Kindergarten and Primary School (3 to 13 year olds)

Recent research into the dental health of Kindergarten and Primary School aged students has revealed the following important facts:

tooth decay affects 50% of first-graders
throughout Australia we estimate that more than 5,000 days of work and 1.2 million hours are lost each year due to dental-related illnesses in children
good oral health is important for child growth, development, and self-esteem
students who miss school due to dental issues are at greater risk of falling behind in their studies.

To address these issues, our Kindergarten and Schools programs enables us to visit your schools using our mobile clinics, provide an initial examination for students, and then offer treatment as required.

To schedule a free dental check-up/screening (and oral health presentation) for your Kindergarten or Primary School, please get them to register using our Expression of Interest Form.

The following factsheets are part of a collection developed by Grow Up Smiling (GuS) for Kindergarten & Primary School students (aged 3 to 13 years):

Dental Care For Your Pre-schooler

Benefits Of A Healthy Mouth

Healthy teeth save time and money. Good oral health means less extensive and less expensive treatment for your child.
A healthy mouth is attractive and can help children form a positive self-image. A bright smile can help win the confidence of peers and teachers.
Healthy baby teeth hold space for permanent teeth and help guide them into the correct position. Severe decay and early loss of baby teeth can result in crowded, crooked permanent teeth.
Children with healthy mouths have a better chance of general health because disease in the mouth can endanger the rest of the body. Consequences of early childhood caries include insufficient physical development (especially height and weight) and a diminished ability to learn.
An untreated cavity can lead to a necessary root canal to alleviate pain and to treat the dental disease.

Parent Tips For A Great Dental Visit

Start now. We recommend that every child establish a dental home and visit a dentist by her first birthday. The earlier the visit, the better the chance of preventing dental problems.
If you have a toddler who has not yet seen a dentist, consider a “get acquainted” visit to introduce your child to the dental office before the first appointment.
Choose a dental practice. Dentists have two to three years of specialized training beyond dental school in treating children. Plus, the offices are “child-friendly.”
Select an appointment time when your child is alert and rested.
You, as the parent, play a key role in your child’s dental care. Children often perceive a parent’s anxiety which makes them more fearful. They tolerate procedures best when their parents understand what to expect and prepare them for the experience. If you have any questions about the appointment, please ask. As you become more confident, so will your child.
Explain before the visit that the dentist is a friend and will help your child keep his teeth healthy.
Add that the visit will be fun.
Answer all your child’s questions positively. (Keep an ear out for scary stories from peers and siblings.)
Be careful about using scary words. Check-ups and 90 precent of first visits do not have anything to do with “hurt,” so do not even use the word!
Read your child a story about a character that had a good dental visit. (Ask the dental office for suggested reading.)
Make a list of your questions about your child’s oral health in advance. This could include such topics as home care, injury prevention, diet and snacking, fluoride and tooth development.
Give your child some control over the dental visit. Such choices as “Will you hold your bear or should I?” or “Which colour toothbrush do you like?” will make the visit more enjoyable.
Give centre stage to the dentist. If the dentist does most of the talking, the dentist and your child will build a better relationship. The parent and dentist can talk after the examination.

Brushing Up On Tooth Brushing

Toddlers can and should be encouraged to help brush their teeth as soon as they can hold a brush.
Parents should brush pre-schoolers’ teeth and supervise the brushing for school-age children until they are 7 to 8 years of age (about the same time they can tie their own shoelaces or write in cursive).
Choose a toothbrush designed for children’s smaller hands and mouths. Look for large handles that help children control the toothbrush.
The best toothbrushes have soft, round-ended (polished) bristles that clean while being gentle on the gums. Remember to throw out a toothbrush after 3 months or sooner if the bristles are fraying. Frayed bristles can harm the gums and are not as effective in cleaning teeth.
The best times to brush are after breakfast and before bed.
The child should use toothpaste with fluoride. Young children, especially preschool-aged children, should not swallow any toothpaste. Careful supervision is encouraged.
For children under 2-years-old, use a smear of fluoridated toothpaste. For those 2 to 5 years old, a small pea sized amount of fluoridated toothpaste on the brush is recommended. Ingesting too much fluoride can cause fluorosis of the developing teeth. Fluorosis usually is mild with tiny white specks or streaks that often are unnoticeable.
When all sides of a tooth cannot be cleaned by brushing alone, it is time to begin flossing the child’s teeth. Ask the dentist for tips on flossing the child’s teeth.

