Prevention and Control of Dental Decay in Children and Adolescents Practical Solutions
Dear parents,
Healthy and cavity-free teeth can not only lead to a beautiful smile but also contribute to chewing, maintaining a proper diet, and ensuring the health and alignment of our children’s permanent teeth.
To achieve this goal, it is important to understand that prevention and control of decay require the observance and implementation of practices. Neglecting any of these practices can lead to the onset and progression of dental decay. These practices include:
- Full adherence to oral and dental hygiene
- Use of Fluoride Sources
- Performing preventive and restorative treatments to reduce or eliminate inaccessible areas and minimize the population of cariogenic bacteria
- Control of a sugary diet
- Full adherence to oral and dental hygiene
This involves the removal and control of dental plaque. Dental plaque is a soft, dense mass derived from saliva, various bacteria, and their byproducts. It has an adhesive nature and, if oral hygiene is not maintained, it accumulates on the tooth surface, often leading to the initiation of decay and gum inflammation.
The primary mechanical means of controlling dental plaque are the use of toothbrushes and dental floss. For some children, chemical control of dental plaque is recommended, such as the use of fluoride mouthwashes or chlorhexidine.
Rubbing and friction of the toothbrush remove dental plaque.
Toothbrush:
- Manual toothbrushes are selected based on the thickness of their bristles (soft, medium, hard), the size of the brush head, and the thickness of the handle for each individual.
For children, a soft toothbrush is usually preferred due to the low risk of gum injury and its high cleaning power between the teeth. Additionally, using toothbrushes with smaller heads and bulkier handles compared to adult toothbrushes is more suitable.
- Electric toothbrushes are helpful in removing dental plaque, especially in children and patients who lack sufficient manual dexterity in using a traditional toothbrush, due to the movement generated in the brush head.
Tooth brushing technique:
There are different methods of tooth brushing, but we will describe the two common and suitable methods for children:
- Rotational method: In this method, the toothbrush head is placed on the gum, and the bristles are positioned towards the root. As the side bristles touch the gum, lateral pressure is applied, and at the same time, the toothbrush head is moved in a brushing motion towards the biting surface.
- Horizontal scrub method: In this method, the toothbrush is placed horizontally on the outer or lingual surface of the teeth and moved back and forth with a scrubbing motion.
Regardless of the child’s age or whether brushing is done by parents, the horizontal scrub method effectively removes plaque. Therefore, in most cases, this method is recommended for brushing children’s teeth.
In all tooth brushing methods, the outer, lingual, and occlusal surfaces of the teeth should be brushed. Additionally, the positioning of the toothbrush head on the lingual surfaces of the front teeth and the distal surfaces of the back teeth allows the use of the brush head’s tip to clean these areas. Tooth brushing is considered complete when all accessible tooth surfaces are clean.
As soon as teeth erupt at around six months of age, parents should start cleaning them. This can be done using a soft, moist cloth wrapped around their fingers.
The amount of toothpaste used should be minimal (about pea size) as excessive toothpaste can irritate the child and since brushing is a mechanical method for plaque control, using a large amount of toothpaste will not have a significant effect.
The use of fluoride toothpaste is recommended when the child can spit it out (around 3 years of age).
The use of dental floss:
The primary purpose of dental floss is to clean the surfaces between teeth that are in contact with each other, as toothbrushes cannot access those areas and they are out of reach of self-cleansing by saliva.
To use dental floss, an appropriate length of floss is selected and wrapped around the middle fingers of both hands. It is then guided between the teeth using the index fingers and thumbs.
Dental floss with a handle solves the problem of fingers entering the mouth and provides better control over the movement of floss. It is also more convenient to use for back teeth. However, the flossing technique is the same in both cases, and the floss should pass between the contact point of two teeth in a sawing motion. Then, the floss is pressed against one of the tooth surfaces and guided towards the gumline. This process continues until the gum becomes slightly white, but the child should not feel any pain. Subsequently, we move the floss up and down beneath the contact point of the two teeth (the range of floss movement is from the whitened area to below the contact point). We repeat this action several times.
Now, we move on to the next tooth surfase, which is cleaned using the same method.
Children usually acquire the skill of using dental floss between the ages of 9-12.
Tooth brushing and flossing before bed is essential.
Using dental floss during the day is not mandatory, but brushing after main meals and especially after consuming sweet and sticky snacks is ideal. Since this method is often not feasible, an intermediate approach is recommended, where the child thoroughly cleans their teeth (brushing and flossing) before bedtime and brushes their teeth at the beginning of each day. Additionally, during the day, rinsing the mouth with water after consuming snacks is recommended.
