Diwali and Dental Caries - Here's What To Expect

It is time for Diwali, the season of celebration that starts now and lasts till the end of the year. This festival is also all about fun, frolic and most definitely food. It is difficult to imagine celebrations without food, without elaborate mithais prepared for friends and family, ladoos and jalebis enjoyed by the family, and children rushing about with sweets stuffed in their mouth.

As much as this whole scenario conjures up happiness and fun, there is a lot to deal with once the festivities are up, and the most important being BAD TEETH and oral problems.

Sweets and delicacies are unavoidable, and so are the after-effects of gorging on them; bad teeth, bad oral odour, and with children, the first signs of caries and gum trouble. 

As much as we love snacking on food throughout Diwali and thereafter, there are little unwelcome visitors snacking on the food collected in our and the kid’s mouth, that if left untreated or not looked after, can cause a whole host of problems, many of which are already known.

• Plaque and Caries - Sugary foods cause tooth decay. Period. Whether you give your child something mildly sweet or chocolates and desserts loaded with sugar, they will cause harm in the mouth and eventually caries. Another important factor, is the frequency at which they are eaten.

Eating foods of different kinds, almost always causes something to remain in the mouth, debris that gets accumulated between teeth and gums. Bacteria present in the mouth, feed on all these foods. In the case of sweet stuff, these bacteria feed on the carbohydrates in sugar, especially refined sugars in desserts to produce acids, which combine with saliva to form plaque. The plaque deposits itself on the teeth over a period of time, causing erosion of the tooth and caries.

• Bad Odor – Infrequent brushing and rinsing of teeth, causes the accumulated food build-up to cause an additional set of problems. Bad odour from the mouth is one such. Acid build-up in the mouth due to remaining food, tends to cause further damage to the teeth, leading to bad breath. The tongue is also a storage of bacteria and contributes to it.

• Dry Mouth – The more you eat, the more saliva is produced, yet consequently, the more sugars you consume, makes that saliva get used up quickly and causes dry mouth and bad breath. Dry mouth can result in frequent gum irritation, pain, inflammation and difficulty in swallowing.
  

As much as the harm that sweets can do during this time, Diwali is really incomplete without indulging in them. You really can’t stop the children from eating what they like. Here are a few practices to follow during this festive period;

• Brush the children’s teeth twice daily, even more frequently if required. No matter how long the day is, how tired and sleepy they are, never put them to bed without cleaning their mouth and brushing their teeth. This will help them in the long run by also enforcing a good habit.
  
  
  
  

• Avoid kids indulging in frequent snacking, in between meals. This helps reduce food accumulation in the mouth, and also lowers the exposure to sugar. Let them eat whatever they like, but in one sitting at one time.

• Drink juices, milk and other liquids with a straw. Sweetened liquids remain longer on children’s teeth than solids. Using straws will limit their contact with teeth, and also make it easier to get rid of them when brushing.

• Ensure they drink a glass of water after having sweets, or rinse their mouth every time they do. This can loosen up any accumulated food particles and prevent further damage.

• Enjoy sweets and sugary foods during a meal, rather than before or after it. Indulging in juices or snacks throughout the day, is giving bacteria a fertile ground to grow and flourish. But letting children have sweets together with their meals, ensures that the other foods prevent these sugars from sticking to the teeth and remaining in the mouth.

• Reduce rewarding good behavior with a sweet treat. Occasional snacking on sweets is fine, but keeping children busy with such foods for distraction, or as reward for a good job, sends across a wrong message. This not just harms their behavior, but teeth as well.

• Brush, rinse, clean and ensure nothing remains in the mouth. This cannot be emphasized enough. Brushing all areas of the teeth, especially the ones at the back and the molars, cleaning the tongue and flossing the mouth whenever possible, ensures that the festivities don’t leave children with harmful, long-lasting effects.

Children can and must enjoy Diwali, indulge themselves with sweets, but it is left up to us as parents to ensure their teeth and dental health don't take a hit because of this.