Dental Care For School-Age Children

Preventive Step 1: Good Home Care

Tooth brushing should be performed twice daily. The best times to brush are after breakfast and before bed. Parents should supervise the brushing for school-age children until they are 7-8 years of age (about the same time they can tie their own shoelaces or write in cursive).
The best toothbrushes have soft, round-ended (polished) bristles that clean while being gentle on the gums. The handle should be the correct size to fit your child’s hand.
When adjacent tooth surfaces cannot be cleansed by brushing alone, it is time to begin daily flossing. Initially, floss the child’s teeth. As the child matures, supervise her flossing. She should master this skill around age 10.
Snack in moderation, no more than three times a day. Snacks should contribute to the overall nutrition and health of the child. Cheese, vegetables and yogurt are all nutritious snacks.

Preventive Step 2: Fluorides

Fluoride not only helps prevent cavities and slows the growth of decay, but it can also reverse decay in its early stages. The enamel of a tooth remineralised with fluoride is stronger than the original tooth surface.
Water fluoridation is still the No. 1 cost effective way to prevent tooth decay.
If a child does not have access to adequately fluoridated water, a dentist can advise parents about other sources of fluoride, such as fluoride supplements.
The AAPD recommends “an individualised patient caries-risk assessment before prescribing the use of supplemental fluoride-containing products.” Also, the AAPD states that “significant cariostatic benefits can be achieved by the use of fluoride-containing preparations such as toothpastes, gels, and rinses, especially in areas without water fluoridation.” Mouth rinses may be incorporated into a caries-preventive program for a school-aged child at high risk.

Preventive Step 3: Sealants

Most cavities in children occur in places that sealants could have protected. Pit and fissure decay accounts for 80 to 90% of cavities in permanent back teeth and 44% in baby teeth.
Sealant placement in children and adolescents has shown a reduction of cavities incidence of 86 precent after one year and 58 precent after four years. With appropriate follow-up care, the success rate of sealants may be 80-90 precent even after a decade.

Preventive Step 4: Limited Snacking

If children have poor diets, their teeth may not develop properly. Children need protein, vitamins and minerals, especially calcium and phosphorous, to build strong teeth and resist tooth decay and gum disease.
Parents should select snacks for dental health and for general health, providing sound nutrition as defined by the “MyPlate” of the US Department of Agriculture.
Snacks, served no more than three times a day, should contribute to the overall nutrition and development of the child. Some healthy snacks are cheese, vegetables, yogurt, peanut butter and chocolate milk.
A food with sugar or starch is safer for teeth if it is eaten with a meal, not as a snack.
Shop smart. Do not routinely stock your pantry with sugary or starchy snacks. Buy “fun foods” just for special times.

Preventive Step 5: Regular Dental Visits

Regular dental visits help children stay cavity-free. Teeth cleanings remove plaque build-up on the teeth. Plaque irritates the gums and causes decay.
Fluoride treatment renews the fluoride content in the enamel, strengthening teeth and preventing cavities.
It is essential to get an on-going assessment of changes in a child’s oral health by a dentist. For example, a child may need additional fluoride, dietary changes, sealants or interceptive orthodontics for optimal oral health.

How Dentists Work With Children

Why would a dentist use behaviour guidance with a child? The main goals of behaviour guidance are:

Establish communication.
Alleviate fear and anxiety
Deliver quality dental care
Build a trusting relationship between dentist and child
Promote the child’s positive attitude toward oral/dental health and oral health care

Since every child is different, dentists have a wide range of approaches to help a child complete needed dental treatment. A dentist makes a recommendation of behaviour guidance methods for the child based upon her health history, special health care needs, dental needs, type of treatment required, the consequences of no treatment, her emotional and intellectual development, and parental preferences.

There are two main reasons why a dentist utilises behaviour guidance techniques for the child.

The first reason is anxiety. Children typically respond to an unfamiliar dental office in the same way they respond to a new paediatrician, new childcare provider, or first visit to someone’s home. Some are totally comfortable; others are fearful in the new or unfamiliar situation.
The second reason is pain. If a child’s first visit to a dentist is an emergency situation, perhaps because of a toothache or mouth injury, she is far more likely to be unhappy during the visit. This is why the most important behaviour guidance technique is early and regular dental visits. If a child visits a dentist when her mouth is comfortable, she is much more likely to find the visit pleasant and fun.

