With the festive season just over, dental professionals are already beginning to see a sharp rise in the number of children attending their clinics with pain in the tooth and are warning parents that a rise in dental caries among children is imminent. The Sunday Observer spoke to Consultant in Community Dentistry, Institute of Oral Health, Ministry of Health, Dr Nilantha Ratnayake to find out the causes and most importantly how they can be prevented with simple practical methods affordable to all .
Excerpts.
Dr Nilantha Ratnayake
Q. While Christmas and the New Year celebrations have concluded, schoolchildren who indulged in eating excessive sweetmeats during the season are already complaining of toothache with health officials warning that a rise in caries among schoolchildren is imminent For the benefit of our readers tell us what is Dental caries?
A. Dental caries, commonly known as tooth decay, refers to the formation of cavities (small holes) in the teeth that compromise the health and structure of the tooth. It is the most common oral disease among children. The main reasons are excessive / frequent consumption of sweets, poor oral hygiene and lack of exposure to fluorides.
Q. A recent study in Australia, where dental caries is said to be one of the highest among schoolchildren in the world, around 2 in 5 (42 percent) children had experienced decay in their primary (baby) teeth, and 1 in 4 (24 percent) children had experienced decay in their permanent (adult) teeth. What is the prevalence rate in Sri Lanka according to your latest figures?
A: According to the latest National Oral Health Survey in Sri Lanka, 3 out of 5 children (63 percent) had experienced decay in their primary (milk) teeth, thus prevalence is significantly high compared to Australia. However, the prevalence of decay in permanent (adult) teeth in children (12-year-old) is only 30 percent. Therefore, decay in the milk teeth is an issue among Sri Lankan children we need to address.
Q. The study further revealed that children in low-income households were twice as likely to have untreated decay in their primary (36 percent) and permanent teeth (15 percent) as children in high-income households (18 percent and 7 percent, respectively.) Is it the same in Sri Lankan households too?
A: In Sri Lanka, we do not have data to show that children in low-income households have more untreated decay. Overall, untreated tooth decay is high among Sri Lankan children. However, what we have observed particularly with the current economic crisis is that the dental health of low-income families is more affected.
Q. Studies in some countries including Australia, have shown that children aged 5 to 10 years have an average of one and a half decayed, missing or filled baby teeth. Is this similar to our own scenario of caries in children? For example, age wise and gender wise is there a difference in those who are more vulnerable to dental caries among our own local school going population? If so,why?
A:The condition is worse among Sri Lankan children with regards to milk teeth. According to our National Oral Health Survey, among 5-year-old children, average number of milk teeth affected by decay is 3. However, the average number of permanent teeth affected by decay in children (12-year-old) is only 0.6, which can be considered as satisfactory. Milk teeth are more vulnerable to decay and there is no gender difference observed with regard to vulnerability.
Q. Schoolchildren apart, can toddlers who have not been taught proper dental hygiene get caries?
A: A toddler is a child approximately 1 to 3 years old. Oral hygiene of toddlers is totally a responsibility of parents, as they are too small to take care of their teeth.
Q. So what are the early signs of dental caries that parents must watch out for in their children?
A. In milk teeth, initial caries appear as ‘white spots’ on teeth. Sometimes these spots are brownish in colour. In front teeth, these spots are seen closer to the gum margin. If such white spots are seen, a dentist should be visited immediately. Clinical fluoride therapy will heal these white spot lesions and prevent them progressing into cavities. In addition to clinical fluoride therapy, brushing with fluoridated toothpaste will assist in healing these initial caries lesions.
Q. Most dental surgeons agree that early dental caries often leaves behind harmful impacts on a child starting from the time the child cuts his /her first tooth. What are these adverse effects?
A. Teeth are essential for three important things of life namely speech, nutrition and appearance. Having decayed teeth or missing teeth due to caries affects speech of a child. Decayed teeth affect the diet and can negatively impact the growth and development of a child. Moreover, having decayed front teeth can affect the confidence and self-esteem of a child which can impact on the psycho-social development of the child.
Q.As a Consultant in Community Dentistry share with us some useful preventive strategies that can be adopted to maintain good oral health in children as guidelines for our readers on how to teach children to brush their teeth according to their different ages?
A. Reducing sugar consumption, maintaining proper oral hygiene and use of fluoridated toothpaste are the key strategies to prevent tooth decay. Usually, the first milk tooth erupts into the mouth around the age of 6 months. From that point onwards, parents should take care of their child’s teeth. Teeth of child should be brushed by parents with a fluoridated toothpaste using a junior toothbrush. Just a thin smear of toothpaste should be applied on the toothbrush bristles which are equal to the size of a rice grain.