Bruxism - Teeth Grinding Isn't Always Harmless

When children are growing, there are several things you need to be aware of, their weight gain, their food intake and the general state of their health. Often parents tend to ignore the mouth, assuming that as long as teeth are brushed and general mouth hygiene is maintained, everything will be alright.

Teeth brushing and observing the regular milestones of milk and permanent teeth aren’t the only things that need to be observed, since there are many other problems that point out to underlying issues in children, which if not treated affect teeth and their physical health, as well as add to the stress as they grow up.

One such condition that many parents tend to overlook, is Teeth Grinding or Bruxism. Although not a symptom, it points to an underlying .

Teeth grinding, teeth gnashing, or the unconscious act of clenching and unclenching teeth is present in most kids, with 2-3 out of 10 children having this problem. Most children grow out of it by the age of 7 years, but many others carry this habit well into adulthood. 

 Although the reasons are unknown, experts have given a few reasons for this condition,

• Stress induced teeth grinding, especially when children aren’t able to cope with a new situation, such as a test at school or meeting new people. An argument with parents or siblings or arrival of a second sibling is also seen as a probable cause
•  Mal-aligned top and bottom teeth which causes irritation and subsequent teeth gnashing
•  Pain anywhere in the face is also a cause, whether earache or appearance of new teeth 
•  Hyperactivity and restlessness
•  Kids with medical conditions ( such as cerebral palsy) or who take certain medication.

 How does one whether your child is grinding their teeth?

Have you heard your child’s jaw moving continuously or regular sounds from their mouth during bedtime? If you hear them grind their teeth while asleep, without being aware of it, and they experience a painful jaw or mouth on waking up or pain when chewing, it indicates they suffer from the condition.

What harm can it cause?

Bruxism as such is a temporary harmless condition, and children most often outgrow it. In those children where this condition persists, symptoms of headache or earaches are often complained. 

What harm can it cause the teeth?

A side effect of bruxism is the harm it can do to the child’s teeth. Nightime grinding, gnashing and clenching the teeth, can wear down tooth enamel, gradually chip off teeth, make the tooth temperature sensitive and also cause lingering jaw and mouth problems and pain.

It is important to take the child to a pediatric dentist, before the condition causes severe irreparable damage to the teeth in the long run. A dentist will examine the child’s teeth for chipped tooth enamel, and any other wear and tear.  In addition questions related to stress or tension will try to be discerned.

All these observations will give the dentist information on whether the cause for bruxism is psychological (stress induced) or structural (misaligned teeth) and treat the child accordingly. 

 Treatment

While the condition is outgrown by most children, some kids who have severe pain and wearing out, are prescribed a mouthguard; a thin protective mouthpiece moulded to the child’s teeth that acts as a barrier between the opposing sets. This can take care of the major problem.

If the cause is emotional or psychological, the underlying cause needs to be found out by talking to the child, understand reasons that are upsetting them, and try and resolve the issue. If it seems more complicated, then their fears will need to be eased by counseling.

Bruxism usually stops when the milk teeth are lost. In few cases the condition might continue well into teenage years. The condition cannot altogether be avoided, because most often, it is a coping mechanism in children, and their natural reaction to growth and development. It can however be avoided by talking to children frequently, letting them open up and ensuring regular visits to the pediatric dentist are carried out for optimal dental health.

How to help a child who is anxious about the dentist - Part 2

In the first part of this blog we discussed finding a child-friendly dentist and how to help your child before an appointment.

Maybe you have a dental appointment approaching. How can both you and your dentist make things easier for your child during their visit?

How can the dentist help my child?

