Last month, I was very fortunate to be invited to a talk on dental hygiene for children at Expat Kitchen given by an ex-classmate of mine who is a specialist in Paediatric Dentistry, Dr Ng JingJing from The Oral Care Centre. This talk was hosted by Colgate Singapore in conjunction with the launch of their new toothpaste, the Colgate Maximum Cavity Protection plus Sugar Acid Neutraliser.
Now that J is 7 years old, his baby teeth are dropping out and are being replaced with permanent teeth which he has to learn to look after for the rest of his life…and Little E is becoming more independent with her morning routine (which includes brushing her own teeth). So it’s up to me to teach them how to look after their teeth. I have always wondered if I am doing it right so this dental hygiene workshop was very useful for me.
I actually learned a great deal from Jing – she has two kids of her own so she had plenty of practical advice to share and it was enlightening to learn about kid’s oral hygiene from an expert mom!
Dr Ng JingJing’s Expert Advice on Paediatric Oral Care
1. Instil good brushing habits from young – a stepwise approach
Step 1: Once babies are beginning to wean onto solid food, use a clean, damp washcloth to clean the mouth and massage their gums – this helps them get used to having their mouths cleaned after mealtimes.
Step 2: When the first few little teeth start erupting, transition to a baby toothbrush with a very small head and very soft bristles. Use only cooled, boiled water to clean the teeth. Avoid ‘kiddie flavoured toothpaste’.
Step 3: Teach your child to spit. Once your child is around 18 months old, get your child to observe you brushing your own teeth and spitting toothpaste out into the sink. Then, clean their teeth with water and a soft bristled toothbrush and get them to try spitting into the sink. They will not yet be able to master spitting at 18 months, but hopefully with practice they should be able to spit effectively around 2-3 years old.
Dr JingJing’s Expert Mom Tip #1: Being able to spit is one of the key steps to brushing teeth. This is because swallowing toothpaste containing fluoride is undesirable as this leads to fluorosis which causes discolouration of the teeth. For this reason, Dr Jing advises parents to teach children that toothpaste is medicine, and cautions parents against using ‘kiddie flavoured toothpaste’ which is designed to be more palatable for children, as this encourages children to eat the toothpaste instead of spitting it out.
Step 4: Introduce toothpaste as soon as possible (i.e. once your child is attempting to spit into the sink). It is now recommended for children under 2-3 years old to use fluoridated toothpaste as this has been shown to greatly reduce dental caries (i.e. tooth decay). Start by putting a very tiny smear (not a ‘pea sized amount’) of fluoridated toothpaste onto the toothbrush. Once your child is effectively able to spit (usually over 3 years old), increase the amount of toothpaste to a pea-sized amount.
Dr JingJing’s Expert Mom Tip #2: Parents should use a very tiny smear or a ‘rice sized amount’ of adult toothpaste for kids under the age of 2 who are not yet proficient at spitting. The mint flavour of the toothpaste tends to be unpalatable for kids and will reinforce the idea that toothpaste is medicine and the child will be more likely to spit the toothpaste out (or dribble it out) into the sink instead of swallowing it!
(Any fluoridated toothpaste should be good enough, however, if you are particularly paranoid about dental caries especially in kids who may not be very thorough when cleaning their own teeth, you can consider using Colgate’s new toothpaste, Colgate Maximum Cavity Protection plus Sugar Acid Neutraliser, which contains a triple combination of arginine, an insoluble calcium compound as well as fluoride that has been shown to aid in remineralising tooth enamel and reversing early dental caries by neutralising sugar acids and restoring the pH of the tooth surface to a healthy level. I received a sample of this fancy new toothpaste from Colgate and I’ve been using it at home for the last month.)
Step 5: Continue to brush your children’s teeth for them until they are around 6-7 years old. This is because a child’s motor skills are generally not good enough to effectively manipulate a toothbrush to properly clean the inner surfaces on the teeth, especially the back teeth in the upper jaw.
Dr JingJing’s Expert Mom Tip #3: If your preschooler is becoming more independent, it is okay for them to start learning to brush their own teeth, however, parents should continue to monitor their preschooler’s teeth daily to make sure that they are adequately cleaned, and consider brushing their teeth for them a second time, especially in the evenings before bedtime.
2. Treat dental caries or tooth decay like an infectious disease – because it is!
Dental caries is actually the most common transmissible and infectious disease in humans. It is possible to minimise dental caries by adopting habits that minimise the transmission of cariogenic, tooth decay-causing bacteria.
