Is Dental Decay Contagious?

Tooth decay is the single most common chronic childhood disease, despite also being preventable.

Is dental decay a contagious disease? 

Is it possible to catch it from someone else?

In a previous post we discussed what causes dental cavities. 

To summarise, bacteria (germs) in our mouths convert sugar in food and drink that we consume into acid which damages teeth.

Bacteria live in dental plaque - a sticky film which builds up naturally on our teeth. Dental plaque contains many types of bacteria but only a small number of these cause dental decay. The main type of bacteria which causes dental caries is Mutans streptococci. Studies have shown that individuals with higher levels of Mutans streptococci are at a greater risk of cavities.

Recent research has shown that babies are not born with decay-causing bacteria. Any time after birth bacteria can be passed on from other people, especially mothers and other close caregivers. Once these bacteria are transmitted to a babies mouth, especially after the first teeth come through, they multiply and become established within dental plaque.

Bacteria can enter the baby's mouth by kissing, sharing food utensils, toothbrushes or other habits that transmit saliva.

If parents and other caregivers have cavities and poor oral hygiene they will have higher levels of decay-causing bacteria which can be passed onto their child.

The risk of a child developing cavities will be less if they are not infected with decay-causing bacteria at an early age.

Children can also "catch" bacteria from other children by sharing food and toys, but they are more likely to receive bacteria from their mother and other close relatives before this happens.

What can be done to reduce the risk?

Parents and caregivers can reduce the risk of passing on decay-causing bacteria from their own mouths by:

• cleaning their own teeth well, to reduce the amount of plaque (which contains bacteria)  in their mouths
• avoiding sugary snacks and drinks between meals which can lead to decay 
• visiting the dentist regularly for check-up and getting any cavities filled 
• avoiding sharing items such as food, spoons, cups and toothbrushes with their baby
• kissing the baby on their cheek, rather than the mouth

Questions about Local Anaesthetic

Your dentist has told you that your child needs a local anaesthetic at their next visit. You may be worried and have questions. We will discuss many of the common questions in this blog post:

What is local anaesthetic?

Local anaesthetic is a type of medicine given as an injection to temporarily numb a specific area of the mouth. 

How does it work?

Local anaesthesia blocks pain by stopping pain signals being carried by nerves to the brain. This causes a complete loss of pain sensation to a specific area, without affecting the rest of the body. Pressure sensations may still be felt.

Why is local anaesthetic (LA) used in dentistry?

Although shallow fillings can often be completed without LA, it is required for deeper cavities, treatment involving the nerve of the tooth and tooth extractions, among other procedures. Local anaesthetic makes painless procedures possible and therefore makes treatment easier and more comfortable.

What is the difference between local and general anaesthetia or sedation?

General anaesthesia (GA) is used when a patients needs to be asleep for an operation or procedure - this can only be done by a trained anaesthetist in a fully equipped hospital. 

In conscious sedation, a sedative is given either by mouth (tablet or liquid), injection, or inhalation (gas and air). The patient remains awake and responsive but is more relaxed and less anxious. Local anaesthetic is often used in addition to sedation or GA.

Local anaesthetic does not affect consciousness. Only the specific area of the body being numbed is affected.

Is Local Anaestheic safe?

Local anaesthetics are used routinely every day for dental treatment all over the world, with relatively few problems. 

As with all medication, care and attention must be taken to ensure local anaesthetic is used safely. Good dentists will use safe techniques carefully and inject slowly. To ensure a safe dose a child's size and weight need to be taken into account, as the maximum safe dose is lower for children than for adults.

Allergies to commonly used dental local anaesthetics are extremely rare. Allergies to preservatives used in LA have been known, although they are not common.

Epinephrine (adrenaline) is commonly added to local anaesthetics as it increases the duration of the numbing effect and also reduces bleeding. For patients with significant heart or thyroid problems LA without epinephrine may be used.

From what age can children be given LA?

Very young children are sometimes unable to cooperate for treatment with local anaesthetic. This is because they do not understand the numb feeling or the reason for it. With reassurance and explanation appropriate to the child's age, some children as young 3 years old can accept treatment with local anaesthetic. For young children who unable to cooperate, temporary treatment may be done to make the child comfortable until they are able to accept further treatment. If there is severe infection treatment under general anaesthetic may be required.

What if I or my child are worried about the injection?

Anxiety about injections is common and understandable. Finding a good dentist who is understanding and sympathetic will go a long way in reducing anxiety.  Relaxation or distraction techniques can be used. For very anxious patients, conscious sedation with inhaled nitrous oxide and oxygen may be an option. Talk to your dentist about your anxieties but try not to convey your worries to your child. In our experience at Small Bites we have found that the children are often are less anxious than their parents!

How can the dentist make it easier for my child?

