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5 things you need to know about oral health and toddlers

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Julie Barker, dental therapist and founding member Oral Health Advisory Panel* answers your questions on oral health and toddlers

  1. If a customer visits the pharmacy and asks for some advice on establishing a good oral health care routine for their two-year-old, what should I suggest?

Toddlers can be notoriously reluctant to cooperate when it comes time to brush their teeth, however it is vitally important that parents are vigilant with keeping little mouths and teeth clean. A good oral hygiene routine can prevent dental caries, and pave the way for a healthy mouth through to adulthood.

Some people may believe that the ‘baby teeth don’t matter’, and alarmingly almost half of Australian parents believe that getting cavities is just a normal part of childhood. But those milk teeth are actually very important placeholders for the future adult teeth, and tooth decay in early childhood can be a predictor for long-term dental health problems.

Establishing an oral hygiene routine early on will help to make the process less stressful for everyone. For customers with younger children, let them know that they can start establishing an oral hygiene routine as early as six months – even before teeth start to appear – by rubbing a clean wet cloth around the baby’s mouth morning and night, and involving them in the parents’ oral hygiene routine.

For your customer with a two-year-old, you could suggest that they make brushing teeth a game, taking turns to brush, or get the child to copy Mum or Dad while they brush. Other strategies include having a special tooth-brushing song that plays for the required two minutes, or having the child sit on the parent’s lap while they brush. Novelty toothbrushes, or electric brushes designed for children, may also help plus there are some fantastic mobile apps around which teach and encourage children to brush every tooth and for the necessary time.

Children need parental assistance at least once a day to properly brush their teeth until their fine motor skills are sufficiently developed, usually around eight years of age.

  1. What advice can I offer a parent of a toddler about keeping baby teeth free from decay?

There are two things that parents can do to ensure their children’s teeth stay healthy and decay free;

  • regularly cleaning the teeth; and
  • keeping the diet healthy and low in sugar.

Brushing teeth for two minutes twice a day – after breakfast and before bedtime – is the most effective oral hygiene routine for people of all ages, including toddlers. Parents need to pay particular attention to the night-time brush, as that’s when all the food particles that have built up over the course of the day will be removed. Until the child’s  fine motor skills are well developed (around age 8 – 10) they will need an adult to brush for them or after them to ensure no spots are missed particularly along the gum line.

Parents also need to include flossing in the routine once the child’s second baby molars are through. This can either be with traditional floss, or you could suggest they use pre-loaded dental floss sticks to make things easier.

Diet is another important component of maintaining decay-free teeth, and minimising drinks and foods that are high in sugar and/or acids should be a goal. Fresh food is always preferred, as many processed foods are high in sugar and acid, and many also stick to the teeth, causing potential issues. Foods and drinks that are a high risk for causing childhood dental decay include soft drinks, fruit juice, lollies, muesli bars and dried and/or processed fruit. Parents should also be made aware of the sugar content of children’s vitamins and medications and a sugar free option promoted where possible.

If the toddler still uses a bottle, encourage the parent to avoid putting anything in it besides water, milk or formula. Toddlers should also never be put to bed with a bottle containing anything other than water, as even milk and formula can pool around the teeth and gums, promoting decay.

  1. What should I tell a customer who asks what age they should first take their child to the dentist?

It’s recommended that children have their first visit to the dental clinic around their first birthday. At this stage, the visit is more about familiarisation than any in-depth assessment, although they may have their teeth counted and be checked for certain risk factors. It’s important that they don’t wait for a problem before introducing their child to the dental clinic. Encourage your customer to seek out a dental practitioner who is experienced with children, to ensure a positive experience for their child.

 

  1. If a customer visits the pharmacy and I notice their young child is sucking his thumb, what advice can I offer on getting him to stop, and why it’s important?

Unfortunately, prolonged thumb or finger sucking in children can cause the front teeth and surrounding bone to be pushed out of place, leading to problems with bite and teeth alignment as the child develops. While sucking is a natural soothing reflex, it is important that children limit the behaviour before it starts to cause problems, which may be as young as two to four years old.

Encourage your customer to talk to their child and try to get them to understand how important it is that they stop. They could also try to limit the times and places that the child is allowed to suck their thumb, for example only at home, close to bedtime, or perhaps in the car. It’s important that the parents don’t get angry about it though – the thumb sucking is a coping strategy for the child, and making the situation tense and frightening will most likely make things worse. Positive reinforcements, like a star chart, may also be effective in changing the behaviour.

Frequently thumb or finger sucking is accompanied by cuddling a soft toy or blanket and these items can become triggers for the sucking. If the child is trying to give up the habit they may need to let Teddy go for a holiday to the top of the cupboard or donate their blanket to someone who needs it more.

Parents need to be assured that children will grow out of their thumb sucking eventually, and trying to make it happen before they are ready could cause unnecessary anxiety.

 

  1. When a customer brings in their upset toddler who is experiencing pain and distress from teething, is there anything I can suggest that might help?

Teething effects all children differently. Some will exhibit no signs at all, while others can be very badly affected. Common signs of teething include excessive drooling (which can cause painful rashes on the face, chin and neck), general crankiness, swollen gums, sleep disturbances, lack of interest in food, and a tendency to chew on anything they can get to their mouths.

Teething can be a very painful and distressing experience for babies and parents alike! Parents can help to ease the pain by gently massaging their baby’s gums, and encouraging their baby to chew on clean, cool teething toys, or a cold face washer. Teething rusks are not recommended due to their high sugar content, and their tendency to stick to the teeth and gums. Advise your customer to also try to keep on top of the excess drool by wiping it away before it can cause any nasty rashes.

There are several effective over-the-counter preparations available that may help ease the pain of teething. The best ones to recommend are free from sugar, alcohol and aspirin.

  • *The Oral Health Advisory Panel (OHAP), is a group of independent healthcare professionals with the aim of raising awareness of the importance of good oral health and its impact on general wellness.  The Panel aims to take oral health beyond the dental clinic. Follow them via twitter @OHAPanel to stay up to date with practical advice on good oral health habits.

References

Julie Barker, Oral Health Advisory Panel (OHAP) website, Oral Health for Baby, Toddler and Adult http://www.ohap.com.au/oral-health-for-baby-toddler-adult-julie-barker/

 

Julie Barker, OHAP website, Teething Story http://www.ohap.com.au/teething-story/

 

Colgate Professional website, ‘Oral Health for Infants and Toddlers’ http://www.colgateprofessional.com.au/patient-education/articles/oral-health-for-infants-and-toddlers

 

OHAP, Oral Health and General Health in Australia: The Great Disconnect (2015), available at http://www.ohap.com.au/wp-content/uploads/2015/08/OHAP-Report_The-Great-Disconnect_150811F.pdf

 

NSW Health Dental Health Resource Package for Childcare Professionals http://www.health.nsw.gov.au/oralhealth/Publications/nsw-little-smiles.pdf

 

Dental Health Services Victoria website, ‘Dental advice for babies and toddlers’ https://www.dhsv.org.au/dental-advice/general-dental-advice/babies

 

WebMD 9 ways to wean a child off thumb sucking http://www.webmd.com/parenting/features/9-ways-to-wean-a-child-off-thumb-sucking#1