Treatment room at Small Bites

• Taking things one step at a time will help to build up confidence. It is usually best to start with a check-up and simple cleaning before moving onto other treatment.  
• Young children are not able to sit still or concentrate for long periods of time, so visits are best kept shorter or have breaks when needed.
• The dentist may introduce a "stop signal," like raising a hand, that can be used so that your child can let the dentist know if they are not comfortable or need a break.
• Distraction can be used to give your child something else to think about other than the dental treatment. For example, music, cartoons on a TV screen or simply chatting about something else.
• A good dentist will explain things in a way that your child can understand as they go along. Long explanations and words may be confusing for your child. It is best to have a separate chat with parents while the child plays it the waiting room if required.
• The dentist can first explain, and then demonstrate any tools or materials before using them. For example, an instrument can be used on the back of the hand or finger nail before it is used in the mouth so your child knows what it feels like. 
• Although the dentist should be friendly with your child they may need to use a sterner tone of voice if a child is not listening and following instructions much the same as a schoolteacher would.

Certificate of Bravery

• Positive Reinforcement - when a child behaves and cooperates well they should be rewarded with praise, stickers, a small gift or "bravery" certificate.

Should parents stay in the room for dental treatment?

This depends on your child's age and behaviour. Young children (below 4 years) tend to experience separation anxiety and therefore it is usually advised that parents stay in the room. 

Some children "play up" to their parents and behave better when they are not in the room. One solution for this is to allow the parent or carer to stay in the treatment room whilst the child behaves well, but ask them to go to the waiting room if the child is not listening and following instructions.  

How can I help my child during a dental visit?

• In the previous post we discussed the importance of staying positive and encouraging your child. 
• For young children, you may need to help support your child on your lap while that dentist checks their teeth as shown in the picture.

• If your child makes a fuss try to remain calm. Dentists who treat children regularly will have seen their share of tantrums and be prepared for this. Allow the dentist to guide you on how to best support you child.  
• Some children will "act up" at the dentist to try to avoid treatment. If they are immediately taken out of the treatment room they are more likely to do the same thing the next time. Instead it should be explained to the child what needs to be accomplished in that visit. If cooperation is difficult it is better to achieve a lesser goal than planned, for example, placing a temporary filling, than abandon treatment altogether.

It is better to use rewards after the treatment is over than to promise bribes before hand. 

Show your child how proud you are of them for each new achievement.

Finally - Prevention is better than cure

Although, with some help, the majority of children can learn to cope with (or maybe even enjoy!) visiting the dentist the goal should be to prevent the need for dental treatment as far as possible.

It's a great feeling to take your child for a check up and be told that there are no cavities!

Here are some tips for preventing dental decay and gum disease:

• Thorough tooth brushing twice a day, morning and night. For more brushing tips see this post (click for link).
• Rinsing out the mouth with water after eating.
• Eating a healthy diet and making snacks and drinks, between meals, sugar free as far as possible. 
• Dental sealants are a coating placed on the biting surface of the back molar teeth by a dentist. They protect the narrow pits and grooves of the tooth which can be prone to decay. See this post for more information (click for link).
• Regular check-ups not only get your child used to visiting the dentist but enable any early signs of dental disease to be spotted and prevented from progressing into a bigger problem.

How you can influence your child's dental health

Children learn by copying important adults in their lives. This is a natural process by which children learn about the world around them. 

Your behaviour, expressions  and reactions will usually have a greater impact on your child than what you say to them. 

Parents have a unique position of influence in their children's lives, as a role model and first teacher. This influence can have either a positive or negative effect. How can we use this influence in a positive way to improve our children's oral health?

• Parents choose what babies and young children eat. Parents usually introduce children to the same foods that they eat.  If children are given a healthy, balanced diet at an early age they are much more likely to choose a healthy diet themselves when they are older. 
• If you are constantly snacking on high fat and high sugar snacks your children are likely to do the same. When shopping, plan your meals and also think about healthy food to keep in the house for snacks when you or your children get hungry between meals. 
• For more information on a diet that is good for you teeth see this link.

• Give your children a good example to follow by letting them see you brushing your teeth regularly. 
• Teach your child about the importance of looking after their teeth. There are books and videos which can make learning fun.

• You will need to brush your child's teeth until they can learn to do it effectively for themselves from around six years old. Older children will still require encouragement and supervision. Also see post on top toothbrushing tips.
• Children whose parents regularly visit the dentist are more likely to do the same.
• Take your child to visit a dentist before they have any pain or problems. Find a dentist who is good with children. Regular check-ups enable the dentist to assess your child's risk for developing decay or gum disease and give preventive advice. Any problems can also be seen early and treated or prevented from progressing.