Local anaesthetic should ideally be used when a child is cooperative and has accepted other treatment well.

Explanation and reassurance are very important. For a young child the dentist may say that they are going to give some special medicine or "sleepy juice" to make the tooth go to sleep for a while, so that they don't feel any pain while the tooth is fixed. Older children with more understanding may be told that this involves an injection.

A numbing gel placed on the gum for a couple of minutes before the injection often works very well, so that the injection is hardly felt. At Small Bites we also use a very fine needle which minimizes pain or discomfort during injection. 

It is necessary to wait 5 or 10 minutes to give the local anaesthetic time to work before starting treatment.

How long does the numb feeling last for?

This will depend on the technique used but usually between 1 and 3 hours. It should be explained to the child that their lip/cheek (and sometimes also tongue) will feel strange. The affected area will feel swollen/bigger but not look any different.

What precautions should I take after my child has had local anaesthetic?

Tell you child that the numb feeling will take some time to wear off. Care should be taken that they do not bite their lip or tongue during this time. Hot food and drink and any food that they need to chew should also be avoided until the feeling has returned.

If you have any other questions you can either talk to your dentist or leave a comment below.

Protecting our children from abuse - Part 3

In the first post in this series we discussed the importance of good communication with our children for giving safety guidelines and listening to their concerns. In the second, we looked at signs of potential abuse and what to do if you know, or suspect a child is being abused.

In this post we will discuss safety guidelines for various situations.

Staying safe while out and about

Starting to go outside without adult supervision is an important part of growing up and gaining independence. You will need to decide how and when to start giving your child more freedom based on their age and maturity. 

Children need challenges and responsibilities, but they also need adults to support, guide and step in when needed. Children under eight years old should not be left to play out of sight or near busy roads.


Talk with your child about the following:

• That they must always tell you where they are going, what they are doing and who they are with.
• Warn them never to go into dangerous areas such as construction sites.
• Discuss what to do and who to contact in an emergency.
• Talk about bullying and what they should do if they are being bullied.
• Not to talk to adults they don't know and never to go off with an adult - even if they know them - without telling you first.
• If someone makes them feel uncomfortable, worried or scared to talk to someone in authority eg. police, park keeper, watchman. (If there is no one available speak to an adult with a child, if possible).
• Come home as quickly and safely as possible or, if you are out, go to a friend or neighbour's house whenever they feel worried or scared.

Schools, daycare, clubs and activities

When our children are at daycare, school or other organised activities we want to make sure that they are safe and well looked after. 

• Get recommendations from friends and family on the best school or club for your child.
• Make sure that the facilities are clean and safe and staff are caring and well trained.
• Ask about the school or club's policies on child protection and health and safety. 
• Always discuss with your child what they have been doing each day and allow them to share any problems or concerns.
• Maintain good communication with the teacher or organizer. This will enable you to discuss your child's progress and development, as well as any concerns or problems.

Leaving your child home alone

Before deciding whether it is safe to leave your child, or children, home alone consider these important factors:

• The age and maturity of the child.
• The place where the child will be left.
• How long and how often the child will be left alone.
• Whether there are any other children present and their ages.

Babies and young children should not be left alone, even for short periods of time. If possible, find a trusted adult who can look after your child while you are away.

If you do leave an older child alone make sure they are happy and confident about the arrangements. A child under 16 years old should never be left overnight.

Here are some guidelines to follow:

• Talk to your child about keeping safe at home and point out potential dangers.
• Put obvious dangers (eg. medicines, matches) out of child's reach.
• Leave a contact phone number and be available to answer it immediately.
• Give numbers of other trusted people they can contact if needed.
• Give clear instructions about what to do in an emergency and phone numbers for emergency services.
• Tell them not to answer the door to strangers.
• If they answer the phone, tell them to say mum and dad are busy (not out) and take the person's name and number.
• Tell your child when you will be back and make sure you are back on time.
• Talk with your child after you return home to discuss and problems or uncertainties.

On-line Safety

As computer, mobile and internet technology has progressed at a rapid pace over the last decade, our children often know more than we do. They may go on-line to connect with friends, make new ones, to browse the internet for information, chat with others and play games. The internet can be a very useful source of information. However, most children and many parents are unaware of potential dangers of being online.

