Recent data from the Royal College of Surgeons shows that 80% of one- to two-year olds in England did not visit the dentist in the year to 31 March 2017. This is despite the fact that NHS dentistry is free for children under 18.
Tooth decay is the cause of a great many of the general anaesthetics and hospitalisations that children undergo in Britain, and it would seem sensible to have a nationwide strategy of oral health care based upon prevention.
For many years it was accepted wisdom that children should attend the dentist for their first visit at around the age of three years. I am unable to ascertain the rationale behind this, but behaviour expectancies must have played a part. Below the age of three children are frequently described as being ‘pre-cooperative’, meaning that dentists found it difficult to manage their (and possibly parental) anxieties. Be that as it may, at the age of three, many children have decayed teeth, and if more than a few tooth surfaces are involved, it is called early childhood caries (ECC). For those unfortunate children it would have been so much preferable to have visited the dentist at an earlier age and by doing so probably have avoided any decay at all by having their own oral health structured around prevention.
Although there is almost certainly a genetic component to susceptibility to dental decay (or caries to give it the scientific name) by far the greatest causative factors to the disease process are to be found within the mouth – dietary components and tooth cleaning efficiency or rather lack of efficiency. Within hours of tooth-brushing a layer forms on the surface of the tooth enamel, and this becomes colonised with bacteria to become dental plaque. The bacteria feed upon dietary sugars and in the process produce acids. When the acidity reaches a certain level, usually within 30 minutes of the sugar-intake, the surface of the enamel begins to soften and that is the start of the decay process. The acid-level falls to below the critical level after a few hours, until the next intake of sugar. Therefore the more frequently foods containing refined carbohydrates are taken, the higher the risk is for decay to occur. Also, the removal of dental plaque from the tooth surface greatly reduces the numbers of potentially harmful bacteria.
Research from Leeds a few years ago has shown that when health visitors gave this simple oral-health message to mothers of infant children, the incidence of ECC fell dramatically for those children. Therefore it makes sense for the first dental visit to occur at around the age of twelve months. Most children have about eight teeth that age, and almost all of them will be decay-free. The opportunity to explore with the parent and the child’s diet is of great importance during this visit, as well as the bottle-feeding and tooth-cleaning regime. The parent can be shown how to clean the teeth; what toothbrush and toothpaste will be suitable; learn possible benefits and advisability of fluoride in the toothpaste or supplements, and how frequently the child should be reviewed. At the same time the health of the oral soft tissues can be assessed, as well as how well the enamel has been formed and the growth of the facial bones. Even at that tender age dentists can sometimes make fairly accurate predictions concerning the quality of the enamel of the permanent teeth, and of future orthodontic needs! As I have previously discussed in a MyBaba article, mothers are frequently unsure of the advisability or otherwise of dummy- or thumb-sucking, and this first visit is an ideal time to discuss this with the dentist.
When children become toddlers they frequently fall, and so dental injuries can occur. If you have already established a ‘dental home’ for your child then hopefully both you and your child will be able to receive immediate examination and advice in a more relaxed environment.
In summary, it is sound advice to take your child for his or her first dental visit around the first birthday. If yours is one of the few children who already have signs of dental decay, your dentist can show you how to minimise or even reverse those early stages. I have now virtually retired from clinical practice after almost 40 years at Weymouth Street, but my colleagues are still there if you need a dental home for your child.
Weymouth Street Paediatric Dental Care
33 Weymouth Street
London W1G 7BY