Beyond the Tooth Fairy

Will Government Policies improve our Children’s Smile?

As ever, the Early Years sits right at the heart of societal issues. This time we are being asked to help look after children’s oral health. Why? Because the level of tooth decay (caused by having too much sugary food and drink and not cleaning your teeth and gums) remains a deep concern. So much so that the government has committed to deliver a supervised toothbrushing scheme for 3- to 5-year-olds, targeting the areas of highest need.

My question, however, is why start at age three when children begin teething around six months – a time when their teeth are most vulnerable? Additionally, during the first two to four years, the enamel is still soft, and parents often assume that milk teeth are unimportant.

Here is why oral health is a concern:

• Prevalence of decay: Approximately 23% of 5-year-olds in England have experienced tooth decay.
• Average affected teeth: Children with decay typically have 3-4 decayed teeth.
• Early childhood decay: Around 11% of 3-year-olds show visible tooth decay.
• Decay occurs when the sticky microbial forms on the tooth surface, called plaque. Which eventually dissolves the tooth’s enamel protective layer. Continuing high intake of sugar will cause cavities which cause pain, discolouration, rotten teeth, infection and abscesses.
• Regional disparities: Children from deprived areas are more likely to experience tooth decay than those from less deprived area
• Hospital admissions: Tooth decay is the most common reason for children aged five to nine to be admitted to hospital in England

But it is not just the health of teeth and gums that is impacted, tooth decay affects children’s speech:

• Learning to speak: Tooth decay in children can significantly impact their speech development by causing discomfort or pain while speaking. This can lead to difficulty pronouncing certain sounds clearly, particularly if front teeth are affected, potentially resulting in speech impediments like lisps or unclear articulation due to improper tongue placement when missing or damaged teeth are present. This can further affect a child’s confidence in communication.
• Pain and discomfort: Cavities can cause pain when chewing or speaking, making children hesitant to articulate words properly and cause anxiety.
• Misaligned teeth: Tooth decay can contribute to misaligned teeth (malocclusion), which can interfere with tongue placement and sound production.
• Missing teeth: Severe tooth decay can lead to tooth loss, especially in the front of the mouth, which are crucial for forming certain sounds like “s” and “th”.
• Impact on specific sounds: Children with tooth decay may struggle with sounds that require precise tongue placement against the teeth, such as “f,” “s,” “z,” and “th”.
• Speech therapy needs: In severe cases, children with tooth decay-related speech issues may require speech therapy to correct pronunciation problems. This will be a problem because they are in short supply.

I am sure people are thinking ‘isn’t cleaning teeth the role of parents and part of the bedtime ritual’?  Of course it is and many children already brush their teeth at home and in their settings, follow a healthy diet, and visit the dentist annually. But sadly, they are the lucky ones. Unfortunately, many others, especially those in disadvantaged circumstances, face a much higher risk of tooth decay. Poverty, poor quality diet and food and drink high in sugar and low nutritional value are just three of the reasons.

To address, this ‘Smile for Life’ is coming to your setting in the molar shape of a supervised toothbrushing programme. Nursery staff will oversee children brushing their teeth with fluoride toothpaste to instil good oral hygiene habits early on. Areas with high need will be targeted initially but we definitely need to engage all parents.

 In addition to toothbrushing what can help?

• Breastfeeding helps especially if parents can breastfeed exclusively for the first 6 months.
• Avoid added sugar – especially when added to foods by manufacturers and chefs in restaurants and cafes/coffee shops etc .
• Restrict sweets and dried fruits to mealtimes. Sticky, chewy sweets can be especially bad for you because of the way they stick to your teeth and deep between the crevices of your back teeth, encouraging the growth of cavities.
• Replace squash with milk or water
• Limit or dilute fruit juice. Beware of apple juice
• No fizzy drinks
• Fluoride helps to strengthen enamel. It is naturally present in drinking water and is topped up in some parts of the country where it is very low.  Where water is fluoridated children are 28% less likely to have tooth decay and recent research extended this number to 43%. It is in all toothpastes.

It’s imperative that we support the children who are the innocent victims of their circumstances and  become knowledgeable about the issues surrounding  tooth decay and maintaining good oral hygiene. So, let’s Smile for Life and, with the help of the tooth fairy’s magic dental dust, get ALL children to clean their teeth regularly by brushing properly (no sucking the brush) and develop good oral health habits for life.

5 Dental Quiz Questions to Prepare You (no Googling!)

1. How many teeth has a small child by age 3?

2. How many molars do adults have?

3. What is the tooth enamel?

4. Where do you find fluoride?

5. What are the necessary dental hygiene routines for children?