Parents play an important role in their child’s safety during dental treatment. In particular, stay up-to-date on the child’s health status. Be certain to inform the dentist about changes in the child’s medical history, including any illnesses and any medications, both prescription and over-the-counter.

A well-informed parent should know the choices available to relieve the anxiety or discomfort of the child during dental treatment. Working together, a parent and the dentist can select the best treatment methods to make the child’s visit as safe and comfortable as possible.

A Menu Of Methods

Tell-Show-Do

The dentist explains the treatment in words just right for the child’s age and level of understanding, shows the child the procedure in a simplified manner, then performs the treatment without deviating from the explanation.

Positive Reinforcement

The dentist praises and rewards the child for any behaviour that helps with treatment.

Distraction

In this technique, the child’s attention is diverted away from what might be perceived as unpleasant. The paediatric dental team chooses treatment words carefully, passes instruments out of the child’s sight and occasionally distracts the child’s attention away from the treatment with conversation, music, movies or even video games.

Voice Control

The dentist changes voice tone or volume to calm a child or get a child’s attention. Typically, the dentist speaks in a soft, controlled tone and repeats messages as necessary. Some dentists advocate use of a loud tone occasionally to discourage disruptive behaviour or movements, such as reaching for a sharp instrument that can pose a risk to the child. If parents are not comfortable with the use of voice control with their child, then they should certainly speak to the dentist about the issue.

Modelling

This technique encourages a child to replicate the behaviour of another patient undergoing a positive dental visit. Prior to her own appointment, she would observe a cooperative “model” patient receiving dental treatment. When children can see and hear others experiencing dental care in a positive fashion, they may be more relaxed and more inclined to cooperate for their own treatment. Modelling can be accomplished by watching an audio-visual video or by observing a live patient model such as a sibling, other children or even parents.

Modelling also can occur on a recurring basis within an open clinic setting. Some dentists design patient treatment areas without walls or partitions between patient chairs. The ability to observe other children’s positive responses to treatment at every appointment can help promote a positive attitude and build a trusting relationship between the child and the dentist.

Local Anaesthetics

A topical aesthetic can be applied with a cotton swab to numb the surface of the cheek or gums. (It is similar to the gel you rub on a child’s gums when they are teething.) A local aesthetic, such as lidocaine or articaine (similar to Novocaine), may be injected in a specific area of a child’s mouth to prevent discomfort during treatment. These local anaesthetics cause temporary numbness that may last longer than the appointment. Parents must be careful about giving children hot food or liquids, and watch that their children do not bite their lips or cheeks before the numbness wears off.

Nitrous Oxide/Oxygen

If a child is worried by the sights, sounds or sensations of dental treatment, she may respond more positively with the use of nitrous oxide/oxygen. Nitrous oxide/oxygen, which you might know better as laughing gas, can reduce anxiety and gagging in children and make long appointments easier. The child breathes the gas through a mask placed on her nose and remains fully conscious during treatment. Recovery after treatment is rapid and complete.

Protective Stabilisation

Protective stabilisation is an approach that limits a patient’s movement during treatment in order to decrease risk of injury and allow treatment to be completed safely. Possibilities in this category include asking the parent to hold the child on her lap with her arms hugging the child. Another approach is the use of a body “blanket” that holds the child’s arms and legs still and away from the mouth. Stabilization may be recommended for children who are very young or have difficulty remembering the importance of keeping their hands away from dental instruments. Used only after other behaviour guidance techniques have been considered, this approach is sometimes necessary to protect a child from the sharp, fast moving instruments required in dental treatment. It also can be used in conjunction with other techniques such as sedation.

Sedation

This technique uses medications for your child’s safety and comfort during dental treatment. Sedation can help increase cooperation and reduce anxiety and/or discomfort associated with dental procedures. In particular, it can prevent injury by helping a child stay still around the sharp or fast-moving instruments needed for treatment.

For this technique, the dentist selects a medication and dose based upon your child’s overall health, level of anxiety and dental treatment recommendations. It is not intended to cause a loss of consciousness. (In other words, the child is relaxed but not asleep. She is able to respond to touch or voices.)