Brushing should be performed at least for 2 minutes and children should be trained and encouraged to spit out toothpaste after brushing. Toothpaste should not be swallowed. Children should be assisted to brush their teeth until around the age of 5 and thereafter should be supervised when brushing till the age of around 8. The amount of fluoride toothpaste used can be gradually increased from a ‘smear layer; to a ‘pea sized’ amount from the age 3 to 6 years. From 6 years onwards, a pea sized amount of toothpaste can be used. The child can switch to an adult toothbrush around the ages 6-8.
Q. When you refer to regular check-ups for schoolchildren how often should these check-ups be?
A. Sri Lankan schoolchildren attending the government schools are covered by the School Dental Service of Sri Lanka, which is manned by the School Dental Therapists. They screen mouths of all schoolchildren in grades 1,4 and 7 annually, and treat dental caries and other oral diseases. However, it is better to visit a dentist once a year for an update on the child’s oral health status.
Q. Using fluoride toothpaste is now being recommended for all children as well as older persons. Why? What are the benefits of fluoride?
A. Fluoride is a proven agent to prevent dental caries. Fluoride toothpaste is the best mode to deliver fluoride into oral cavities of populations in a country like Sri Lanka. The World Dental Federation has recommended that the fluoridated toothpaste which contains 1000-1500 ppm fluoride is effective in reducing tooth decay in both children and adults.
Q. With the high price of tooth paste many underprivileged homes continue to use kitchen salt to brush their teeth. Is this a good thing?
A. Not only kitchen salt, there are reports that some of the underprivileged groups are switching to alternatives such as charcoal and tooth powder. Such practices cannot be accepted. Kitchen salt, charcoal and tooth power are abrasive material and can damage the tooth enamel. Long term users of such material to clean teeth will end up with a worn set of teeth,
Q. Herbal tooth paste without artificial colouring or flavours and using a mixture of herbs locally grown has been recommended by many ayurvedic dentists. What is your opinion on such tooth pastes?
A. Having herbal ingredients is not an issue provided the toothpaste contains fluoride. There are a number of herbal toothpaste brands marketed in Sri Lanka, which contain the recommended concentration of fluoride. Make sure your toothpaste contains fluoride.
Q. Betel chewing is still a popular practice among mostly low income groups including bus drivers, auto drivers on long journeys. What is the most serious health impact that this unhealthy practice can have both in the short term and long term?
A. The main issue with chewing betel quid is it can lead to oral cancers. In Sri Lanka, the most common cancer among males is oral cancer. Chewing betel along with tobacco and areca nut is the cause for 85 percent of oral cancers in Sri Lanka. Both tobacco and areca nut contain several carcinogens (cancer causing chemicals) which act on the oral soft tissues and initiate the pre-form of cancer, known as Oral Potentially Malignant Disorders (OPMD). With time these will transform into cancer. Therefore, all measures should be taken to get rid of this harmful habit.
Q.You also referred to eating a healthy low sugar diet. Describe what a healthy low sugar diet is for schoolchildren. Aren’t they expected to eat more starch and sugar as their bodies are still growing and using up so much energy?
A. A child’s diet should be a balanced diet which contains sufficient amounts of carbohydrates, proteins, fat and vitamins. Fruits and vegetables should be essential components of a diet.
It is refined carbohydrates that need to be restricted. Sticky sugary dietary items such as chocolates and confectionery are the main cause of tooth decay. Consumption of such items should be reduced in both quantity and frequency and should be restricted to main meals.
Q.What are the present gaps you see in delivering optimal care to minimise risks of dental caries and cavities in Lankan children?
A. The main issue is addressing the decay in the milk teeth, which affect 63 percent of our Grade 1 children. The children below 5-years of age cannot be captured until they start schooling. Once they start schooling at the age of 5, they will be examined by the School Dental Therapist. However, by that time children are suffering from advanced caries in their milk teeth.
Q. How would you like to close those gaps? Any suggestions?
A. Most of the Sri Lankan children attend pre-schools at the age of 3-4. Therefore, there is a need for a comprehensive preschool program to capture these vulnerable children at the pre-schools. There are plans in the Ministry of Health for such a comprehensive program to tackle early childhood caries.
Q. What has the Institute of Oral Health done so far by way of interventions and innovations to educate children and parents and the community on good oral habits?
A. The Dental Public Health Unit of the Institute of Oral Health, Maharagama caters for newborn babies of pregnant mothers registered in the unit and children of any age. We run a model state-of-art preventive clinic that delivers a complete package of oral health for children which include health education to comprehensive clinical preventive procedures.
Q. Do you have a message for all our readers, especially schoolchildren on how to maintain good oral health throughout their lives?
A. All dental diseases are related to our unhealthy behaviour. Reducing sugar and refined carbohydrate consumption, brushing teeth twice daily with a fluoridated toothpaste, avoiding betel quid chewing, smoking, and alcohol will prevent you from main oral diseases.
