Role of dental hygiene for young kids

Good dental hygiene is a small effort now that pays off immensely over time, making it one of the most valuable habits parents can encourage in their young children.

Figures from a University of Luxembourg survey entitled 'Health Behaviour in School-aged Children' found that in 2022/23, one in three children between the ages of five and seven had untreated dental caries, otherwise known as tooth decay which can signify the beginning of cavities.

Pediatric dentist Sarah Gregor of Kidssmile in Mertert believes that oral hygiene for young children is something that is not talked about enough. “It has a massive impact on the entire quality of life for a child.”

In her practice she has had to extract teeth in two and three-year-olds because of tooth decay. One particularly harrowing case was when it was necessary to take out nine decaying teeth, she recalls

Speech development 

Extracting milk teeth is extremely serious as not only is the child understandably upset, confused, and sore after such a procedure, but their milk teeth are also integral to a range of functions.

“People very often think that it is just milk teeth, and the new teeth are coming later on. If a child needs comprehensive treatment on, for example, eight or nine teeth and if they are quite young or not co-operative, then we need to put them under general anesthesia. This is what I have to do at least once or twice a month at the hospital in Esch,” she reveals.

“Sometimes there are only one or two small caries, and we can treat them using laughing gas once they have reached three years old.”

Milk teeth play a significant role in speech development, she outlines.

"They are very important in guiding the tongue when it comes to forming vowels and certain sounds with your mouth. When the teeth are missing, the tongue never learns how to pronounce vowels properly. If a child loses teeth at such a young age, very often they develop speech problems. It also has a massive impact on the growth of the jaw. The jaw becomes underdeveloped because they can’t chew properly.”

Sleep quality

Sleep quality is also impacted when teeth are extracted in early childhood, Gregor explains.

“When teeth are missing, the child learns a wrong pattern of swallowing, leading to mouth breathing at night, which leads to a chronically blocked nose and enlarged adenoids. This causes sleeping issues as they never reach the deep phases of sleep, and they are not rested the next day. Very often the kids are overtired throughout the day. Many are misdiagnosed with ADHD because this is one of the symptoms – being hyperactive in order to avoid falling asleep during the day.”  
 
This in turn has a knock-on effect on learning. “They have a short attention span, they cannot concentrate, and they cannot focus on things throughout the day just because they are overtired. They tend to get sick easily because when they are constantly mouth breathing, they are not breathing in air through their nose. Then all the dirt, bacteria, and viruses are not filtered out. The enlarged adenoids can get infected. It is all connected,” she highlights. 
 
Dr Gregor adds that if a child loses milk molars, very often they will have ongoing detal orthopedic problems. This is because the existing teeth will move into where the milk molars should have been, and there will be a lack of space when the time comes for the permanent teeth to come through.  

Sugary foods 

Sugary foods consumed by young children are a “massive problem” she says.

Obvious sources of sugar are in sweets and chocolate, but there are also the hidden sugars in foods that parents need to watch out for. She warns that the sugar contained in foods like breakfast cereal, fruit juices, or fruit pouches can have a “horrendous impact” on kids’ teeth.

When it comes to fruit, she encourages parents to offer their kids whole fruit instead of purees. Citing the example of apples. Eating a whole apple is less harmful to the teeth than the pureed version thanks to the chewing action which stimulates saliva breaking down the fructose (sugar) and creates a mechanical cleaning effect as the child eats the apple. Sucking on purees will layer the sugar on the teeth.

Also, citric acid is often added to stabilise fruit purees, so the combination of the fruit sugars and the acid is a bad combination for enamel, she explains.

Electric toothbrushes 

In terms of how many times a day to brush, Dr Gregor advises twice a day – once in the morning after breakfast before the kids leave for school and at night before bed.

“For the morning time, I recommend a manual toothbrush because it is important that kids still know how to use one. But for the nighttime, I would recommend an electric toothbrush just because the results are a lot better with the electric toothbrush in comparison to a manual one."