This approach may be recommended for apprehensive children, very young children and children with special health care needs who would not be able to receive necessary dental care in a safe and comfortable manner without it.

Sedation is safe for children when it is administered by a dentist in line relevant professional guidelines. Parents should feel free to discuss with their dentist the different medications and sedation options, as well as the special monitoring equipment used for patient protection.

General Anaesthesia

Medically speaking, general anaesthesia is an induced state of unconsciousness. In practical terms, the patient is asleep and unable to respond to touch or voices. It is most often recommended for children with extensive dental needs who cannot tolerate the treatment required to restore their oral health. For example, if a toddler was suffering from severe early childhood caries and required multiple root canals and crowns, the parents might agree that general anaesthesia was the most comfortable and safest way to complete treatment. Or, it may be the treatment of choice for a child with a mental or physical disability for whom a hospital setting provides the safest and best approach to care.

All parents should know that children face the same risk under general anaesthesia for dental treatment as for any other surgical procedure. The treatment should be provided only by highly qualified health professionals, including dentists with advanced education in anaesthesiology, dental or medical anaesthesiologists, oral surgeons, and certified registered nurse anaesthetists. Whether the treatment is provided in a dental office or a hospital, it should feature special monitoring and emergency equipment and trained support personnel. Parents should talk openly with their dentist about the benefits and risks of this treatment.

Should I Stay Or Should I Go? The Dilemma Of Going Into The Operatory With Your Child During Treatment

Should you go with your little Sarah during treatment or should you stay in the reception area and relax with a magazine? Dentists differ on whether parents should accompany their children during treatment. In some offices, parents are required to accompany their children as a way to ensure parent education about good oral health. In other offices, children are encouraged to go back for treatment on their own. That way, the dentist and team can focus on the child, work directly with the child and build a positive relationship with the child right away. In still other offices, parents make the decision. They are welcome to relax in the reception area or join their child during treatment

Bottom line: You can find a dentist whose approach matches your preferences.

If you do go with your child:

Stand or sit in a location where your child knows you are nearby but cannot see your face. (Even a very young child is totally tuned in to your facial cues. It only takes one worried look to inadvertently upset your child.)
Be a silent observer. Let the dentist build rapport and provide positive coaching for your child.
If your child needs physical reassurance, you might consider holding your child’s hand or having your toddler sit on your lap.
Be assured that the dentist or a member of the team will keep you carefully informed about your child’s dental health and development. Typically, this takes place in a one-on-one conversation right after the treatment is completed.
Stay at the dental office during the appointment. Although some parents are tempted to drop their children off and run errands, knowing that you are nearby can be reassuring to your child. Also, the dental team will need to obtain consent from and provide instructions to a responsible adult.

If you do not go with your child:

Be assured that the dentist or a member of the team will keep you carefully informed about your child’s dental health and development. Typically, this takes place in a one-on-one conversation right after the treatment is completed.
Stay at the dental office during the appointment. Although some parents are tempted to drop their children off and run errands, knowing that you are nearby can be reassuring to your child. Also, the dental team will need to obtain consent from and provide instructions to a responsible adult.

When do adult teeth appear?

By six years of age, most children will start losing their baby teeth and their adult teeth start appearing. Some children start losing their baby teeth early (i.e. 4 and a half) and some later (i.e. 7-8 years). Usually, we see the lower front incisor or the molar teeth first. However, the adult (i.e. 6 year) molars may appear first.

Mouth Guards In Sports

50 to 80 precent of all dental injuries involve the front teeth of the upper jaw.
The most common injuries to permanent teeth occur secondary to falls, followed by traffic accidents, violence and sports.
A child should wear a mouth protector while participating in any activity with a risk of falls, collisions or contact with hard surfaces or equipment. This includes sports such as football, baseball, basketball, soccer, hockey, wrestling and gymnastics, as well as leisure activities such as skateboarding, skating and bicycling.
Consequences of traumatic injuries for children and their families are substantial because of the potential for pain, psychological effects and economic implications.
The National Youth Sports Safety Foundation in 2005 estimated the cost to treat and provide follow-up care for a permanent tooth that was knocked out is between $5,000 and $20,000 over a lifetime.
A mouth guard not only protects the teeth but may reduce the force of blows that can cause concussions, neck injuries and jaw fractures.
There are 3 types of mouth guards: preformed (purchased at a store and held in place by clenching the teeth), mouth-formed (also known as “boil and bite”) and custom-fabricated. Parents should ask their child’s dentist which type is most appropriate for their child.

