BSDHT Treating the under-fives

Children’s dental health is reliant upon responsible adults understanding what needs to be done.

Nearly a quarter of England’s 5-year-olds have tooth decay affecting, on average, three to four teeth.1 A Public Health England report 2 noted that 10.7% of the children surveyed already had tooth decay, despite having erupted molars for only one or two years.

Confusion reigns

Sometimes it is not that parents do not want to give their child the best dental start in life, it is often that they are confused. A survey of 1,000 mothers in the UK revealed confusion about when and how to start a baby’s oral health regime. 3 The results of mothers’ habits and perceptions on a baby’s oral care and teething showed lack of clarity about when a child should first visit a dentist:

  • 13% believe they should first take their baby to the dentist at six months;
  • A staggering 72% of mothers say that they have never seen any information on gum care for babies;
  • Over half (53%) report turning to their mothers for information on managing their baby’s teething pain;
  • Only 10% said that they get this information from their dentist.

Where to begin?

Parenting skills as well as a good local social support network is crucial to the introduction of positive oral health behaviours.  But many parents have a number of issues that prevent them from caring for their baby’s teeth. Reasons given include: parents’tiredness; lack of confidence in their skills as a parent; finding the information confusing; the widespread availability of sugary foods and drinks; and their perception of the lack of local child-friendly dentists.

Access to information, resources and dental-care services

Parents need local support and consistent information and tools. However, there are often barriers to communication and in recent times, COVID-19 has been the main blocking mechanism. The familial and social restrictions introduced in response to the COVID-19 pandemic have had a huge effect upon the dental health and welfare of children.

BSDHT treating children under-fives

These include:

  • Different birth experiences therefore limited contact with health professionals for new parents;
  • ‘Shielding’ and ‘social bubbles’; preventing information gathering via habitual, familiar patterns of socialising;
  • Inability of some people to access professional sources of information via websites and social networking forums;
  • Lack of opportunity to see dental professionals;
  • Disruption to family structures and routines.

Official statistics show a significant drop in the number of children who visited a dentist during the pandemic. In the year up to 31 March 2021, dental appointments fell from 58.7% to 23% meaning that nine million children have missed out on treatment! Twelve million cases of dental treatment were delivered in 2020-21; a drop of 69% compared to the year before. A total of 30 million dental treatment courses have been lost since the first national lockdown.

Experience counts

Children have differing needs from adults and consideration must be given to developing manual dexterity, sensitive tastebuds and new experiences.

Children are social learners and they learn through experience, environment and imitation, which is why oral health education, establishing an early years toothbrushing routine and visiting the dentist from an early age for acclimatisation purposes, is so important.

Repetition… repetition…

It is vital to bear in mind that a child’s perception is very different from that of an adult. We may need to repeat something or show an action a few times in order for the child to grasp it and this includes finding the right words. And obviously no two children or experiences are the same so we need patience in abundance! An active and engaged child is at the core of the oral health of the future, which throws up its own set of challenges in providing child-friendly products and welcoming experiences. 

Bathroom and bedtime 

Imitation really is the sincerest form of flattery in the case of toothbrushing. Parents are the first and ideal role models for children. Carrying out their own thorough toothbrushing routine for two minutes two times day is the best example to set a child. Establishing a bath and bedtime routine including toothbrushing using tick charts to keep a track of progress and rewarding with a sticker or bedtime story is an ideal end to the day. It is usually and easier to maintain as opposed to the mornings when the hands on the clock seem to move quicker! 

First time dental visits

The British Society of Paediatric Dentists national Dental Check by One scheme encourages parents and caregivers to take a child for their first dental check-up before the age of one and dental hygienists have a key role to play in a children’s oral health. 

Top tips from practising dental hygienists and therapists (who are also mums!)

Greater Manchester Mouth Care Tool Kit

“In order to make the visit as smooth as possible, it would be great for parents to read books or watch programmes that involve visiting the dental clinic, so that the children have an idea of what to expect from their visit. Also consider encouraging the child to come into the surgery on their own, so there is no confusion about which adult is in control. I personally find that from the age of 4 years upwards, young children respond better when Mum/Dad are not in the room.”

Helene Schirmer – Lead Dental Therapist, Happy Kids Dental

“I believe the best method for treating under-fives is to take an innovative approach. In our practice we’ve created several methods, one of these is our ‘Toothbrushing Academy’ appointments which are engaging sessions aimed at starting healthy habits early, having fun learning about teeth and acclimatising young children to visiting the dental practice so that as they grow older they don’t develop a fear of the dental team. Having a positive patient relationship and making prevention fun and easy, is ‘key’ to being able to help with the transition to treatment.”

Isabel Brandon – Dental Therapist, 4a Dental

I’m from the Greater Manchester area which, unfortunately, experiences significant amounts of tooth decay, even from before school age. I believe a parent’s involvement can have a hugely positive impact on not just their child’s oral health. But their overall general health too. Less decay = less missed school in order to attend appointments, less sleepless nights due to pain.”

As Natalie Wong concludes for the dental profession: “The under 5s age group is so magical, and we, as dental professionals, can help build trust and good experiences from a young age.” 

Early Years – ‘The future is literally in our hands’

From September 2021, the Early Years framework must explicitly include a new requirement to promote the good oral health of children in the existing requirement to promote good overall health. While it is up to individual providers to determine how they meet this requirement in a way that works best for their
setting, all providers will need to take steps to find ways in which they can encourage children to care for their teeth and gums.  

Key points

  • Non-dental health professionals have a key role in early years toothcare
  • It must be recognised that infants, toddlers and young children have differing dental-care needs to adults
  • Practices that reduce parent-to-baby transmission of decay-causing bacteria should be encouraged
  • It is important to encourage care of gums before and during teething
  • Alternatives such as chewable toothbrushes and Xylitol dental wipes for infant/toddler tooth and gum-care should be considered
  • Flossing should be introduced as part of children’s oral care routines
  • The use of Xylitol in toothpastes, mouthwashes, sweets and chewing gum is recommended to improve dental health.

    Author: Dominique Tillen is the founder and managing director of
    Brush-Baby Ltd.

    Correspondence: marian@brushbaby.co.uk