Children's Oral Health Advice

As an Ofsted registered early years provider, we follow the Early Years Foundation Stage (EYFS). The EYFS framework states that early years providers must promote good oral health of children who attend their setting.

Oral health is important, even with baby teeth. This is because children’s baby teeth:

• help them to bite and chew
• support speech and language development
  
• help them feel confident when they smile
  
• make space for and help to guide adult teeth
  

Good oral health also keeps children free from toothache, infection and swollen gums.

Why is Oral Health Important?

Tooth decay is the most common reason why 5-9 year olds are admitted to hospital, sometimes for removal of multiple teeth under general anaesthetic.

In 2017 a quarter of 5 year olds had tooth decay, with an average of 3 or 4 teeth affected, despite tooth decay being almost entirely preventable. Tooth decay and poor oral health in childhood can have significant consequences in later life.

Key Take Home Messages

Read to the end of this newsletter for lots of useful links and resources including videos to listen to while brushing your children's teeth!

key messages:

• Primary (baby) teeth come through from around 6 months old and permanent (adult) teeth come through from around 6 years old.
• The breakdown of sugar by bacteria in the mouth causes acid to be produced which causes tooth decay.
• Do not give juice in bottles or sippy cups.
• Toothbrushing with a fluoride toothpaste before bed and at least one other time in the day for two minutes each time plus a healthy diet, low in sugar, helps prevent tooth decay.
• Teeth erosion can be caused by acid from the diet, medicines, vomiting or reflux.
• The risk of teeth erosion is reduced by cutting down acidic food and drink and restricting these at meal times. Water and milk are safe to drink.
• Teeth should not be brushed after vomiting or reflux as this can cause more damage to the teeth.
• A knocked out permanent (adult) tooth should be held by its crown, rinsed under cold tap water if dirty (maximum 10 seconds) and positioned back in the mouth. If this is not possible, place in milk or saline. Seek dental treatment immediately

Visiting the dentist

It is recommended that children are taken to the dentist once their first tooth comes through and by the age of one, so children can get used to the experience.

The first dental visit is normally short and is a chance to meet the dental team in a friendly way. The dentist may ask the child to sit on the dental chair or on the lap of a parent or guardian. The dentist will check the teeth for decay and check the gums and rest of the mouth.

The dentist may suggest painting on fluoride gel (varnish) on the teeth as a regular treatment to reduce the chances of developing tooth decay. The dental team will give advice on mouth care and answer any questions.

The British Society of Paediatric Dentistry Dental Check by One (DCby1) campaign encourages children to be taken for a dental check-up before their first birthday.

Did you know - NHS Dental check-ups and treatment with dentist are FREE for:

Children under the age of 18

Pregnant mothers and until your baby's first birthday.

What we do to support:

We get creative: We use imaginative activities to teach children about oral health. For example we:

• Set up dentist role play to familiarise children with the dentist's environment.
• Practice brushing teeth on dolls and toys.
• Read stories about teeth and smiles.
• Use large teeth models and brushes for children to practice on.

Tooth Development

Primary Teeth are the first set of teeth which develop, these are also known as baby teeth. The primary teeth shed to allow for the permanent (adult) teeth to come through. The picture shows the timings of the teeth coming through the mouth.

Baby teeth matter and children who have decay in primary teeth are more likely to get decay in permanent teeth.

Dummy (pacifier) and Thumb/Finger Sucking

Dummies generally cause less problems than thumb sucking as a dummy sucking habit can usually be discouraged before 6 years old, when the adult teeth come through. Dummies should never be dipped in anything sweet (e.g. honey), as this can cause tooth decay.

Did you know - A sucking habit after age of 7 years can cause permanent change in the position of permanent (adult) teeth.

To stop a thumb or finger sucking habit, it can help to:

Use positive encouragement, such as a reward system.

Use physical barriers such as a plaster, bandage, sock, cotton glove or a bitter tasting nail varnish.

Speak to your dentist or orthodontist for more information. A ‘habit-breaker’ dental appliance may be recommended, which can make thumb sucking more difficult.

What we do to support: We allow children their comfort through dummies or thumb sucking, but use gentle encouragement to stop.

• We create a calming environment and model calm behaviour.
• We distract children and use other methods of comfort, such as teddies and books.

Tooth Decay

Tooth decay occurs when:

1) Bacteria in the mouth breakdown sugar

2) The bacteria produces acid

3) The acid softens the tooth surface

4) Over time, this causes a hole in the tooth, known as tooth decay

Did you know - Sugar or honey should not be added to milk. Bottle feeding at night can lead to tooth decay.

Never put juice or anything other than water or milk in a bottle or sippy cup:

• Tooth enamel damage: The sucking motion of a bottle can bathe teeth in juice, which can erode tooth enamel causing tooth decay.
• Sugar intake: Sugary drinks in bottles can increase the amount of sugar a child's teeth are exposed to, which can lead to tooth decay.

