we are not registered) as it may be harder to find a dentist. In order to be paid this money dentists will need to track changes on their patients therefore less new patients may be taken on.

8. Tooth development First adult tooth at about 6-7 years old
The last milk tooth falls out at about 12 years old
The front lower incisors are usually the first to erupt. The teeth erupt in pairs. There can be wide variation between babies as to when the first tooth erupts but if no teeth at all have erupted by their first birthday they should visit their dentist for advice.

9. Tooth decay is preventable
Cleaning teeth
A tooth friendly approach to food and drink
Both are needed if we are to prevent gum disease and tooth decay

10. Tooth brushing is important for two reasons
Cleaning teeth
Tooth brushing is important for two reasons
1 – Removing Plaque 2 – Applying Fluoride
Cleaning teeth- the mechanical act of brushing helps to prevent gum disease and by applying fluoride it prevents against tooth decay.

11. Brushing children’s teeth
Brush gums as well to prevent gum disease
Use a toothbrush with a small head
Help with brushing until your child is at least 7 years old
Brush twice a day for 2 minutes
The brush before bedtime is the most important
Start brushing as soon as the first tooth appears, the bacteria that cause tooth decay can grow in your baby’s mouth as soon as the first tooth erupts. Brush gums as well to prevent gum disease. Use a toothbrush with a small head, in order to get into all the nooks around the tooth. Help with brushing until your child is at least 7 years old, it requires the same skill as joined up handwriting, therefore discourage the use of a battery or electric toothbrush until they are able to use a manual brush properly (they may use too much force and an electric brush will wear down the tooth). Brush twice a day for 2 minutes (once all the milk teeth are through). The brush before bedtime is the most important (and nothing to eat or drink after cleaning) as the natural defences such as saliva are reduced at night times so decay is more likely if sugary food or drink has been left on the teeth.

12. Tooth brushing Try to start in the same part of the mouth each time
Angle the toothbrush towards the gums & brush gently
Clean outside, inside and biting surfaces of the teeth with a small circular motion
Try to start in the same part of the mouth each time
Angle the toothbrush towards the gums & brush gently
Clean outside, inside and biting surfaces of the teeth with a small circular motion
Laying your child in your lap, sitting on your knee or the cradle their head in the curve of your arm can be good positions

13. Why use a Fluoride toothpaste?
Fluoride acts in three ways:
It slows the growth of bacteria
It helps to strengthen the outer enamel layer of the teeth
It remineralises early decay back into tooth again
Fluoride is fantastic but it should be treated as a medicine therefore do not let your child eat it from the tube. It acts in three ways:
It stops bacteria growth
It helps to strengthen the outer enamel layer of the teeth
It remineralises early decay back into tooth again
So should always use a fluoride paste for maximum prevention.
Fluoride is fantastic for your teeth but do not allow your child to eat toothpaste from the tube

14. Toothpaste
From 3 years old use a small pea sized amount of 1350–1500 ppm of Fluoride toothpaste (adult strength paste)
Use mint flavoured toothpaste as fruit flavoured may not contain sufficient fluoride
Spit out excess paste but don’t rinse out after brushing
0-3 years old use a small smear of toothpaste with at least 1000 parts per million (ppm) of Fluoride. Baby will only swallow an incredibly small amount of fluoride because only a smear. Buckinghamshire has low levels of Fluoride in the water supply (about 10% of optimum) therefore extremely safe in this dosage. 3 years and above use a small pea sized amount of 1350–1500 ppm of Fluoride toothpaste (adult strength paste). At 3 years of age a child should be able to spit out so the amount on the brush can increase but we all only need pea sized amount (including adults). Use mint flavoured toothpaste from the start as then will adapt better to the adult paste when older. Spit but don’t rinse out –to keep the fluoride in place.

15. How tooth decay happens
Sugar + bacteria = acid
Acid + enamel = decay
Plaque bacteria grow in our mouths all the time. Sugar is used by the bacteria in plaque to make acid.
Acid removes salts and minerals from the tooth causing decay.

16. Frequency of acid attacks through the day
Saliva is vital in preventing decay.
Saliva neutralises the acid and eventually starts to repair the damage. The whole process of repair (remineralisation) takes time. The more often in the day you eat food or drink containing sugar, the more likely there will be tooth decay. By keeping foods and drinks containing sugar to mealtimes this allows the teeth time to remineralise. 

17. Fruit flavoured squash
Children will drink for the sake of it as they like the sweet taste
This can result in them feeling full and not eating their meals
Harmful to teeth even if sugar free
In contrast.....
They will drink water when they are thirsty and it will quench their thirst but not affect their appetite
Sweet drinks are unsuitable for young children – they are a poor source of nutrients, displace more nutritious foods and are acidic.
Water quenches the thirst and replenishes body fluid; it does not spoil the appetite and is not harmful to teeth. It also helps to prevent constipation.

18. Limit sugary foods and drinks to main mealtimes only
Remember
Limit sugary foods and drinks to main mealtimes only
By allowing long periods without sugar intake the mouth can maintain a normal pH which dramatically reduces the risk of dental decay.

19. What can you give them between meals?
Fresh Fruit
Fresh vegetables
Bread
Cheese
Crackers
Plain yoghurt
Milk
Water
Any sugar free foods
Fruit and vegetables are ideal e.g. slices of cucumber or carrot as they count as part of your 5 a day. Cheese helps to counteract the acid but an adult portion size is the size of a small matchbox so be aware of the fat content. Natural yoghurt with fresh fruit added is better than pre- made versions which contain large amounts of sugar (approximately 5 teaspoons)

20. Fruit Should be eaten in natural form only
Smoothies or fruit juice will be acidic and cause damage to the enamel
Dried fruit causes decay so should not be eaten between meals
A variety of fruit is good for health as part of a healthy balanced diet. Fruit is fine for oral health as long as it is consumed in its natural form i.e. a slice of melon, apple etc. The sugar is held inside the cells of the fruit and needs to be released to cause damage, this tends to happen in the stomach Fruit in its natural form also contains lots of water. For these reasons it is not harmful to teeth (unless sucked for a prolonged period).
When it is juiced or made into a smoothie the number of pieces of fruit needed to make the drink increases and the acid content becomes concentrated. This acid will cause erosion. One portion of fruit juice counts towards your five a day. It should be drunk at mealtimes only, well diluted and preferably drunk using a straw when your child is able to do so.
In dried fruit e.g. raisins the sugar content is more concentrated than in its fresh natural form and will cause tooth decay, therefore these should only be eaten at mealtimes.

21. Thank you for listening and remember......
Brush teeth and gums twice a day especially before bedtime
Use a toothpaste which provides optimum levels of fluoride
Spit don’t rinse out
Keep sugary foods and drinks to meal times
Visit your dentist regularly
To recap the main messages for healthy teeth are:-
Brush teeth and gums twice a day especially before bedtime
Use a toothpaste which provides optimum levels of fluoride
Spit don’t rinse out
Keep sugary foods and drinks to meal times
Visit your dentist regularly
Thank you for listening

22. To recap the main messages for healthy teeth are:-
Brush teeth and gums twice a day especially before bedtime
Use a toothpaste which provides optimum levels of fluoride
Spit don’t rinse out
Keep sugary foods and drinks to meal times
Visit your dentist regularly
Thank you for listening