Parents have a key role in helping their children to develop a proper oral hygiene routine in the first years of their life. They should lead and supervise their children’s tooth brushing approximately for the first 12 years, until motor and mental functions allow the child to routinely perform a proper tooth brushing technique alone.
After brushing the teeth for their children for the first 2 years of life, parents will have to use playful motivation to encourage their children to brush their own teeth from about 3 years onwards – the time when children want to brush their teeth alone.
Each time the child has finished brushing, parents should re-brush the hard-to-clean areas. At the age of around 6 years, children are able to brush their teeth using a proper brushing technique. In this phase, parents have to continue supervising the regular brushing efforts of their children.
The special anatomical situation of changing dentition makes it indispensable that parents still need to help their children in the daily tooth brushing task until eruption of the second molar (around the age of 12).
some important specifications:
- Start cleaning or brushing teeth as they appear in the oral cavity.
- it is imperative to keep check on consumption of sugar,sweets,chocolates so as to reduce formation of cavities.
- child has to be instructed to brush twice and regularly use mouth wash,especially after having sweets and non veg food.
- Regular check up is advised every 5 months,keep regular checkup on teeth and observe for any pain,discolouration,black or grey areas in teeth and report to your dentist.
- It is most important that till children grow up,parents understand the need to maintain good oral hygiene because only after that will they be able to explain the same to their children.
The foundation for healthy permanent teeth in children and teenagers is laid during the first years of life. Poor diet, poor habits of food intake and inadequate tooth brushing habits during the first 2 years of life have been shown in several studies to be related to tooth decay in children. The development of caries in primary teeth further increases the risk of developing caries in permanent teeth.
Therefore it is essential to establish a proper oral hygiene routine early in life to help ensure the development of strong and healthy teeth. Parents, as consistent role models, are key for setting a daily routine and to making their children understand the importance of oral hygiene. Tooth brushing should be presented as a habit and an integral part of the daily hygiene routine. Children are very sensitive to social stimuli such as praise and affection, and learn best by imitating their parents. Physiological and mental development affects the oral care of children.
Importance of the primary dentition(milk teeth)
Primary teeth start to erupt in children from the age of six months. The primary dentition is complete by approximately two and a half years of age. The enamel of primary teeth is less densely mineralized than the enamel of permanent teeth, making them particularly susceptible to caries. Primary teeth are essential tools, both for chewing and learning to talk. They help to break up food into small pieces, thereby ensuring efficient digestion. A full set of teeth is an essential prerequisite in learning correct pronunciation.
Primary teeth also play a vital role in the proper alignment and spacing of permanent teeth; it is therefore imperative that they are well cared for and preserved until normal ex-foliation takes place.
Establishing a proper oral care routine early on in life sets the foundation for the development of healthy and strong permanent teeth. In addition to good oral hygiene, diet also plays a key role in keeping teeth healthy. In this respect it is not only the quantity of sugar that is important, but also the frequency of consumption. As much as possible, children should be limited in the amount of sweets between meals, especially in the evening or at night.
New permanent teeth
Although permanent teeth are already partly formed in children aged 0 to 3 years, eruption only occurs later in life (from about 6 years on) when the 32 permanent teeth (16 in the upper and 16 in the lower jaw) replace the 20 primary teeth.
During this time root resorption and crown shedding of primary teeth take place. With the eruption of the first permanent teeth (from about 6 years on), the mouth contains a mixture of both primary and permanent teeth, which puts children at increased risk of caries. Often the eruption of this permanent tooth is not realized neither by the child nor by the parents, because it is positioned behind the last primary molar and is not replacing any primary tooth.
Although enamel is fully formed at eruption the surface remains porous and is inadequately mineralized. Subsequently, a secondary mineralization occurs (second maturation), in which ions from the oral cavity penetrate hydroxyapatite and increase the resistance of the enamel against caries. Furthermore, any primary teeth with caries form reservoirs of bacteria, which can easily attack the immature enamel of the new permanent teeth. During the eruption, the occlusal surfaces of the new permanent teeth are on a lower level than the primary teeth.
Toothbrushing becomes more difficult than before, given the coexistence of loose primary teeth, gaps and newly erupting permanent teeth. The jaw is also growing significantly, making space for more teeth. The cleaning of the narrower interdental spaces becomes more important with increasing numbers of permanent teeth.
