"Ouch, my tooth hurts, Mummy!" - Dr. Terry Teo answers your questions on kids' dental problems
Should you let your child's decayed milk teeth fall out or should you visit a dentist? What do you do when your kid refuses to brush his teeth? These are just a few of the questions Dr. Teo of The Dental Studio has answers for in this article...
Dr. Terry Teo is a highly qualified specialist paediatric dentist who practices full-time at The Dental Studio, Singapore. He has a wealth of experience in handling a wide range of kids’ dental issues and is particularly interested in paediatric behaviour management, including kids with special needs.
Earlier this year, theAsianparent gave you, our lovely readers, the opportunity to ask Dr. Teo all your questions about dental problems in kids. In this article, he provides informative answers to the questions he received about Early Childhood Caries (ECC) and dental hygiene routines.
Please note that the following information has been edited for brevity and clarity.
Q: What is the right time to bring my son for his very first dental check-up? He is nine months old, has eight baby teeth, and is already eating a variety of foods that may contribute to tooth decay.
A: All children should have their first dental visit as soon as the first tooth grows, or by their first birthday. This is important to assess for potential risk of oral disease and to educate parents on proper oral hygiene practices. Thus, now is the perfect time for your son’s first dental examination.
At nine months of age, the main contributor to tooth decay in infants is usually formula milk, which contains a lot of added sugar. This form of decay is called Early Childhood Caries (ECC) and is a disease that progresses very quickly.
Early Childhood Caries can begin from as young as when the first tooth erupts, especially if your child is constantly drinking formula milk from a bottle during bedtime and not having his teeth cleaned after.
Q: We have only just started a routine of brushing our two-year-old boy’s teeth. He sometimes reacts very aggressively against this, especially when he’s tired, and we often give up trying on such occasions. Is it okay to give up, or should we insist on the routine?
A: Your child is at the age where he is beginning to test the boundaries and limits that you set for him. If he refuses to brush his teeth and you give in to him, he will know that the way to get out of it is to throw a tantrum.
If this continues, it will be very difficult to cultivate good oral hygiene habits in your son. Perseverance, therefore, is key. Be firm and do not let him go to bed unless he has brushed his teeth, as regular brushing is the foundation of good oral health.
I know it is difficult, but it is much easier to instil discipline and habit in your son at age two than at age three or four! Once the habit of consistent brushing is formed, there will be less and less resistance as the days go by.
Q: My son is 14 months old now. Can I start using toothpaste when brushing his teeth?
A: Besides helping to remove plaque trapped on the tooth surface, toothpaste delivers the most important protective ingredient to your child’s teeth: fluoride. Fluoride is necessary to prevent ECC, which is a disease that now affects up to half of all six-year-old children in Singapore.
If you are practising good dietary and oral hygiene habits for your son resulting in a lower risk of ECC, then it is not necessary to use fluoridated toothpaste until he learns to spit. If however, he is at high risk of developing ECC, it is better to use a smear of 1000ppm fluoride toothpaste on his toothbrush during brushing to gain its protective effect.
Do not finish up with rinsing his mouth, as this will result in him swallowing more of it. Gently wipe away the excess toothpaste after brushing. If you only use a smear of it on his brush and wipe after, the small amount he may swallow will have no harmful effect on his growth and development.
Q: Six of my three-year-old’s upper front teeth are decayed. Also, his teeth are only around two-thirds of the size of normal sized milk teeth.
He has been on fluoride toothpaste since last year and we brush his teeth every night. I want to know if fillings can be done on his decayed teeth. Will the procedure be painful and how long will it take?
A: From what you have described, your son has severe ECC. At this stage of the disease, starting him on fluoride will no longer work as a preventive measure unless all the decay is treated because the cavities are too deep and still actively progressing.
Most of the time, the teeth can still be filled or restored. If the decay progresses into the nerves causing a painful infection, then either more complicated treatment such as nerve treatment is needed, or the teeth have to be extracted.
How this treatment is delivered, along with the timing and number of visits required, thus depends on how badly decayed his teeth are and how able he is to cooperate with dental treatment.
Q: My five-year-old old daughter’s upper front teeth are all decayed, probably because she eats lots of sweets and still drinks milk from a bottle at night.
Should I just wait until her milk teeth fall out on their own? Or should they be removed? My concern is that removing her teeth will be traumatic for her as there are quite a few that will probably have to be taken out.
A: From her habits, I can tell you that your daughter also has cavities in her baby molars. At age five, she will still have these molars to chew on for around five more years, and her front teeth for another two years before they fall out.
During this time, the cavities caused by the decay will get bigger and may lead to pain and infection. This will affect her appetite and sleep and can possibly result in acute dental emergencies.
Not all rotten teeth need to be extracted. Depending on the size and extent of the cavities, treatment may still be possible to restore form and function to the teeth, but the longer the delay the harder they will be to save.
Parents always ask if decay in baby teeth can be left alone until they drop out, as they are sometimes not giving pain. You do so at your child’s risk because when pain comes it is often severe and disruptive to the entire family.
Q: Prior to my five-year-old daughter’s first visit to the dentist, I told her about what she should expect during the visit by reading books, watching videos and role-playing. She sounded confident but got scared and cried during the actual visit.
Now she has to see the dentist again to fill a cavity and for a clean-up but I know she’s going to get very anxious again. Please advise.
A: Do not be disheartened. All children have unique and different personalities, but we must not forget that they possess limited ability to cope with stressful situations.
A dental visit (especially one involving drilling and filling) is a very stressful situation even for adults, and sometimes no amount of preparation can adequately equip your young child with the skills needed to cope with this experience.
The key is proper history taking, examination and the discussion and agreement of a treatment plan that specifically addresses your daughter’s condition (in this case, tooth decay) in relation to what she can realistically tolerate.
Paediatric dentists are able to treat most children comfortably by employing behaviour management techniques. In more apprehensive children, light sedation using “happy gas” may be employed to make them more relaxed.
Sometimes in severe cases, dental treatment may even have to be performed while the child is temporary asleep under general anaesthesia. This may sound scary, but is extremely safe when performed by a qualified paediatric dentist, and ensures that the treatment is done to the highest standard of care possible.
Q: What is the difference between a paediatric dentist and a general family dentist? Lots of dentists treat children and some say they have a special interest in treating children.
A: Lots of general dentists treat children as part of family dental care, and are wonderful at handling kids.
However, a Paediatric Dentist is one who devotes their entire practise to treating children from birth to adolescence, much like medical paediatricians do. Thus, they generally do not treat adults.
Paediatric dentists are recognised as specialists in their field. They go through up to three years of additional training after their basic dental degree to attain the knowledge, skills and expertise needed to master all the complexities of children’s dentistry.
This results in an additional qualification, usually a Master’s degree, which is reflected after the dentist’s basic dental qualification (usually a Bachelor of Dental Surgery).
theAsianparent would like to thank Dr. Teo for his insightful answers to our readers’ questions. Do look out for the next article in this series where Dr. Teo answers your questions on cosmetic dental issues in kids and more.
How much do you know about kids’ dental problems and how does your child react when taken to the dentist? Share your stories with us by leaving a comment below.
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