DENTAL CARE FOR CHILDREN IN THE COVID TIMES

The year 2020 has been challenging in a number of ways. Adjusting, adapting and modifying ones ways of life in the most optimal and safest possible way seems the best way forward.

However, expecting young kids to understand the intensity of the situation is very hard. Most parents have loosened up with respect to their screen time allowance and most importantly food habits. Many parents complain of increased consumption of junk and sweet food items.

In this context, the most common challenge faced by the parents has always been that it is very difficult to get their child to brush their teeth, more so in the present times.

Also read: Special Needs and COVID-19

WAYS TO INSTILL A POSITIVE ORAL HYGIENE PRACTISE

• Make brushing a fun family activity
• From a very young age, instil a positive attitude towards brushing. It should never seem like a punishment
• Use musical brushing videos to make them interested and learn the right techniques of brushing and tongue cleaning from a very young age
• Kids learn best by observing- TELL-SHOW-DO. So it is always suggested that they watch a parent/older sibling while brushing their teeth. The important points to be kept in mind are the technique of brushing and the time duration of 2 minutes
• The technique: (image A)
• Vertical brush strokes from the gum line onwards onto the tooth for the upper and lower front teeth
• Vertical circular brush strokes from the gum line onwards onto the tooth for the upper and lower molars (back teeth)
• To & fro brush strokes on the occlusal (biting) surfaces of the teeth
• Vertical brush strokes on the surface of the teeth facing the upper palate and tongue (palatal & lingual surfaces)

Till children turn about 6 years old they don’t develop sufficient dexterity in their hands to be able to brush well. So it is advised that the parents brush their teeth twice a day, while teaching them the proper technique of brushing and flossing. A habit of gargling should be inculcated from a very young age.

(Image A)

PROCESS OF DENTAL DECAY

The process of dental decay is not a result of a single factor but a combination of the below (image B) factors present together for a considerable period of time.

Any food/liquid present on the surface of the tooth for a long period of time along with plaque (which contains oral bacteria) begins the process of tooth decay by creating an acidic environment in the oral cavity.

Dental plaque is a colourless, sticky film that is constantly forming on the teeth. Hence it is very important to brush thoroughly twice a day. Plaque not cleaned well also leads to halitosis (bad mouth odour) in children.

(Image B)

DENTAL CARE TIPS

Dental care till 6 months of age:

Till at least 6 months of age, (in the most ideal situation) children are exclusively breastfed. Majority of the children get their first milk tooth by about 6 months of age. Till such time, it is advised that parents use a moist gauze piece wrapped around their fingers and gently rub it around their gums. It serves to keep their gum pads clean and at the same time acclimatises the child to the action of someone cleaning their gums pads.

Clean gum pads also mean lesser dental plaque. Cleaner the gum pads, easier the eruption of teeth. Keeping the gum pads clean is very important to have a very smooth process of tooth eruption.

The healthier the gum pads and the oral cavity, the healthier the child. This influences the process of teething.

Teething is notoriously known to be a very difficult and a hard time for the children and their parents. During the same time as that of teething (beginning at around 6-7months of age), the child is developing his own innate immunity. It is also the time when solids are introduced to the child. Thus making them susceptible to fever, stomach infections, loss of weight, crankiness.

Ideally teething should not cause any of the above symptoms as it is widely believed. Keeping a clean oral cavity/gums pads should help in reducing or totally eliminating the pain and swelling associated with teething.

Dental care post tooth/teeth eruption:

If parents get into the habit of cleaning their child’s gum pads post breastfeeding, it is always easier to get children to brush their teeth.

According to the American Academy of Paediatric Dentistry, it is advised to start brushing their children’s teeth with the eruption of the first tooth. Brushing should be done using fluoridated toothpaste meant for children. Always check the contents before investing in a toothpaste. The fluoride content should not exceed 1000 ppm. Till about 5 years of age at least, children do not gargle well and end up ingesting some amount of toothpaste. So to avoid any kind of fluoride toxicity, it is advised to use paediatric variants. IAPD (International Academy of Paediatric Dentistry) recommends daily tooth brushing with

fluoridated toothpaste of 1000PPM using age-appropriate amount of toothpaste as below.

(Image C)

For children under 3 use a smear of toothpaste. This is a safe amount even without spitting.

For children over 3 use a pea-size amount and encourage the child to spit the excess.

Night time breast or bottle feeding should ALWAYS be followed by cleaning of teeth. If the child is very young, it is advised to use a finger brush and clean their teeth. But once old enough, it is advised to brush their teeth at night using Fluoridated toothpaste meant for children. Nothing but plain water should be consumed after that.

Nursing bottle syndrome or baby bottle decay or early childhood caries (ECC) is extremely common in cases where night time feeding is not followed by the cleaning of the teeth.

ECC (image D) begins as faint white lines on the surface of the upper front teeth. This then eventually proceeds to cavitation and eventual involvement of the other teeth.

Image D

MODERN CONCEPTS

The CHOCOLATE BANK concept is relatively recent and works well with children and parents. It was devised by a financial advisor to help his children learn the basics of profits, gains and losses.

The child should be given a box like a piggy bank. It should be used to bank chocolates and sweets/junk food that the child receives during the week. The chocolate bank can be opened twice a week. At such times the child should be allowed to consume 1-4 variants. This should however be followed by rigorous brushing and gargling.

The damage to the teeth is more due to in-between the meal snacking rather than during the meals. The chocolate bank principle takes care of two major things: control in the quantity and frequency of junk/sweets.

A biannual dental check-up is always recommended. It not only helps to get any dental treatment done in the earliest stages thus totally avoiding any painful experience but also help the child develop a positive and worry-free attitude towards a dental visit.

Join us for an interactive and exclusive FB Live session with Pediatric Dentist, Dr Anamaya Bhobe, as she lets us know ways in which we can take care of the oral health of our family without stepping out.

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About the Author

Dr Anamaya Bhobe

Dr Anamaya Bhobe, has been practicing pediatric dentistry in Mumbai for almost a decade now. She has also pursued a specialized course in Myofunctional Therapy for children. This involves the correction of oral habits and their implications on the growth and development of a child.