Development stages of children from the age 0-12
As soon as the first primary teeth erupt into the oral cavity, parents should begin brushing their children’s teeth. From the age of two years, teeth should be brushed twice daily with smaller than a pea-size amount of children’s toothpaste. Small children tend to swallow a large amount of toothpaste, so that there is a risk of developing dental fluorosis. Supervised application of the amount of toothpaste to the toothbrush is important.
Due to the risk of fluorosis, the fluoride content of toothpaste for children up to the age of 5–7 years was reduced in most European countries (250 ppm to 750 ppm). Beginning with the eruption of the new permanent teeth, children should be switched from a low fluoride containing children’s toothpaste to a higher fluoride containing toothpaste (1000 ppm to 1500 ppm). This ensures the best caries protection as possible for their new permanent teeth.
Toothpaste with an age adapted content of fluoride is recommended
Primary teeth should be brushed by parents twice a day from the first tooth onwards. Parents should re-brush thoroughly after the child has brushed first. From the age of 6 years children have the ability to brush their teeth alone twice daily. However, parents must supervise the tooth brushing (until the age of 12) and check on the condition of the toothbrush. A worn toothbrush is also less effective at cleaning teeth.
Types of Toothpaste
There are many different types of toothpastes on the market. The “all in one” toothpaste contains a combination of agents to reduce tartar formation, improve gum health and prevent dental caries. It is important to verify that the effectiveness of toothpastes advertising improved or new formulations have been “clinically proven” by seeking information from dental public health personnel with expertise in the field.
Fluoride toothpastes make up more than 95% of all toothpaste sales. It is well recognised that the decline in the prevalence of dental caries recorded in most industrialised countries over the past 30 years can be attributed mainly to the widespread use of toothpaste that contain fluoride. Investigations into the effectiveness of adding fluoride to toothpaste have been carried out since 1945 and cover a wide range of active ingredients in various abrasive formulations. Fluoride compounds and their combinations which have been tested for the control of dental decay include sodium fluoride, stannous fluoride, sodium monofluorophosphate and amine fluoride. The most widely used fluoride compounds in the Republic of Ireland are sodium fluoride and sodium monofluorophosphate.
Amount of fluoride in toothpaste
The amount of fluoride contained in fluoride toothpaste should be indicated on the toothpaste tube, although this information may sometimes be hard to locate. It may appear after the label “Active ingredient” or as a component under “Ingredients” on the toothpaste tube. Whereas previously fluoride content was given as a percent of volume (% w/v) or weight (% w/w), it is now
accepted that the most efficient method of informing people of the amount of fluoride in a toothpaste is to give the “parts per
million” fluoride (ppm F). Most manufacturers now give fluoride content in ppm F.
Under EU Directive 76/768/EEC, toothpastes are classified as cosmetic products. EU Directives governing cosmetic products prohibit the marketing of cosmetic products (including toothpastes) with over-the-counter levels of fluoride greater than 1,500 ppm F. At present, most toothpastes in Ireland contain 1,000-1,500 ppm F.
Fluoride toothpastes are more effective at preventing tooth decay at higher fluoride concentrations.50 If needed for therapeutic easons, toothpastes containing more than 1,500 ppm F (e.g., 2,800 ppm F) are available but may be obtained only with a prescription.
Fluoride toothpaste for children
Because young infants and children under age 2 years can swallow most, if not all, of the toothpaste when brushing, there has been concern that the use of fluoride toothpaste containing 1,000-1,500 ppm F could give rise to enamel fluorosis of the front permanent incisors. Enamel fluorosis is a condition which can vary from minor white spots to unsightly yellow/ brown discolouration of the enamel due to excessive intake of fluoride. In response to the concern over enamel fluorosis, some manufacturers now market low fluoride “children’s” or “paediatric” toothpastes containing less than 600 ppm fluoride. The effectiveness of these low fluoride ‘children’s’ or ‘padeiatric’ toothpstes in preventing caries has not been established. What has been shown by a number of systematic reviews is that toothpastes with a low fluoride concentration of 250ppm F are less effective than toothpastes with the standard 1,000-1,500 ppm F at preventing caries in permanent teeth.
Recommendations on the use of fluoride toothpaste in children have been produced by the Expert Body on Fluorides and Health
(http://www.fluoridesandhealth.ie/ ). These recommendations aim to minimise the risk of fluorosis from fluoride toothpaste while maximising its caries-preventive benefits. These recommendations can be foundhere.
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