At Ask The Expert, I spoke of the most common infectious disease of childhood, Early Childhood Caries (ECC) or baby bottle tooth decay. A worrying trend in Singapore is that a quarter of all three-year-old children are affected by ECC, and this number rises to half of all children aged six.
Our modern lifestyles are more stressful then ever, and the food and drink available for our children contain more and more added sugars, in both obvious and subtle forms. This, along with poor oral hygiene, is the chief cause of ECC in our children. But that’s not the only link.
Researchers from the UK and the US conducted a study on over 700 children that was published recently in the American Journal of Public Health, showing that a link may also exist between maternal stress levels and propensity for that mom’s child to have tooth decay.
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In the study, biological stress markers were first measured from the blood of mothers. Next, their children between the ages of two to six were dentally screened for the presence of ECC, and the results analysed. It was found that the mothers with elevated stress levels were significantly more likely to have children with tooth decay.
Because the direct scientific link between the two findings is still poorly understood, the researchers sought to investigate how highly stressed mothers may be altering their care-taking behaviors to affect the chances of their children developing tooth decay. Thus, they also conducted interviews with the mothers to explore care-taking factors such as regular dental visits, breast-feeding habits and daily breakfast habits for these children.
The results showed that highly stressed mothers had less time to bring their children for regular dental check-ups, which resulted in most dental decay going undetected until the screening.
Milk formula and the incidence of tooth decay
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What was also interesting was that ECC was almost twice as common among children who were not breast-fed, and highly stressed mothers were significantly less likely to breast-feed their children.
Finally, mothers with higher stress markers were less likely to personally feed their children breakfast on a regular basis. And the children who were at higher risk of ECC were those who were not fed breakfast by their mothers.
In fast-paced Singapore, it is almost a given that motherhood will be stressful. In addition to this, most family units are dual-income, where mothers also work to supplement the cost of raising children. While the published study has shown a link between maternal stress, care-taking behaviours and the presence of ECC in young children, it is still possible to easily achieve optimal dental health for your kids.
The key is dental awareness, coupled with realistic care-taking goals. Every child’s first dental check-up should be done by the age of one, because ECC may aggressively affect baby teeth the moment they erupt. Early and regular dental visits can help detect decay in the initially reversible stages before they become actual cavities, as well as equip parents with the knowledge on how to care for each child’s unique dental needs.
It is undisputed that breast-milk best meets a baby’s nutritional needs. However, not all mothers are able to breast-feed their children, and those who do have varying methods and durations with regards to the practice. What is more important to note is that a higher prevalence of ECC in children not breast-fed could be due to the alternatives they are drinking.
Infant formula milk or worse, a sugary beverage such as Milo or juice concentrate, may be the drink of choice for these young children. When drank regularly especially through a bottle before bedtime, the added sugars in these liquids stick to tooth surfaces and cause tooth decay. It is thus essential to wean a child off the bottle as soon as possible, and to ensure that they always brush their teeth after the last feed at night.
Relax to fight tooth decay
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In the Singaporean and the broader Asian context, children tend to have more than one caregiver (usually a domestic helper or grandparent) while moms are busy working. If consistent parental supervision during breakfast is difficult, then educating the caregiver on how to feed children in the morning will be necessary.
Highly sugary foods should be avoided during breakfast, such as cookies, biscuits, chocolates and very sweet flavoured cereals. Our local breakfast range also contains much added sugars in kaya, sweetened soya milk and buns with sweet fillings such as red-bean paste. As sugar is the main predisposing factor of ECC, it is beneficial to always go for low-sugar breakfast alternatives such as fresh fruit, plain yoghurt, cheese and unsweetened cereals and breads.
Finally, it is important for mothers to actively manage your stress levels by taking some time off for yourselves to do what you enjoy. Not only does this preserve your sanity, but it will also improve the way you care for your child’s dental health.
Dr Terry Teo is a full-time Pedodontist (Paediatric Dentist) with The Dental Studio (TDS), a Singapore Medical Group Clinic. Dr Teo’s place of practice is at The Dental Studio, Paragon.