What is orthodontic treatment and when should it be considered?

Orthodontic treatment corrects crowding or other bite problems. Most orthodontic therapy is done around 10-12 years. However, more treatment is being done when adult teeth first appear (age 6-7 years) and even earlier for some bite problems in the baby dentition (cross-bite).

Early treatment has many benefits:
Remove interference to proper jaw development
Harmonise upper and lower jaw growth and development
Improve direction of tooth eruption
Decrease risk of trauma to protruded front teeth
Remove traumatic bite positions to front teeth
Correct harmful bite habits
Improve aesthetics and self-esteem
Simplify and/or reduce treatment time for later orthodontic therapy
Reduce the chance for impacted permanent teeth
Improve some speech problems
Preserve space for the permanent teeth

Why are there white, brown or yellow spots on the new front teeth?

There are many reasons for tooth discolouration and even healthy children can experience this. Most stains are on the tooth surface and are caused by the build-up of plaque, usually from lack of good brushing. Try adult toothpaste or a mixture of baking soda and water. If this doesn’t work, your dentist should be able to remove the stain if it is on the tooth surface.

Some discolouration is caused by disturbances that happen during tooth growth and cause stains in the enamel (hard outer covering) or the dentin (hard tissue under the enamel). Stains can also be caused by excess fluoride. In cases of childhood malnutrition, chronic illness, long term use of some medications or radiation therapy, tooth spots can result and the teeth will appear malformed (i.e. chipped or broken).

Back teeth (molars) may also be affected. By asking questions about your child’s health history and looking at the teeth, we may be able to identify the cause and suggest options to improve their appearance.

Should I be concerned if my 7 year old child’s baby teeth are still present?

Most children start to get their adult teeth at about six years of age. However, some children don’t get their first adult tooth until after they are seven. When your child gets their new teeth, it’s important that to determine with X-rays all the other adult teeth are growing in the jaw. It’s also important to look for bite problems and ensure all teeth are clean and healthy.

Do you recommend sealants for adult molars?

Most children get this new decay on the pits and fissures of their new adult molars. However, some children do not need sealants because their pits and fissures are closed and do not catch the explorer (a dental probe used to detect signs of tooth decay).

What can I do about my 10 year old who is living on snack food?

Be aware that tooth decay is related to eating foods rich in sugar and cooked starches too often, especially foods that stay in the mouth longer because they are soft and sticky. Cavities can begin in between the teeth before you can see them. Rinsing with or drinking water after these snacks would be helpful. Therefore, your goal as a parent is to encourage moderation and to teach good food habits early on. Get them involved in planning and preparing meals. Encourage your child to drink water frequently.

What is a malocclusion?

Malocclusion is a faulty bite. Most of the time, it happens because the size and shape of the teeth don’t match that of the jaws. It can also happen because the upper and lower jaws don’t match each other and the other bones of the face. A look at your child’s profile (side view of the head and face) may help you to see whether there is a problem with the growth of their jaw and facial bones.

The genetics of the parents determine jaw growth and tooth size of their children. Tooth decay of the baby teeth, premature loss of baby teeth from tooth decay and crowding are major causes of malocclusion. Premature loss of baby teeth due to lack of jaw space from erupting adult teeth also causes malocclusion.

Should I be concerned if my 8 year olds teeth are crowded?

Yes, although crowding is common, we need to consider your child’s future oral health. A child with crowded teeth and jaw problems will not necessarily have more problems as they become an adult. However, adults with crowded teeth have more problems (tooth decay, gingivitis, periodontal disease, TMJ problems) than adults with good jaw and tooth alignment.

Because adult teeth are larger than baby teeth, jaw size and growth may not provide enough space. If you still see crowding by 8-9 years when all of the four upper and four lower adult teeth have erupted, the crowding will probably not improve. For most children and adults, crowding is the most common malocclusion. Sometimes a baby tooth is lost early because of lack of jaw space for new adult teeth. If you see crowding, you should have an orthodontist or paediatric dentist examine your child.

To find out how you can best protect your child’s teeth, contact GUS directly.

Please note that some information has been adapted from the AMERICAN ACADEMY OF PEDIATRIC DENTISTRY 2013 ‘Fast Facts’ factsheet