The most effective method of controlling dental plaque is its removal through mechanical means, supplemented by chemical agents.
- Use of Fluoride Sources
Fluoride sources can be either ingested or topical and include fluoride present in drinking water, toothpaste, daily and weekly mouth rinses, as well as professional fluoride therapy at the dental office.
The use of various fluoride sources strengthens and enhances the resistance of teeth, preventing the development and progression of tooth decay.
The frequent use of fluoride, especially from different sources, is of great importance in controlling and preventing dental caries in children and adolescents.
The enamel of teeth that are sufficiently exposed to fluoride has greater resistance to decay.
Topical fluoride applications at the dental office are usually in the form of gel or varnish, which the dentist applies to the teeth after isolating them from saliva. To prevent excessive fluoride ingestion, strong suction is used. After the procedure, the child is asked to refrain from rinsing, eating, or drinking for half an hour to allow for maximum fluoride absorption. Typically, fluoride therapy is performed every six months during regular dental check-ups for children.
Fluoride mouth rinses are part of chemical products for dental plaque control and are recommended for some children in addition to tooth brushing and dental flossing. These mouth rinses are available in daily and weekly formulations, but due to the risk of excessive fluoride ingestion, they are not prescribed for children under 6 years of age.
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- Performing preventive and restorative treatments to reduce or eliminate inaccessible areas and minimize the population of cariogenic bacteria
Proper tooth restoration is of great importance in caries control programs. Removing decay and restoring teeth reduces the number of bacteria in the oral cavity and facilitates proper chewing by creating an appropriate chewing surface.
Molar teeth usually have grooves and pits that are inaccessible for thorough cleaning due to their depth. If these grooves and pits are not affected by decay, their depth can be reduced using tooth-colored restorative materials (such as fissure sealants). This will eliminate food trapping and microbial activity in these areas.
It is not wise to leave teeth with extensive decay and irreparable crowns because they not only act as a microbial reservoir in the oral cavity but also cause difficulties in chewing in that area.
Prolonged bottle feeding can contribute to the prevalence of decay in infants. Often, parents lack sufficient knowledge about the appropriate time to wean their child off the bottle and start practicing oral and dental hygiene. Therefore, it is recommended that the child’s first dental examination be conducted between 6 to 12 months of age to receive necessary guidance from the dentist before the onset of caries.
It is recommended to discontinue bottle feeding and switch to a cup after one year of age. However, considering the numerous benefits of breastfeeding, we do not recommend eliminating it entirely. Instead, we emphasize the importance of oral hygiene practices after breastfeeding (e.g., cleaning the infant’s teeth with a soft, damp cloth or giving them a small amount of water to drink afterward).
- Control of a sugary diet
The sugar present in food is fermented by cariogenic bacteria in the mouth, producing acid that attacks and breaks down tooth enamel.
The duration of acid exposure in the oral environment depends on how long the food remains in the mouth. For example, liquids like milk and fruit juice, being quickly rinsed away by saliva, keep the oral environment acidic for about 20 minutes. However, with sugary foods that are sticky and adhesive, this time can increase to one hour.
Rinsing the mouth and brushing teeth after consuming sugary foods helps remove the acidic state and allows the damaged areas of the teeth to be remineralized by saliva’s mineral content. In dentistry, the frequency of sugar consumption is more important in terms of caries formation than the amount of sugar consumed. For example, not brushing after consuming large amounts of sugary foods in one sitting keeps the oral environment acidic for a certain period (e.g., one hour). However, if a child consumes sugary substances, even in small amounts, every half an hour, the acidic periods overlap, and for more hours of the day, the mouth remains acidic. If this is repeated on consecutive days, saliva’s mineral content will not be able to repair the damage, and tooth decay will gradually develop.
Some foods alkalize the oral environment and prevent enamel breakdown and caries formation. Among these are foods like cheese, nuts, and oil-containing seeds.
Since children in kindergarten, preschool, and elementary school may not be able to engage in proper brushing, it seems logical to include foods in their diet that have minimal cariogenic potential. For example, instead of various cakes and sweetened foods, we can use bread and cheese with walnuts and different types of nuts. Eating apples and carrots, which help remove large food particles from the teeth, can also be beneficial.
This approach allows us to have a greater impact on improving the oral health of our children, and hopefully, other parents will also be encouraged to follow suit, resulting in children with minimal or even no tooth decay.
Hope for that day to come.
Dr. MOHAMMAD ZAFARASOUDEH
