Is dental disease in children a question of nature or nurture? Are some children genetically more prone to decay or does it occur due to environmental factors?
The research and evidence in recent years has looked at many aspects including the following areas and even though the list below is not exhaustive, it can help us to understand and improve the oral health not only of today's society but those of future generations.
Biological, genetic and host factors:
We are all susceptible to genetic predispositions and that also includes a variety of diseases that affect the mouth.
We all have variants in the quality of our enamel, dentine and cementum.
Some medications bring about a reduction in the flow and quantity of saliva, thus allowing there to be an increase in the levels of harmful plaque bacteria such as streptococcus mutans, the main bacteria involved in the process of decay.
The size and shape of teeth, often under genetic control, can produce developmental defects such as:
Amelogenesis Imperfecta
Hypoplastic pits and fissures
All of these factors can influence our susceptibility to decay.
Passing it down:
Interesting results published from one 27 year recent study, based in New Zealand revealed that the children of mothers with poor oral health are more likely to have dental problems when they reach adulthood. The study was conducted with over a thousand children born in New Zealand in the 1970's. The children were assessed at 5 years old and again at 32. Final analysis 27 years later revealed that almost half of the children, whose mothers had rated their own dental health as very poor, had had severe dental decay leading to extractions.
How do we get plaque bacteria?
It has long been recognised that the harmful bacteria such as streptococcus mutans are transmitted through everyday contact such as kissing, sharing utensils and sucking dummies in an attempt to "clean" them, all allow bacteria to be transmitted from parent to child.
Interestingly, although parents may not have any active decay themselves, they can harbour enough bacteria to infect their children.
What about the rest of the family?
Great family support. Key health influences are family environments that can help and encouraging healthy lifestyle choices and reinforcing trust and belief in the dental care provided.
Public health issues:
There are many views on water fluoridation but it has been very successful in sites in the UK where it was introduced. Caries remains an intransigent public health problem in socially deprived non-fluuoridated areas across the UK
How can we help at Absolute?
We know that caries is a complex condition with many influencing factors and whilst there is little we can do to alter the biological, genetic and socioeconomic concerns, the great news it that we can help you to make a difference in these main three factors:
Plaque control
Diet
Host susceptibility
PLAQUE CONTROL
The main thing to remember is that it is the microbiological activity in the plaque bacteria that results in the conversion of sugar to acid. A really effective oral hygiene regime will help to reduce the incidence of decay and regular and thorough brushing supported by the use of a fluoride toothpaste is important.
The use of a timer and disclosing tablets or solutions really helps children to brush for longer and more accurately. At Absolute we can help both parents and adults by disclosing childrens teeth and helping them to clean more effectively. It's a great way of showing them where the plaque builds up on their teeth and helps them to have greater responsibility for helping look after their teeth and gums and its great fun too!!!!!! Young children need help from parents to brush really well as they will not have developed the dexterity or understanding for really thorough plaque control.
DIET - Interestingly, children have more taste buds than adults and often crave sweeter foods! The first thing we need to look at are the foods and drinks consumed during the day and evenings. The easiest way we find to achieve this is for the patient (or patients parent) to keep a food diary for a week as often our habits are different at weekends. This means recording all the food, drinks and snacks consumed and the times of these as well. We go through this with our patients on a follow up visit and this helps us to see where we can help.
It allows us to help identify the foods and drinks more likely to cause decay. Many of the sugars we consume are not always obvious "Sweets" but can be hidden in other foods which may appear to be savoury.
The frequency of consumption is more important than the food and drink itself and sweet foods and drinks do far less damage when consumed at the one time rather than being spread out throughout the day.
Swapping sugar for xylitol. Xylitol is an artificial sweetener made from the bark of birch trees and and it forms an alkaline environment in the mouth rather than an acidic one which causes decay. It reduces the number of the harmful plaque bacteria and stops them sticking to and building up on the tooth surface. It also encourages the uptake of minerals that are needed to repair damaged enamel. It can be found in sugar free chewing gum and sugar free sweets.
HOST SUSCEPTIBILITY - We know that host susceptibility plays an important part in caries initiation and prevention but we can help by applying fissure sealants and providing topical fluoride therapy in children we know are susceptible to dental decay, thus altering their resistance to decay.
