DENTAL CARE


may experience near-total destruction of the teeth.


TREATMENT The main treatment is to drill out the decays and fill the cavity with substance made from various materials (eg, amalgam and porcelain).6


With


extensive tooth decay, patients may need a crown, root canal or even extraction of the tooth. Dentists tend not to fill cavities in children whose permanent teeth have not come in yet. Younger children who have extensive decay in their milk teeth will most likely have them surgically removed. This will mean that, until their permanent teeth grow in, they will be toothless. In these children, it is not uncommon for dentists to remove multiple teeth; in some cases up to 20 teeth.8


PREVENTION


It is important for parents to know that proper oral hygiene is most effective in preventing cavities. Proper oral hygiene is accomplished by properly brushing and flossing the teeth. Brushing the teeth disrupts the biofilm and leaves the surface of the teeth clean. The majority of the bacteria is removed from the mouth by rinsing and swallowing after brushing and flossing.9


Brushing and


flossing should be done twice a day as the biofilm regrows. Parents can start brushing their child’s teeth from when they first appear. Brands such


as Colgate® and Aquafresh® make soft toothbrushes and toothpaste to cater to children from three months of age. A smear of toothpaste should be used when the child is under two years of age and then a pea-sized amount should be used when they are older. Children may have difficulty removing plaque from their teeth if brushing on their own. Disclosing tablets stain plaque a different colour, making it easier to remove when brushing. These tablets are available for purchase from most pharmacies.


Fluoride is a mineral that can prevent tooth decay and even help to reverse the process in the early stages of demineralisation.7


give their child raw vegetables like cucumber or carrot sticks and fruit such as bananas as an alternative to traditional snacks. Other good snacks include toast, rice cakes and plain popcorn.11


Drinks such as apple juice and Ribena contain a lot of sugar. Water and milk are the best choice for children under three years of age. Furthermore, drinking these sugary drinks from bottles and sippy cups further increases tooth decay - especially to the front teeth.12


Parents should aim Fluoride


also reduces the bacteria’s ability to produce acid. Fluoride can be found naturally in drinking water supplies and also in toothpaste. If a dentist thinks that a child may need more fluoride, they may apply a fluoride gel, prescribe fluoride tablets and or recommend a fluoride rinse.6


Limiting sugary snacks and drinks is one of the most important prevention measures. According to the British Nutrition Foundation, parents should try to limit sugary foods and drinks to meal time only and the amount of foods containing sugar should also be limited.10


Dried fruit is also damaging to the teeth, so it should be given again at meal times instead of as a snack in between meals. Parents can


to introduce drinking from a normal cup from six months of age and to stop bottle feeding from twelve months of age.12


BIBLIOGRAPHY


1. Anopa Y, McMahon AD, Conway DI, Ball GE, McIntosh E, Macpherson LMD. Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme. PLoS One [Internet]. 2015 [cited 2017 Sep 1];10(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4549338/


2. WHO | Oral health. 2016 Feb 11 [cited 2017 Aug 31]; Available from: http://www. who.int/mediacentre/factsheets/fs318/en/


3. sitecore\. New statistics show tooth extraction number one hospital procedure for 5-9 year olds — Royal College of Surgeons [Internet]. Royal College of Surgeons. [cited 2017 Aug 31]. Available from: https://www.rcseng.ac.uk/news-and- events/media-centre/press-releases/new- statistics-on-tooth-extractions/


Some children may


find this transition difficult; however, teaching them to drink from a straw could help with the transition.


NATIONAL SCHEMES Childsmile is the national programme designed to improve the oral health of children in Scotland. This programme also aims to reduce inequalities in both dental health and access to dental services. The programme was developed between 2006-2008, and all practices delivering NHS dental care are expected to deliver Childsmile interventions. The introduction of the Childsmile programme has saved the Scottish Government approximately £5 million in dental treatment between 2001-2002 and 2009- 2010 and has started to reduce the gap between affluent and deprived communities.12,13


all children will have access to:


• A tailored care programme within Primary Care Dental Services


• Free daily supervised tooth brushing in nursery


• Free dental packs to support tooth brushing at home


There is also support targeting children and families in greatest need through:


• Additional home support and community interventions


• An enhanced programme of care within Primary Care Dental Services


• Clinical preventative programmes in priority nursery and primary schools


• Daily supervised tooth brushing in P1 and P2 in priority primary


schools


More information about Childsmile can be found at www.child-smile.org.uk •


4. Government S, House SA, Road R, Tel: EE 3dg. Health of Scotland’s population - Dental Health [Internet]. Scottish Government, St. Andrew’s House, Regent Road, Edinburgh EH1 3DG Tel:0131 556 8400 ceu@scotland.gsi.gov.uk. 2003 [cited 2017 Sep 1]. Available from: [URI]http:// www.gov.scot/ID3/83715


5. Childhood Hospital Admissions [Internet]. [cited 2017 Sep 1]. Available from: http://showcc.nhsscotland.com/ isd/6468.html


6. Dental Health Foundation [Internet]. Dental Health Foundation. [cited 2017 Aug 31]. Available from: https://www. dentalhealth.ie/dentalhealth/causes/ dentalcaries.html


7. The Tooth Decay Process: How to Reverse It and Avoid a Cavity [Internet]. [cited 2017 Aug 31]. Available from: https://www.nidcr.nih.gov/OralHealth/ OralHealthInformation/ChildrensOralHealth/ ToothDecayProcess.htm


At a population level,


8. Moss R. The Worrying Truth About Childhood Tooth Decay [Internet]. HuffPost UK. The Huffington Post; 2016 [cited 2017 Aug 31]. Available from: http://www.huffingtonpost.co.uk/ entry/tooth-decay-in-children-sugar_ uk_577bcedae4b0f7b5579600c2


9. mrzezo. 2: Dental Caries: Etiology, Clinical Characteristics, Risk Assessment, and Management [Internet]. Pocket Dentistry. 2015 [cited 2017 Aug 25]. Available from: https://pocketdentistry. com/2-dental-caries-etiology-clinical- characteristics-risk-assessment-and- management/


10. Children - British Nutrition Foundation - Page #1 [Internet]. [cited 2017 Sep 1]. Available from: https://www.nutrition. org.uk/healthyliving/lifestages/children. html?limit=1&start=3


11. Choices N. Kids’ teeth Q&A - Live Well - NHS Choices. 2017 Sep 8 [cited 2017 Sep 1]; Available from: http://www.nhs.uk


12. Briggs H. Preventing tooth decay in toddlers - tips for parents - BBC News [Internet]. BBC News. BBC News; 2014 [cited 2017 Sep 1]. Available from: http:// www.bbc.co.uk/news/health-29426307


13. Children’s dental health improving [Internet]. Scottish Government News. [cited 2017 Sep 1]. Available from: https:// news.gov.scot/news/childrens-dental- health-improving


SCOTTISH PHARMACIST - 35


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