Figures published by the Office of Population Censuses and Surveys in 1994 and 1995 show that four per cent of children aged two already have some decay. By the age of four this figure has risen to 30 per cent, and by the time they start school, 45 per cent of children have some decay.
Tooth decay is becoming a disease of deprived children. Their families may not use toothpaste or teach their children proper brushing techniques. They also tend to allow more sweets and sugary drinks because these keep the children quiet and occupied. Many of these children will not be registered with a dentist. In the inner city area of City and East London, for example, only 43 per cent of children are registered with a dentist, while in more affluent areas such as West Sussex the figure is as high as 83 per cent.
Dentist's corner
Some nursery schools in deprived areas, such as The Comet Nursery School near Hoxton in the borough of Hackney, are taking steps to try to overcome these problems. As part of the local health authority's community dental service screening programme which covers all primary schools and nurseries, a dentist from the local hospital visits once a year to look at the children's teeth and recommend where parents can take a child to a dentist.
The nursery staff have created a 'dental clinic' corner where the children can role play being at the dentist. Ann Kent, the head, thinks this helps back up the teaching the children already receive about good diet and care of the teeth. 'The nursery has for years only offered milk and water to drink I think that drinking water is such a good habit for children to get into,' she says.
In the past the nursery has also shown videos about preventing tooth decay to the parents.
Preventing tooth decay
Diet
Keep sweet foods for mealtimes Children who nibble at sugary foods all day or constantly sip sweet drinks are at the greatest risk of tooth decay. Never allow children to drink sweet drinks from bottles, especially in bed, as this bathes the teeth in sugary solution over a long period.
Try to keep sugary foods for mealtimes. After eating a meal the child will tend to eat smaller quantities of sweet foods. Similarly, very sweet acidic drinks should be diluted, kept to an occasional treat, and drunk at mealtimes as well. Some of these drinks are so acidic that it is best not to brush teeth directly after drinking them, as this can remove the damaged enamel from the teeth.
Milk and water are the best drinks for children, followed by diluted unsweetened fruit juices.
Cleaning the teeth
Supervise brushing Children up to the age of seven should always be supervised when cleaning their teeth. They should be taught to clean all the surfaces of the teeth twice a day with a vigorous up and down movement. In an older child, using disclosing tablets to reveal the plaque can help to show what is needed to remove it.
Use children's toothpaste You should always use a specially formulated toothpaste for children under six, because these have lower levels of fluoride than adult toothpaste. They also usually have a milder taste which children find more acceptable. Use a small amount, about the size of a pea, to avoid overdosing on fluoride. This is particularly important if the child is being given oral fluoride drops or tablets as well.
After breakfast and bed
These are the usual times for tooth cleaning, although some nurseries provide toothbrushes for the children to use after lunch, too.
Fluoride
Check fluoride levels Modern toothpastes contain fluoride which helps protect the teeth. Fluoride may also be given to children as drops or tablets from birth onwards. It is important to check with a health visitor, doctor or dentist on the level of fluoride in the local water supply so that the correct dose can be given. At present only 10 per cent of the population drinks water with added fluoride and the Government is considering whether to extend this. Too much fluoride can cause discolouring of the teeth. Occasionally this can happen if too much fluoride toothpaste is used, although most dentists think that the benefits outweigh the risk of a few children developing discoloration of the teeth.
Visiting the dentist
Befriend a dentist. It is a good idea for parents to take a child to the dentist sometime around the second birthday, just to familiarise them with the environment. The child can ride up and down in the chair and look at all the equipment. The dentist can tell the child to 'open wide' and talk about the importance of proper cleaning.
Dental care
Fillings
If a child visits the dentist and there is only mild decay in the milk teeth, the dentist may well suggest reventive measures rather than putting the child through the trauma of filling a tooth. If the decay is more advanced, fillings are usually the best solution. It can be difficult to control the amount of moisture in the mouth with a young child, and they will not normally be able to keep the mouth wide open for long, so glass ionomer cement is used instead of the old silver fillings.
Extractions
If a child needs a tooth extracted, this is normally done with a local anaesthetic. Most dentists do not want to take the risk of using a general anaesthetic, especially after the recent cases where children have died during routine dental extractions. If a child has visited the dentist regularly then he or she is less likely to be frightened.
Fissure sealing
When the child's first permanent molars come in at about six to seven years, these can be protected by fissure sealing. The deep fissures in the teeth in which food can be trapped are etched and cleaned, and then filled with a flowable plastic which is set with strong light using fibre optics. In children with decay this process can be provided free on the NHS; otherwise parents usually have to pay.
NW