By the point children see paediatric dentist Dr Jennifer McCafferty, they won’t just have an issue with one tooth. “They’ll have multiple teeth in hassle. I’ll see quite quite a few cavities within the one child,” says McCafferty, who works at Citygate Specialist Dental Clinic, Cork.

McCafferty gets referrals from family dentists when patients are very young — and when the “extent of their dental needs” requires her services. “A big volume of kids I see are treated under general anaesthetic in hospital. I see a variety of children with autism or where co-operation is proscribed.”

She has seen dental decay in children as young as one 12 months, and in a typical week, she sees a big variety of three- to six-year-olds.

Based on the study Fluoride And Caring for Children’s Teeth, 2013-17, which took place in primary schools in Dublin, Cork, and Kerry, dental decay affects one in three children by the point they’re five years — and it affects 4 in 10 children of their everlasting teeth.

McCafferty wishes parents knew in regards to the risk aspects for childhood tooth decay and that they’d seek preventive care earlier.

She says parents might be quite surprised to search out their child has dental issues they never suspected. “Until a dentist does a radical examination, early cavities won’t be identified. Parents won’t see it by brushing their child’s teeth.

“So that they won’t notice until the kid develops pain and by the point that happens — and there’s infection — the cavity has been there some time. We’re catching it quite late.”

She says children should see the dentist by their first birthday so that oldsters might be advised in regards to the pitfalls — particularly around food regimen but in addition in relation to tooth-brushing habits — that might predispose the kid to dental decay.

“Management would then be quite a bit less complex, more straightforward. Children wouldn’t be missing time from school, parents wouldn’t be missing time from work and also you’d have a less upset child,” says McCafferty, who has seen extreme cases where infection spreads from tooth to surrounding soft tissues within the face and the kid becomes generally unwell and wishes hospitalisation.

Dentist visits

Findings from the National Longitudinal Survey of Children in Ireland (Growing up in Ireland) show that lower than 5% of kids aged three years visit the dentist. Parents think that is a great thing but it surely isn’t, says Dr Dympna Kavanagh, chief dental officer on the Department of Health. “We would like young children to determine a dental ‘home’, so that they turn out to be acquainted with going to the dentist after they don’t have an issue. So after they do have an issue, they won’t have any fear about going.”

Bringing your small child to the dentist early builds positive associations for the kid, says McCafferty. “So going to the dentist is definitely fun. They’re sitting up within the chair, getting their teeth counted after which getting a little bit sticker. As an alternative of a primary visit where they’re in pain, the dentist’s poking on the [affected] tooth, they’ve had a number of sleepless nights and everybody’s drained and stressed.”

Understanding the biology of the mouth and its role in digestion helps us see why some dietary habits are protective of kids’s teeth — and others aren’t.

Dr Siobhán Lucey, senior lecturer in paediatric dentistry at UCC and consultant paediatric dentist at Cork University Dental School & Hospital, says it’s normal and perfectly healthy to have bacteria in our mouth. “The oral cavity is an element of our gut,” she explains.

But some decay-inducing bacteria can metabolise free sugars to provide acid. “This lowers pH level within the mouth and causes mineral to be faraway from tooth enamel, leading to a cavity developing in a tooth. If there’s a high frequency of sugar intake, the balance suggestions in favour of dental decay.”

Lucey highlights saliva’s helpful effect within the mouth. “It keeps teeth, gums, and the skin contained in the mouth healthy. It keeps all these tissues lubricated and helps in keeping pH neutral. It helps to remineralise enamel after a sugar attack.”

She says children and adults might help maintain saliva’s protective role by remaining hydrated throughout the day.

Obvious wrongdoer foods that put children prone to tooth decay include chocolate, sweets, cakes, biscuits, cordials/squash, fizzy drinks, juices. “We suspect really sticky, chewy sweets often is the most harmful, but any sugar-containing food or drink might be as harmful as the following.”

Amongst these Lucey includes dried fruits, for instance, raisins, yogurts with high sugar content, yogurt-covered/flavoured rice cakes, smoothies, many cereals, and milk alternatives, a variety of that are sweetened.

She recommends as a substitute plain/natural/Greek yogurt with chopped-up fruit added in and porridge and low-sugar cereals (lower than 5% added sugar) as breakfast options. Secure snacks would come with popcorn, chopped veg, plain rice cakes, and corn cakes.

There was a big demand for dental services for youngsters because the pandemic. Because of HSE staff redeployment during that period, fewer dental appointments were offered in 2020 and 2021. “It’s also reasonable to assume — during what was a difficult time for all of us — children got out of their normal routine,” says Lucey.

“Many colleges have a healthy lunchbox policy and when children were at home, away from that structure, they might have increased their frequency of snacking.”

Warning that children who snack regularly are at higher risk of tooth decay, she says food and drink-free time is significant for healthy teeth. “Frequent snacking on sugar-containing food means an acid attack on our teeth. The pH will drop for about 40 minutes and that’s when the decay process can occur. The more repeatedly we allow this to occur, the more likely a cavity is because pH is low for more often than not,” she says, adding that the critical point at which decay can occur is when pH drops below 5.5.

Golden hour

Lucey suggests five food intakes day by day for youngsters: Breakfast, lunch, dinner, and two snacks, though water and milk are an exception and might be taken outside of the five. “It’s good to have a golden hour of food-free time before bed — once we sleep our saliva is of course reduced, so children would have less ability to neutralise an acid attack.”

Other tooth-friendly suggestions include having treats as a part of/at end of a meal (prevents extra acid attack when treat is taken individually), eating a bite of cheese post-treat, which helps neutralise acid within the mouth, and eating whole fruit quite than mixing/liquidising it into juices/smoothies.

“The cell wall of fruit accommodates sugar. When liquidised, it’s released and becomes more available for bacteria. Also, after we chew whole fruit, saliva-production is stimulated, which is protective.”

The HSE recommends that each one drinks, apart from breastfeeds, must be taken from a cup or beaker by the age of 1. At night specifically, milk sugars from a bottle can start tooth decay. “It’s because they continue to be in baby’s mouth undisturbed because normal salivary production reduces at night,” says Lucey.

A myth still prevails that baby teeth aren’t essential, whereas, says Lucey, they’ve a very important role in function (eating, speaking), for aesthetics and for youngsters’s self-esteem. “In addition they hold onto space for the adult teeth, so that they help guide adult teeth into position.”

Until they’re two years old, children’s teeth must be brushed, using water. From age two, use fluoride toothpaste and be sure that brushing’s done twice day by day, including before bed. “Encourage children to spit out toothpaste afterwards, but to not rinse. Letting the residue remain allows the fluoride to have more profit,” says Lucey.

The National Oral Health Policy, Smile agus Sláinte, was published in 2019. Access to early oral healthcare, especially advice and prevention, was identified as a priority motion. Again, the pandemic has delayed implementation of the policy, though the Department of Health says it’s now a priority to “ensure implementation proceeds in earnest”.

A serious aim is to minimise the need for general anaesthesia for tooth extraction. “We currently have 7,000 children waiting on general anaesthetic for removal of teeth,” says Kavanagh.

“We are able to’t measure what number of nights’ sleep are lost, what number of schooldays — and all the opposite impacts of pain and decay.”

It’s high time, she says, that we move from a system of ‘diagnosing and treating’ children’s dental health — and as a substitute embrace a ‘proactive and preventative’ approach.