Chronic dental problems:

A child’s worst nightmare

by Carol Aloysius

Did you know that paediatric dental disease, also referred to as childhood tooth decay, is often referred to abroad, as the number one chronic childhood illness? Left untreated, childhood tooth decay can have devastating consequences that extend beyond the dental chair. Rampant decay can negatively impact a child’s overall quality of life, inhibit their cognitive and social development and compromise their growth, function and self esteem.

Studies in the US show how negatively tooth decay can impact on the life of a young child. It affects his/her growth, can lead to malnourishment, bacterial infections and sometimes emergency surgery, putting the child’s life on the line. According to data:

* Paediatric dental disease is 5 times more common than asthma and 7 times more common than hay fever.

* Left untreated, pediatric dental disease can lead to malnourishment, bacterial infections, required emergency surgery and even death.

* Pain and infection caused by tooth decay can lead to problems in eating, speaking and learning.

* Dental disease has been linked to heart disease, stroke, diabetes, pneumonia, poor pregnancy outcomes and dementia.

* Health care specialists in US believe that dental care is the most prevalent unmet health need of children in the United States. Recent data reveals: An estimated 16 million children in America have untreated tooth decay; more than 51 million school hours and 164 million work hours are lost each year due to dental disease, leading to increased educational disparities and decreased productivity. And only 1.5% of 1 year olds have had a dental office visit compared with 89% who have had an office-based visit with their physician.

* How does Sri Lanka compare with these gloomy figures?

* A limited study of dental caries conducted in the Ragama Medical Office of Health area, of some 410 pre-school children aged 2-5 years attending child welfare clinics recruited for the study in the Gampaha district reveals the following: The survey was conducted by two medical researchers in 2012 and is worth quoting, as it gives new insights into the problem .

The results revealed that none of the children included in the study had a routine visit to a dentist, although practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years.

Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and significant dental caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys, it said.

To get more insights into the problem, the Sunday Observer spoke to Community Dental Surgeon, Dental Unit, Health Ministry, Dr A.M Uttara Amilani.

Excerpts…

Dental problems in children have soared in recent years.
Can you give an estimated figure of the number of schoolchildren with dental problems in Sri Lanka

Q: Has there been a national survey? When?

A. According to the National Oral Health Surveys conducted in Sri Lanka in 83/84, 94/95 and 2002/2003, prevalence and severity of Dental Caries has shown an overall declining trend.

Q: It is said, paediatric diseases (Dental Decay) are five times greater than asthma and 7 times more than hay fever in the UK. Your comments?

A. Yes

Beside the world burden of dental decay, more than half of the Sri Lankan child population has experienced tooth decay. According to the third National Oral Survey Report of 2002/2003, the prevalence of tooth decay among five year olds is around 65%.

Q: What is the cause for this increase? Too many sugary foods? Junk foods?

A. Tooth decay is closely related to oral health related behaviour. The frequency and amount of sugary /junk foods play an important role in developing dental caries. Eating sugary foods, junk foods, and taking sugary drinks is definitely a predecessor of dental caries in children.

Q: How early in life does a child develop a dental problem?

A. Tooth decay can start as early as the age of around one and a half to two years.

Q: Can genes play a role in dental problems?

A. Still we don’t have scientific evidence regarding this matter.

Q: What about thumb sucking, lip sucking, tongue thrusting and other habits that can also wreck your teeth in early childhood?

A. These behaviours can induce malocclusion.

Q: What are the most common dental problems you see in children in Sri Lanka today? Are they different from those in the past? How and why?

A. Dental decay and gum diseases are the most prevalent oral diseases among children. However, the prevalence rates are now declining.

Q: Why?

A. Because of the introduction of the Fluoride which is the most important substance which helps in preventing tooth decay via the Fluoridated tooth paste in Sri Lanka.

In addition to that, this declining trend may be a result of the awareness raising by the Ministry of Health via health education materials such as, posters, leaflets, lectures, health talks to the public.

Q: Many children today are losing their milk teeth early due to poor oral habits. What are the reasons?

