In Ireland the average age of a child's first visit to the dentist is eight. This despite advice that the best time is before their first birthday. Its 10 am on Monday morning after the half-term, and this wouldn't be a common time for children to come in for a check-up. I normally see twenty children a week on average, but these appointments are usually after school, or during the holidays, today I was surprised to see a young child. His parents were concerned that his teeth were a bit yellow, and that despite brushing they couldn't get the stains off.
The young lad I saw was three years old, and a very friendly, happy chap who was excited to see inside our clinic. I think he might have been prepped before hand as he seemed to know all about the rinse and the light and the mirror. He had apparently seen Ben 10 and Peppa pig visit the dentist and was happy enough that we were nothing to be scared of. With very young children we are always hopeful before they open their mouths that this is going to be something simple, small bit of plaque, dietary staining, maybe even a calculus deposit. Quick scale and polish and we're all done. Stickers all round and happy, smiling faces. Great job Dr. Rymer!!
Not today. When this little man opened up we were horrified and down-cast to see the teeth he had been living with. All four of his upper front teeth completely decimated. Black, crumbly stumps with sore-looking, inflamed gums. Mum and Dad were similarly devastated when they heard the news. Bottle caries is the diagnosis. This happens when a child is either given a bottle or sippy cup to go to bed with, or spends all day with a bottle or a sippy cup being used as a pacifier. They had initially been sending their son to bed with formula in a babies bottle, and then a sippy cup with cows milk. Occasionally during the day he might have a little juice but not very much.
So, the immediate treatment is that we will have to organise for the extraction of these four teeth, very simple and quick procedure that is going to be done in Limerick as soon as possible, we will then wait for a few years for the new adult teeth to come through and replace them. Okay, the smile isn't going to look great in the family photos, but the black stumps didn't look great either, and at least he is going to be pain free.
But how did this happen? Milk? Formula? I thought they were healthy and that they would be safe for the teeth? We spent some time chatting to the parents and their understanding of dietary issues with sugar and night time feeding. Based on those conversations we gave the following advice.
1) No night time bottles unless just water.
Some sugars cause a lot of problems with tooth decay, others aren't so bad, but even the natural sugars (lactose) in cows milk can contribute to tooth decay especially when combined with a diet high in refined sugars. Formula milk is often sweetened with sugars (maltose, dextrose, sucrose) and can be a source of decay. For this reason, we advised water in the bottle at night, or avoid the bottle at night all together.
2) Avoid the sippy cup
Teach your child to drink from a regular cup as soon as possible, preferably by 12 to 15 months of age. Drinking from a cup is less likely to cause liquid to collect around the teeth. Also, a cup cannot be taken to bed. The newer style no-spill type are actually worse for their teeth than the regular ones.
3) Toothbrushing
You can start to use toothpaste, but only use a small pea-sized amount of fluoride toothpaste.Pea sized toothpaste. The advice in Ireland is that under 2's don't use any fluoride toothpaste, but this goes against current best practice as advised in the UK and the US. But in this case the parents had been brushing using no toothpaste once per day.
Supervise brushing twice a day,morning and night.
Children under seven years are not able to brush their own teeth properly, they need help. unfortunately in this case the young man had been handling his own brushing for at least the last year.
Never rinse after brushing, just spit
It takes two minutes to brush teeth properly EXACTLY THE SAME LENGTH AS THE BABY SHARK SONG - yay...
I think Mum and Dad whilst disappointed at the bad news that we delivered, are pretty happy that we can solve this before the teeth start to become sore, and I think they will come to terms with the problems he has with his smile right now. They were not neglectful, they were using milk, they were sparing with juice, they were encouraging brushing. It was just a few minor adjustments that were needed. Its a shame about his teeth, but the bouncy little chap didn't seem too bothered heading out with his Spiderman toothbrush and his dinosaur pencil. He had a positive experience at the dentist, we were able to offer a solution to the parents problem, no judgement, no lectures, just helpful education.