PreventionofToothDecay-Children

AtkinsonBrignallCaringDentistry,42-44LondonRoad,Sevenoaks,KentTN131AS01732459222 1

Cavitiesoccuras a result of the toothdecayprocess thathappensover time.Did youknowthatitisallpreventableandyoucaninterruptandevenreversethisprocesstoavoidacavity?Tohelppreventtoothdecay, it isbesttohaveanunderstandingofwhy itoccurs inthefirstplace,whatevertheage.Toothdecaycanbethoughtofastheresultofaninfectionwithcertaintypesofbacteriathatuse sugars in food to make acids. Over time, these acids can make a cavity in the tooth.Throughout the day a tug of war takes place in ourmouth. Ordinarily in the mouth the pH fluctuatesthroughouttheday.FormostpeoplethepHatrest,asdeterminedby their saliva, is roughly7 (neutral).Aftersugars are ingested, they are metabolised by the oralbacteriatoproduceacidsandthepHinthemouthfalls.Once it falls below a “critical pH” of about 5.5 the tooth structuremicroscopically starts todissolve.Salivacontainsbicarbonate,whichisalkalineandthisbufferstheacidtocausethepHtoriseandreturntoaneutralhealthystate….untilthenextingestionofsugars.Ourteethgothroughthisnaturalprocessof losingmineralsandregainingmineralsallday long.Providingsugarsaretakenonlyatregularmealtimes,thebodyisnormallyabletocope,butwhensugarsare taken in betweenmeals, the recovery phase is over-ridden and the tooth continues todissolve.As the toothdissolves, thebacteriamove in to thisareaandtheprocesscontinuesuntilacavityisestablished.

Inperfecthealth,susceptibilityvariesbetweenindividualsandevenwithinthesamefamily.Itdoesn’tseemfair,butithappens,soifdecayistobepreventedweneedtohelp.Preventionofdecayrevolvesaroundreducingthesugarintakeandparticularlythefrequency,reducingthenumberofbacteriathatcanmetabolisethesugarsandstrengtheningtheteeth

tomakethemmoreresistanttodecay.

VariationinoralpHthroughoutthedayinresponsetosugarintakeandit’spotentialtodissolvetoothenamelandcausedecay.

Theinteractionofbacteria,sugarsandteethleadingtodecay(red),andtheoptionsforprevention.

ImagecourtesyofNIDCR

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Reduction of dietary sugars is by far themost important factor here.Whilstrefinedsugar(sucrose)istheworstcause,glucosethatisaddedtomanyfoodsandsnacksisapotentcausewhilst inmoresusceptibleindividuals fructose in fruit and occasionally even lactose in dairyproducts can cause decay. Did you know that one portion of bakedbeanscontainstheequivalentof4cubesofsugar,theaveragelow-fatfruityoghurtcontains(4½cubes)ofsugarinevery100gandabowlofbowlofCrunchyNutCornflakesorFrosties9cubesper100g. Sugars, justbecause theyarenaturaleg inhoney,doesnotmeanthat theywillnotcausedecay;driedfruitsequallywillcontainlotsofsugarcondensedfrom the original fruit. Suggestions for “safe” snacks are unsweetenedcrackers, oatmeal biscuits, crisp bread, rice cakes, savourymuffins, breadrolls, pitta bread, chapattis, toast fingers, bread sticks, carrots, cheese,cottage cheese, cheese spread, Marmite, humus. For most people, freshfruit,naturalyoghurt,naturalfromagefraisandothernaturalmilkproductsare fine inmoderation. Cheese in particular appears helpful in preventingdecay, as it helps neutralise the acids, with the casein it contains givingfurtherbenefits.Whilstpoororalhygiene,withresidualdebrisaroundtheteethactingasfoodforthebacteria,canbeasignificantcontributortodecay,goodoralhygienealonewillnotreducethebacterialnumbers enough to prevent decay. Xylitol is a naturally occurring sugar that harms thebacteriathattrytometaboliseit,resultinginasignificantlyreducednumberofbacteriatobepresent in themouth. It isbestused in chewinggumandmints, the recommendation is tochew6piecesofgumdaily.Westockavarietyofflavoursbutonceaflavourissettledon,itischeapestboughtinbulkon-line(egSpry600piecepacks).TheuseofXylitolasanalternativetosucroseindrinksetcisnotrecommendedasinenoughquantityitcancausediarrhoea.Fluorideisamineralthatcanpreventtoothdecayfromprogressing.Itcanevenreverse,orstop,early toothdecay. Itprotects the teethbymaking the tooth surfacemore resistant to dissolving and helpsreplace lostminerals inexistingearlydecay. It is importanttobrushtheteethtwiceadaywithfluoridetoothpasteandavoidrinsingafterbrushingbutjustspitoutinstead,asrinsingremovesthefluoridethatwillgivethebenefit.Itisnow recommended that children under 3 should use a smear of paste of no less than1000ppm (eg Aquafresh Milk Teeth), and children 3-6 yrs a pea sized amount of 1350-1500ppm concentration (eg Aquafresh Little Teeth). Higher fluoride toothpastes for olderchildrenandadultsarealsoavailableonprescriptionfromthedentist,ifdeemednecessary.TheDepartmentofHealthrequiresdentists,withparentalconsent,toapplyfluoridevarnishtochildren’steethbetween3and16yrsoldateveryexaminationandinsomecases,dependingon decay risk, more frequently. The use of fluoride mouthwashes may be helpful in highsusceptibilitypatients,butmustbekeptseparatebyanhourorsofromthetoothbrushing.Sincemostcavitiesinchildrenandadolescentsdevelopinthemolars(thebackteeth),it'sbestin susceptible patients to get these teeth sealed as soon as they erupt. Sealants are thin,plastic coatings placed onto the chewing surfaces of the back teeth (molars). Food andbacteria can get stuck in in the uneven surfaces of those teeth and stay there a long timebecause toothbrushbristlescan'teasilybrush themaway.Sealantscover thesesurfacesandformabarrierthatprotectsteethandpreventsfoodandbacteriafromgettingtrappedthere.Last but not least; don’t forget that regular dental visits areessentialforthemaintenanceofhealthyteethandgums!