<b>CHILDREN´S ORAL<br>HYGIENE</b><br>Specific care for babies<br>and children
CHILDREN´S ORAL
HYGIENE

Specific care for babies
and children

Good oral hygiene should start at an earlier age than what is generally believed. And what's more, oral care during childhood, along with acquiring habits for its maintenance, is what will allow adults to keep their teeth throughout their lifetime. For this reason, instead of waiting for the first teeth to appear, it is wise to begin oral hygiene practice in newborns with a piece of cotton gauze moistened with drinking water.

This should be done for a variety of reasons, the obvious being to keep infants' mouths clean, and another is to get them used to this habit. Many parents, from lack of awareness, tend to initiate their children's oral hygiene around the age of two years (age in which they can begin to use a toothbrush). And it is quite likely that by this age a child's first caries has already appeared.

In order for this habit to become an essential part of a baby's or child's daily routine, it should be performed in the most enjoyable manner possible:

  • Carry out hygiene when the child is relaxed and in a good mood, without waiting until right before bedtime, which is when they tend to be more tired or cranky.
  • Negotiate and offer choices. We can either pre-select the toothbrushes we believe to be adequate for children, or we can allow them to choose for themselves. If the toothbrush has his favourite colour or character, he will be more excited to get brushing.
  • Suggest a pleasant activity for the child, not by way of blackmail or reward, but as an incentive of something to enjoy after brushing.
  • Avoid threats, punishments and negative arguments. It is always advisable to show the positive side of brushing: We brush our teeth to take care of ourselves, just like we do with our hair... 
  • Set aside a toy for brushing time. You can use a puppet, a doll or an interesting object with which the child specifically plays while brushing teeth.

ASSOCIATED PROBLEMS

The oral cavity is a highly diverse ecosystem, with up to 600 different microbial species that colonise different habitats. Oral biofilm (bacterial plaque) is a complex and organised community of microorganisms that can cooperate with each other and that bring about conditions that favour the survival of the toughest bacterial species. The pathogenic bacteria found in oral biofilm are responsible for the aetiology of the two most prevalent oral diseases: caries and periodontitis.

Caries in children cause a series of consequences on the short term, such as malocclusion, and on the long term such as infections, aesthetic problems and difficulty eating; they can also have medical, emotional and financial implications. According to a report issued by the WHO in 2004, dental caries affects 60 to 90% of school-aged children.

Children with early on-set caries in childhood are at higher risk for having new caries in their permanent teeth, which makes good oral hygiene habits very important, in order to therefore pave the way for a decline in interproximal caries among adolescents.

Periodontal disease can be prevented by removing oral biofilm through careful toothbrushing and also by detecting and controlling dental malocclusion, whether congenital (caused by an alteration in the number, size or shape of teeth or by jaw deformation) or acquired (resulting from harmful habits such as prolonged use of a pacifier or bottle, thumb sucking, biting nails or other objects, mouth breathing). Its prevention consists essentially of stopping these bad habits and performing regular dental check-ups (twice per year) to assess risk factors, and not only to detect an injury or wait until a child feels pain.

ORAL HYGIENE

Proper oral cleaning is the key to preventing childhood caries and any other oral disease. And it is the parents' responsibility at least until children have the motor skills to carry out these procedures, never being before the age of 5 years. Children between the ages of 8 and 10 are considered to be able to do this on their own. From this time until adolescence nightly oral hygiene supervision is recommended.

It is important to understand just how damaging it can be for children to go to sleep without removing food debris, as during the hours that we sleep bacterial microbiota develops and grows, to the point of producing caries.

The main guidelines to follow are:

  • Brush your teeth. After the first teeth erupt, children's teeth should be cleaned two times per day. The toothbrush used should be appropriate to the child's age and specifically designed with a long, straight and thick handle with soft, end-rounded filaments and a brush head that is suitable to the size of the child's mouth. It is advisable to clean the sides of teeth (buccal and lingual) using circular movements and chewing surfaces (occlusal) using front-to-back movements.
  • Use fluoride toothpaste. Brushing should be done using a fluoride toothpaste, although this is not recommended in children who have not learned how to spit (normally, younger than 2 years). Fluoride has been shown to be a safe and effective tool in reducing caries and in reversing tooth enamel demineralisation, although supervising its administration in children is necessary, due to possible side effects including soft tissue irritation, etc.
  • Floss between teeth. Dental floss is essential in order to remove bacterial plaque build-up from interdental spaces, which reduces the risk for interproximal caries.

REFERENCES

- Skeie MS, Raadal M, Strand GV, Espelid I. The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age – a longitudinal study. Int J Paediatr Dent. 2006;16:152-60.

- Alm A, Wendt LK, Koch G, Birkhed D. Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age. Caries Res. 2008;42:28-36.

- Douglass JM, Douglass AB, Silo HJ. A practical guide to infant oral health. Am Fam Physician. 2004;70:2113-20.

- John MT, Koepsell TD, Hujoel P, Miglioretti DL, LeResche L, Micheelis W. Denture status and oral health-related quality of life. Community Dent Oral Epidemiol 2004;32:125-32.

- American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent. 2008-2009;30:90-3.

- Unkel J, Fenton SJ, Hobbs G, Frere C. Toothbrushing ability is related to age in children. J Dent Child. 1995;62(5):346-8.

- Nalte A. Microbiología Odontológica con Nociones Básicas de Microbiología e Inmunología. 3a ed. México Interamericana 1984; 198-208.

- Edelstein BL, Chinn CH, Laughlin RJ. Early childhood caries: Definition and epidemiology. En: Berg, J.H., Slayton, R.L. (Eds.). Early childhood oral health, 1.ª ed. Wiley-Blackwell. Iowa 2009; 18-49.

- American Academy of Pediatric Dentistry. Policy on the use of fluoride. Pediatr Dent. 2008-2009; Reference Manual 30: 34-35.

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