“The electric toothbrush can be used starting at the age of three, but sometime kids are ready earlier than that. It’s just as long as they don't bite on the electric toothbrush as that can cause injuries.” 

Tooth decay in babies  

It is not unusual for babies to develop caries, explains Dr Mercedes Rios, a pediatric dentist at Lux Dental Kids.

Rios is so passionate on the subject that she has distributed literature containing practical advice to the Ministry of Health, pediatricians, and daycare centres in Luxembourg to help reduce the prevalence of early childhood tooth decay.

According to Dr Rios, she sees babies at her practice with tooth decay every week, without exception. One common mistake that parents make is thinking that caries are black holes, she points out.

"The first lesions in babies look like half-moon-shaped 'white spots' around the gums of the upper teeth. In fact, it is near the gums that all the remains of milk and food from the day accumulate. Sometimes the spots are also brown because of food pigments. If you notice a color change in the enamel of the upper incisors, go directly to your dentist!  At this point, the disease can be easily stopped by changing the habits that caused it."

There are numerous factors that contribute to caries developing in babies, she points out.  
"Today, babies eat a lot of foods with “hidden” sugars. Sometimes special foods for babies (biscuits, sweet yogurts, honey, children's cereals) or even salty foods (crisps, etc.). The worst foods are those that stick to the teeth, because in children, it stays stuck all day. And also, snacking, because the saliva does not have time to remineralise."

Patience and perseverance

Dr Rios advises parents to have patience and perseverance when it comes to establishing early dental hygiene habits.
"Parents do not brush baby teeth because as babies cry, they think that they will be traumatised. Also, as these are teeth which in the future will fall out, they do not worry about it anymore. Brushing the teeth of a baby is difficult, there is an effective technique that requires patience, but in the same way as changing the diaper or cutting nails, it does not traumatise a child. It's a question of hygiene."
 
In addition, she cites a lack of awareness for prevention emphasising that caries are completely avoidable and the responsibility for teeth health rests entirely with parents.

"We take babies back to the pediatrician to see that everything is okay, but not to the dentist. Children arrive to us when it is already too late: they already have pain, facial inflammation, or have already gone to several dentists who have tried to treat them."

Also, potentially compounding the problem is the fact that the first visit to the dentist is too late, she argues.

"All pediatric dentistry associations worldwide recommend a visit between 12 and 18 months. In Luxembourg, there is a recommended visit at the age of 2.5 years, not obligatory either, but at this age it is already too late for many children. Prevention advice should be given as soon as teeth begin to erupt."

Dr Rios advises parents to be aware of toothpastes that are marketed as organic or for babies as these have no effect against cavities. Also do not look at the age on the tube of toothpaste but rather the ppm content (parts per million of fluoride).

Practical tips for parents and caregivers 

Start early: Begin cleaning an infant’s gums even before teeth emerge. As teeth come in, start using a small, soft-bristled toothbrush, brushing twice daily.

Use the right amount of toothpaste: For children under three, use a rice-sized amount of fluoride toothpaste (1,000 ppm); for ages three and up, use a pea-sized amount. ppm (parts per million of fluoride is indicted on the packaging). At the age of six, the amount of fluoride will be 1,450 ppm.

Teach proper brushing technique: Show children how to brush all surfaces of their teeth gently and to brush for at least two minutes, twice a day. Until the age of around ten an adult should brush the teeth after. For babies, always lift the upper lip to brush the teeth, and if you see a “yellow/ orange coating” on the teeth, be sure to remove it.

Limit sugary snacks and drinks: Reducing sugary foods and beverages can help prevent tooth decay. If they are having fruit, give crunchy fruit instead of sticky fruits - apples instead of bananas for example; combine fruits with natural yoghurt or a piece of cheese as the high calcium content will balance the acidity.

Schedule regular dental visits: It’s recommended to take children to the dentist by their first birthday and continue with regular check-ups every six months. If there is a high risk of caries or poor oral hygiene, it should be every three months.