The risks and dangers of being online:

• Exposure to pornography, violent games and videos and other inappropriate content
• Ignoring Age restrictions
• Cyber bullying
• Friending or communicating with people they don't know
• Sharing personal information
• Grooming and sexual abuse
• Addiction to computer games
• Gambling or running up debts

Guidelines for using the internet safely:

• Discuss with your child about the benefits and dangers of using the internet.
• Set rules and agree boundaries - this will depend upon your child's age and what you feel is appropriate.
• Explain that internet access is a privilege which can be taken away (by confiscating computers, smartphone etc.) if the rules are broken. 
• Know which websites your child is using and who they are talking to online.
• Explain that they should not share personal information online, and never accept friend request from someone they do not know.
• Limit the time your children can spend online and the material or websites they can access. 
• It is best to have the computer in a family area, so that you can monitor usage. If children and teenagers have an internet connect computer in their bedroom, or a smart phone they can go online anytime day or night, unsupervised.
• Use parental and privacy controls. These can be activated from the control panel of the computer or other device, on certain websites, or from a software package (some are free). Click here for more information on parental controls.
• No tool is 100% effective and these should not replace conversations with your child.
• Encourage your child to talk to you if they are concerned about anything they have seen, or communication they have received, on the internet.

Protecting our children from abuse - Part 2

In the second post in our series on protecting children from abuse we will look at signs that may indicate a child is being abused and what to do if you know, or suspect that abuse has occurred.

What is Child Sexual Abuse?

Child sexual abuse involves persuading or forcing a child to take part in sexual activities, exposing a child to adult sexuality or encouraging a child to behave in sexually inappropriate ways.

If we don't make a fuss about the abuse, won't a child forget it?

Children do not forget abuse, it can cause devastating emotional, physical and social effects for the child, even into adulthood. Adult survivors of child sexual abuse may develop harmful sexual behaviours, experience inability to trust close family and friends and have marital problems. If abuse is not reported once discovered, not only will the abuse continue, but the abuser is also likely to harm other children.

Signs could indicate abuse

The majority of children do not report abuse. They may feel too scared, fear that they will not be believed, or have been threatened by their abuser not to tell anyone. Changes in a child's behaviour may be the first sign that something is wrong. 

One or two of the following changes may be a normal part of development but more should raise suspicion of possible abuse:

• Nightmares or sleeping problems
• Becoming withdrawn or unusually clingy
• Changes in personality, become more insecure
• Problems with studies or missing school
• Excessive anger
• Sexual language or behaviour (inappropriate for the child's age)
• Going back to younger behaviours eg. thumb sucking, bed-wetting
• Sudden changes in eating habits
• Become secretive, not talking
• Shows signs of fear of, or avoids being alone with, a particular adult. 

If you suspect or discover that a child is being sexually abused, get professional advice (see options below).  Seek medical advice immediately if you see physical signs of abuse, such as unexplained soreness/bruising of genitals or symptoms of sexually transmitted diseases eg. an unusual discharge.


What to do if a child discloses that they have been abused

A very small proportion (estimated to be 12%) of abused children report it. Even then, the reporting is often ambiguous as they may be too shy to narrate the incident clearly, or a younger child may not have the vocabulary to explain what has happened.

Your response is crucial. If the adult does not believe the child, or makes them feel ashamed, they may never risk telling anyone again and the abuse will continue. 

For example, a child may say, "I don't like that Uncle."

If the adult replies "How can you speak like that, don't be so rude!" the child will feel scared and not give any further information.

However, if the adult responds, "I see, what happened?" the child is able to reveal the reason, which may, or may not arouse suspicion.

An abused child wants two things:

• to be believed
• for the abuse to stop

If a child confides in you about abuse

• Acknowledge the child's feelings and praise them for having the courage to come and tell you.
• Tell the child it is not his or her fault. Do not blame or accuse the child, even if they did not report the abuse when it started - the abuser is the one at fault.
• Do not ask the child to "forgive" "forget" or "adjust"
• Do not confront the alleged abuser - it may give them an opportunity to silence, confuse or threaten the child about speaking out. It may also place the child in danger.
• Tell the child that you would like to take the help of other trusted adults (eg. close family members, child welfare services, medical professionals or police) to help, with the child's permission. 
• Do not tell other people who are not directly required to help and support the child.

Childline has a national toll-free number - 1098 - which an adult who is concerned about a child, or children in distress, can call for help and advice.

In Bangalore, 3 new Collaborative Child Response Units (CCRU) have recently been set up at M.S. Ramaiah Hospital, Bangalore Baptist Hospital and KIMS Hospital. They liaise between children, their families, doctors and other authorities to provide medical, psycho-social and legal assistance. More CCRU's are to be set up in other districts of Karnataka.

It is possible to contact the CCRU's directly, but they also receive referrals from the police, child welfare services and Childline.

Due to the recent "Protection of Children from Sexual Offences Act - 2012"  it has become mandatory for any person having knowledge of a child being sexually abused to report the same to the Special Juvenile Police Unit or local police. A child need never go to a police station, police will come in plain clothes to visit the child and record the statement in the child's own words.

Protecting children is every adult's responsibility.

In the next section, we will discuss guidelines for keeping children safe in various situations, both at home and outside.