Dr JingJing’s Expert Mom Tip #4: Be more paranoid! Teach your kids never to share anything that goes in the mouth. This means no sharing toothbrushes, drinking cups, straws or eating utensils with people outside the immediate family or even with a parent or sibling who has known dental caries or tooth decay. Additionally, parents should not allow people to kiss babies on the mouth as this introduces cariogenic bacteria into an infant’s otherwise ‘sterile’ mouth.
3. Look after the permanent teeth by looking after the baby teeth
Some parents do not worry about caring for baby teeth as these are deciduous and will ‘drop out anyway’. However, it is important to remember that baby teeth act as guides to help permanent teeth to erupt in the correct position. Additionally, teeth are necessary not only to ensure proper nutrition (by being able to chew food properly), but also to help with good speech development. So it does no good for young kids to have their baby teeth removed early as a result of tooth decay.
It is also worth noting that the permanent teeth are often present within the gums of children, waiting directly underneath the roots of the baby teeth – which often means that tooth decay in baby teeth can also spread to the unerupted permanent teeth leading to malformation. So it is worth keeping the baby teeth in good condition!
Dr JingJing’s Expert Mom Tip #5: When the permanent teeth are erupting, sometimes they start erupting behind the baby teeth instead of directly underneath – when this happens, encourage your child to wiggle the baby tooth loose and remove it as soon as possible. If the permanent tooth completely erupts before the baby tooth drops out, it will stabilise the loose baby tooth and lead to more problems such overcrowding, crooked dentition, even tooth decay as permanent tooth surface cannot be adequately cleaned by brushing – in such cases, visit your dentist to have the baby tooth removed.
4. Practice good eating habits for healthy teeth
We all know that sugar is the main culprit behind tooth decay as it is the food on which cariogenic bacteria thrive, making acids that ruin tooth enamel. Parents should be aware that sugar occurs naturally in many foods, but the amount of sugar hidden in processed foods (especially marinades and bottled sauces) beggars belief! I’ll be sharing a low-sugar recipe from Expat Kitchen later on this week which was SUPER easy to make, the kids actually did it all by themselves.
However, just adopting a low-sugar diet is not enough to prevent tooth decay in children. Dr JingJing told us that she has seen many cases of tooth decay in children (and infants) who do not consume any soft drinks, processed foods, sweets or any form of added sugar in their diet. It turns out that these children have a few of the following in common:
- They take a long time to eat during mealtimes.
- They hold food in their mouth for a long time without chewing or swallowing it (‘food pouching’).
- They drink milk/juice or nurse to sleep.
- Despite adequate solid food intake during the day, they breastfeed “on demand” throughout the night (sometimes even nursing constantly for several hours at night).
- They have many tiny meals/snacks frequently throughout the day, or they drink only juice/cordial or milk, spending several hours sipping them slowly.
In these children, their teeth are nearly always in contact with food during the day (and sometimes throughout the night). Even though their diet has been carefully selected by parents to be low in sugar or sugar free, the food is eventually converted into natural sugars by the enzymes present in saliva. Thus, their teeth are constantly sitting in a sugary, acidic environment which leads to decay.
Dr JingJing’s Expert Tip #6: Limit the number of mealtimes to five a day (three main meals and a mid-morning/mid-afternoon snack, or for breastfeeding infants who have teeth it means 3-4 hourly feeds), and limit the length of mealtimes (or nursing time) to 20-30 minutes. During these mealtimes, children can literally have as much sugar-containing food and drinks as parents will allow, but in-between meals, they should only have water.
5. Love your dentist
Once your child’s first tooth comes in, you can start bringing your child to visit the dentist for biannual checkups. Teach your child to love the dentist – do not use trips to the dentist as a threat or a punishment for errant behaviour!
J and Little E started seeing the dentist for ‘checkups’ waaaaay before they could even walk because we have a Convenient Dentist Uncle in the family. He blows them balloon elephants and chickens out of latex gloves.
Dr JingJing’s Expert Mom Tip #7: Primary school going children attending local schools in Singapore actually receive free dental care from their school dental clinic and are entitled to a free checkup every year! Make an appointment on behalf of your child with the school dentist for a checkup midway through the school year, and for the second visit, make an appointment with a friendly dentist of your choice – there are many dental clinics that cater specially to children.