A. Dental decay is the most common reason for losing milk teeth in early life, due to poor tooth cleaning habits and unhealthy dietary habits.

Q:Is tooth decay( dental caries) a common problem? What is it? How is it caused?

A. Tooth decay is a common problem in all age groups in Sri Lanka according to the third National Oral Health Survey report in 2002/2003.

The prevalence of Dental Caries among 5 year olds was around 65% and around 40% among 12 year olds.

The prevalence of Dental Caries among 15 year olds was around 52% and around 90% among adults and 71% among the elderly group.

Our mouths are full of bacteria, some bacteria are helpful but some can be harmful, such as those that play a role in tooth decay process. Tooth Decay is the result of an infection with certain types of bacteria that use sugars in food to make acids. Over time, these acids can make cavities in teeth.

Q:How do you treat an infected tooth?

A. Decayed teeth are restored with restorations after removing tooth debris. According to the severity of the tooth decay restorations vary from simple to advance.

Q: When is it necessary for a tooth to be extracted?

A. A tooth needs to be extracted if the tooth is not appropriate to restore it.

This decision should be made together with the doctor and the patient and with the advancement of the techniques there are many ways and means of restorations, except the tooth extraction. .

Q: At what age does a child get his/her wisdom teeth?

A. At the age of 18 but it may vary.

Q: Can dental problems be prevented? How?

A. Yes. By primordial prevention or primary prevention. Primordial prevention can be achieved by changing attitudes and behaviours, and Primary prevention by early detection of the dental diseases.

Q: How important is a tooth brush and tooth paste for a young child? What is the correct tooth brush a child must use when first introduced to the brushing habit?

A. Tooth brush and tooth paste is a must for every child.

Tooth cleaning has to be started when the first tooth comes to the mouth. Until four teeth appear, tooth cleaning can be done with a finger brush.

If the child has more than 4 milk teeth, parents can use an infant/child tooth brush.

When the child is over 12-18 months of age, the use of fluoridated tooth paste is compulsory.

Q: How much tooth paste must one put on a tooth brush for a toddler?

A. Start with a very small amount (smear layer of tooth paste) and increase it gradually to the size of a green gram of tooth paste by 3 years.

Q: Does flossing help to clean teeth better?

A. Yes. It is very helpful in inter dental cleaning.

Q: What about charcoal and salt as used by our ancestors?

A. Those were used in the past, but now they are replaced with tooth paste.

Q: What are the Dos and Don’ts in oral care?

A. Do’s. Take healthy foods and control snackingBrush twice daily with fluoridated tooth paste Regular dental checkup Don’ts Avoid or control frequency and amount of sugary / starchy foods Avoid tobacco and arecanut products

Q: Do all schools in the island have dental services? How do they operate? Who are the dentists?

A. There is a well-established school dental service in Sri Lanka. Even though every school does not have a school dental clinic there are considerable numbers of school dental clinics in selected schools in a district.

School dental clinics for children (3 – 13) are manned by school dental therapists and adolescent dental clinics for children above age 13 are manned by dental surgeons.

Q: What are the gaps that need to be filled? e.g. Are there enough school dental therapists and dental surgeons, to meet the needs of all school going children in the primary and middle school grades? Is there a training program by the Ministry of Health which trains student school dental therapists in this work?

A. There are around 488 school dental clinics and 62 adolescent dental clinics throughout Sri Lanka to cater to the school population. Children up to Grade 7 can be treated at the school dental clinic and children beyond Grade 7 can be treated at adolescent dental clinics.

Dental Surgeons are graduated through the Faculty of Dental Sciences, University of Peradeniya, and there are many post graduate training programs to upgrade knowledge after they complete the graduate training programs.

School Dental Therapist students are trained at the Dental Therapist Training School, Maharagama.

Q: If parents want their children’s teeth examined in a state hospital, where should they go?

A. They can directly go to the Dental Clinic in a Government Hospital?

Q: Your advice to parents?

A. Be responsible about your child’s Oral Health, supervise your child’s tooth brushing habits and control snacking of your child.