Talking Early Years with June O’Sullivan: In conversation with Linda Greenwall

May 7th 2021

I recently recorded a podcast with Dr Linda Greenwall – founder of the Dental Wellness Trust which supports schools and nurseries to get children brushing their teeth. She tells me that just brushing correctly once a day can make a significant difference to children’s oral health.

London has the third highest level of tooth decay in children under five (27%). In fact, it’s even higher in Scotland and Wales (30%). Given that tooth decay remains the leading cause of hospital admissions for children, it is strongly associated with deprivation and social exclusion.


When do we get our teeth?
The timing of children getting their teeth varies. Some children are born with teeth! Some start teething at four weeks, poor little guys.  But usually it’s six months for the baby teeth (primary or deciduous is the official term). I always think of it as unkind as teething is clearly uncomfortable.

The first permanent teeth arrive about age six. As the child grows, their mouth grows so they have room for more teeth. They usually lose all their baby teeth by the age of twelve – although my daughter still has two baby teeth aged 30. Generally, all the adult teeth are in by 14 years except the third molars known as the wisdom teeth. These appear by the age of 21 and then you have the full set of 32 molars. Except the issue of the wisdom is not something we all have. I still am missing one and more people have them removed.


What is Oral health?
Tooth decay occurs when the sticky microbial forms on the tooth surface, called plaque. It converts the food and drinks and then 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.

Children’s teeth are vulnerable from the moment they arrive.  Especially the first two to four years while the enamel is still soft. Supporting parents to ensure their children clean their teeth is critical to developing long term oral health habits which reduce the risk of decay. Parents often think baby teeth don’t count because they fall out but they are very important to support the growth of facial muscles and aid development of speech. The other issue is that when children lose a baby tooth before there is a permanent one to replace it, their teeth can drift forward which leads to crowding or crooked which leads to them needing orthodontic treatment later on.

Acid in foods and drink such as fruit juice, soft drinks and stomach acids have great potential to harm teeth the main cause of decay is sugar. When sugar is ingested, oral bacteria converts the sugar to acid. As the oral PH falls, the solubility of enamel increases and the loss of mineral from the enamel occurs. Saliva helps to neutralise the acid and repair damage by promoting remineralisation. However, this is a slow process (at least 30 to 40 minutes) and if the challenge is too great, the enamel becomes porous and a cavity will form. That’s why eating snacks before mealtimes is a bad idea as there is never enough gap.

I have crooked teeth for that reason as there was a policy when I was growing up to remove teeth. I still remember going to the City hall to see the council dentist. My father had a similar situation where they removed teeth at the drop of a hat, so a large number of his generation ended up with dentures. He has always resented this even now in his 88th year. Slight imperfections must be the reason every celebrity gets their teeth straightened and sun-blindingly whitened.


What can help?

Breastfeeding helps especially if parents can breastfeed exclusively for the first six months.

Avoid sugar in particular sugars added to foods by manufacturers or when cooking. Sugars that occur naturally in fruit, vegetables and milk can be consumed as part of a balanced diet. Sugars that we need to limit in our diet are called ‘free’ sugars’ which are those added to foods, plus sugars that are naturally present in honey and syrups, and unsweetened fruit juices and purees – where processing has released the sugars from their cell walls, leaving them ‘free’ to do damage.

Restrict sweets and dried fruits to mealtimes.

Replace squash with milk or water.

Limit or dilute fruit juice. Beware of apple juice.

No fizzy drinks.

Fluoride, found in all toothpastes, helps to strengthen enamel. It’s 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%.

HOW and WHEN you brush your teeth is another issue.  Brushing at night means the fluoride stays on their teeth all night.

There is also a new debate as to whether we brush our teeth with a dry brush to avoid diluting the fluoride, but Dr Greenwall says just spit don’t rinse!  Use a dollop of toothpaste the size of a grain a rice for under threes and a pea size for the over threes.

To find out more or get involved with the free supervised tooth brushing programme in your setting visit Dental Wellness Trust and help the tooth fairy sprinkle her magic dental dust!


5 Dental Quiz Questions

How many teeth has a small child by age three?

How many molars do adults have?

What is the tooth enamel?

Where do you find fluoride?

What are the necessary dental hygiene routines for children?