Should my baby use a beaker or a cup? | NHS (youtube.com)

At Portland Nurseries we use:

Doidy Cup Twin Gift Set, Baby First Open Cup from 6 Months +, Slanted Design for Training & Learning to Drink, weaning Essentials for Milk & Water (Turquoise+Turquoise) : Amazon.co.uk: Baby Products

Tooth Brushing

Toothbrushing helps prevent tooth decay and gum disease. Toothbrushing should start as soon as the first primary (baby) tooth comes through.

Teeth should be brushed at least twice every day, once at bedtime and on at least one other occasion and should last for approximately 2 minutes each time. The Brush DJ app can help encourage brushing for the recommended length of time with its 2 minute music timer.

Children should be encouraged to spit out the toothpaste and NOT to rinse their mouth with water. This allows the fluoride in the toothpaste to stay on the teeth for longer.

Did you know - an adult should help or supervise children with toothbrushing until at least the age of 7 years.

Fluoride Toothpaste

It is important for toothpaste to contain fluoride, as fluoride prevents tooth decay. Children must be supervised so they don't eat or lick toothpaste from the tube and to control the amount used.

A smear of toothpaste should be used for 0-3 year olds. A pea size amount of toothpaste should be used for 3-6 year olds.

The amount of fluoride in the toothpaste is written on the packaging as 'ppm' , this means 'parts per million'. Toothpaste that contains 1350-1500ppm fluoride gives your child the best protection.

Did you know - A toothbrush with a small size head and medium texture bristles helps make toothbrushing more effective.

Diet

Diet can have a significant impact on tooth decay. The following simple changes can have a positive impact:

• Reducing the number of times sugary foods and drinks are consumed
• Limiting sugary food to main meals
• Drinking only plain milk and water, sugary drinks have no place in a child's daily diet
• Only prescribing and administering sugar free medicines

What we do to support: Provide a healthy, low sugar menu that meets the Early Start Nutrition Guidelines and the Soil Association's Food For Life Award criteria.

Tooth Erosion

Tooth erosion is caused by acid wearing away the teeth and can result in teeth becoming sensitive and looking different.

The acid which causes tooth erosion could be from the outside environment (extrinsic) or inside environment (intrinsic). An acidic diet and certain medications can cause tooth erosion from extrinsic acids. Vomiting and reflux can cause tooth erosion from intrinsic acids.

Energy drinks, fizzy drinks and fruit juices cause tooth erosion. Safe drinks include water and milk.

Avoid frequent intake of acidic drinks and limit these to meal times (no more than one a day).

Eating fresh fruit is an important part of a healthy diet.

Seek medical advice to manage reflux, eating disorders and management of medications.

Did you know - Teeth should not be brushed after vomiting, reflux or eating or drinking acidic food or drinks as the teeth become soft and toothbrushing can cause teeth to wear away more quickly.

What we do to support: We only serve water and cow's milk/non-dairy alternative drinks throughout the nursery day.

Knocked out tooth

The knocking out of permanent teeth is one of the most serious injuries that could happen to teeth. This accounts for 0.5-3% of tooth injuries to permanent (adult) teeth. The outcome depends on whether a prompt and correct emergency management has taken place.

Children who play contact sports tend to experience a greater risk of knocking a tooth out because of the increased risk of high impact collisions. Wearing a custom mouth guard can help protect the teeth from injuries during contact sports.

Never put a primary (baby) tooth back in its place, if knocked out.

Only a permanent (adult) tooth should be placed back in its position.

If the tooth is dirty, wash it briefly (maximum 10 seconds) under cold running water and reposition it in the mouth. If this is not possible, place in milk or saline. Seek dental treatment immediately.

If the knocked out tooth is soiled and it is not certain when the patients' last tetanus shot was, a tetanus booster may be needed.

Antibiotics may be prescribed.

The 'Save a Tooth' initiative offers excellent advice on what to do if a tooth is knocked out. A copy of the poster is available from the IADT website

Useful Links and Resources

Public Health England: health matters child dental health, guidance to help you prevent tooth decay in children under 5, including links to e-learning.

Children’s Oral Health: healthcare e-learning, aimed at parents, early years healthcare workers, teachers, nurses, GPs and the public.

Oral Health Foundation: early years foundation stage, how children can keep their mouth healthy and the best way to brush your teeth.

Improving oral health in early years: National Institute for Health and Care Excellence Pathways.

Delivering oral health from Public Health England, includes a quick guide to healthy mouths in children.

Fun songs to brush along to:

Brush Your Teeth | Kids Songs | Super Simple Songs

The Tooth Brushing Song 🪥🎵 | Hey Duggee (youtube.com)

The Tooth Brushing Song | 2-minute tooth brushing song for kids (youtube.com)