Did you know that children whose parents are anxious about visiting the dentist are much more likely to become anxious themselves? A recent study showed that parents' attitude towards dentistry are often passed on to their children.

Children look to their parents to learn how to respond  to a new situation and can pick up on their parent's anxiety. This means that some children are very anxious even before they first visit the dentist.

We will look at ways to help anxious children in a future post. For help on overcoming your own anxiety, see this blog (click for link)

Even if you are anxious, try not to let this show to your child. Avoid making negative remarks about the dentist in front of your children.

Once children get interested in looking after their teeth they can be encouraged to see the dentist as someone who helps them to stay healthy.

Does a mother's dental health affect her baby?

When should we start thinking about our children's oral health?

Newborn babies do not yet have teeth - surely this is too early to worry about cavities or gum problems? 

What about during pregnancy?

Expectant mothers are keen to do everything they can for the health of their baby. However, many are unaware that  their own dental health problems can have effects on their general health and their unborn child. 

Research has shown that mothers with gum disease have a three times greater risk of poor and pregnancy and birth outcomes such as pre-term deliveries and low birth weight. This can occur as bacteria from the mouth and their by-products have the ability to cross the placenta to the developing baby and trigger inflammatory responses. Another study has shown a link between gum disease and pregnancy (gestational) diabetes.

Also, mothers with poor oral health and high levels of the bacteria which cause dental decay are at greater risk of passing these bacteria to their newborn babies, putting them at an increased risk of developing dental cavities at an early age. For more information on this, click for the previous blog post.

Problems with oral health in pregnancy

Unfortunately, due to pregnancy hormones, some women can be more susceptible to gum problems during pregnancy. Warning signs of periodontal (gum) disease include swelling, redness, bleeding and sensitivity.

Nausea and vomiting and extreme tiredness can also cause problems and lead to dental hygiene being neglected. Pregnancy cravings and the need to each more frequently may increase the risk of dental decay if sugary snacks are consumed often. 

Many women are concerned about the safety of dental treatment during pregnancy. However, treatment should not be unnecessarily delayed if appropriate safety precautions are taken. Active decay should be removed and the cavity filled. Pain and infection should not be left untreated, as these can cause stress and danger to both the mother and her developing baby. 

Guidance for expectant and new mothers

• Remember that your own dental health can have an effect on your baby, both during pregnancy and after birth.
• See a dentist for a consultation as soon as possible. Be sure to tell your dentist if you are pregnant as this may affect the treatment or medication prescribed. 
• Cleaning (scaling and polishing) and many other treatments are safe during pregnancy, you can discuss the best options with your dentist. 
• The second trimester (14th to 20th week) of pregnancy is usually the best time to get treatment done if required.
• X-rays are generally avoided during pregnancy but if they are required for urgent treatment then small x-rays using a lead apron to protect the rest of your body can be taken.  
• Maintain your oral health during pregnancy to prevent gum disease and decay. Try not to neglect brushing and flossing.
• If you are having gum problems, in addition to regular professional cleaning, using a chlorhexidine (antibacterial) mouthwash may help.
• Diet and nutrition is especially important during pregnancy. Although you will need to eat more frequently, try to choose snacks that are sugar free between meals.
• Take your new baby to see a dentist when they are 1 year old. An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice.

It's never too early to start preventing tooth decay

Young children can start to develop dental caries as soon as their first teeth enter the mouth. As a parent, awareness and prevention can never start too early.

It may be difficult to see all your child's teeth, especially the back molars, and so many children develop cavities before their parents realise there is a problem. By the time a child gets toothache the cavity will already be quite deep. It is best to take your child for a check-up at the dentist at around 1 year old.

An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice. Also, if early signs of dental decay are seen, it may be possible to prevent it progressing to become a cavity. 

In future blogs we will be focusing on what you can do at home to keep your child's teeth healthy.