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Preventing Early Childhood Caries

Preventing Early Childhood Caries: What is it | National Dental Centre Singapore

Preventing Early Childhood Caries - Symptoms

Preventing Early Childhood Caries - How to prevent?

Diet counselling

What are high risk dietary habits?

Frequent and prolonged exposure of a child's teeth to food or drinks containing sugar increases their risk of tooth decay. The bacteria in the mouth act on these sugars to form acids which attack the tooth enamel. High risk dietary habits include:

  • Prolonged on-demand breastfeeding without oral care measures
  • Using a bottle containing sweet liquids (e.g. milk or juice) as a comforter to pacify your child, either in the day or before sleep at night
  • Frequent intake of sugary snacks, sweets or sweet liquids

What are some good dietary habits which should be adopted?

  • Avoid filling your child's nursing bottle with sweet liquids
  • Do not allow your child to fall asleep with a bottle containing milk, formula, juices or sweet liquids
  • Give your child a bottle of plain water if he or she needs a comforter between meals
  • Wean your child of the milk bottle by age one
  • Do not allow your child to snack on demand during the day; consider limiting the number of meals per day to five, including milk feeds
  • Avoid snacking on foods that tend to stick to tooth surfaces for a longer period of time, for example raisins, gummies, chocolate and biscuits
  • Choose savoury snacks or dairy products (e.g. cheese or yoghurt) over sugary ones (e.g. cake or pastries)
  • Encourage your child to finish his or her meals within 30 minutes. Food pouching habits can do serious harm to your child's teeth because the sugars in the food are in contact with their teeth for a longer time. This allows bacteria to produce decay-causing acids for a prolonged period.

Frequent intake of sugary snacks, sweets and sweet liquids can cause early childhood caries

Maintaining good oral hygiene

Why is oral hygiene important and how do I ensure good oral hygiene for my child?

Poor oral hygiene results in the accumulation of plaque on tooth surfaces. Plaque contains tons of acid-producing bacteria that contributes to tooth decay. 

Poor oral hygiene in the primary dentition by the National Dental Centre Singapore

Tips for good oral hygiene by the National Dental Centre Singapore

Fluoride

What is fluoride and how does it prevent decay?

Fluoride is a naturally occurring mineral found in soil, water, foods and teeth. Research has shown that fluorides are very effective in preventing tooth decay. Fluoride works in three main ways:

  • Antibacterial action
  • Promotes tooth remineralisation (helps minerals to be deposited back into the tooth)
  • Hardens the tooth surface, making teeth more resistant to decay

Types of fluoride

Most people get sufficient fluoride exposure from various sources, including fluoridated tap water and toothpaste, food and beverages. Additional sources of fluoride include mouth rinses and professionally applied fluorides.

Types of fluoride include those in the environment, homecare fluorides and professional topical fluoride application

Should my child use fluoridated toothpaste?

Fluoridated toothpaste containing a minimum of 1,000 parts per million (ppm) fluoride is effective in preventing tooth decay. Always supervise your child when using fluoridated toothpaste.

For children three years and above, a pea-sized amount of fluoride toothpaste should be used. A smear amount of fluoride toothpaste is recommended for children younger than three years old, and with a high risk of tooth decay.

Smear or rice-grain amount of toothpaste by the National Dental Centre Singapore Pea-sized amount of toothpaste by the National Dental Centre Singapore

(Left) Smear or rice-grain amount of toothpaste            (Right) Pea-sized amount of toothpaste

Risks associated with fluoridated toothpaste

While fluoride toothpaste has great benefits in controlling tooth decay, it should be used judiciously. Ingesting excessive amounts of products containing fluoride during the formation of a child's permanent incisors (below age three) can lead to mild fluorosis of these teeth.

Fluorosis is an intrinsic white discolouration of the tooth structure, which forms in response to high systemic levels of fluoride. It disrupts the normal process of tooth mineral formation, resulting in areas of hypomineralisation (lower mineral content) which changes the colour of the tooth structure. Mild fluorosis appears as chalky white discolourations near the edge of the tooth, while severe fluorosis can result in brown discolourations. Mild fluorosis is common and generally harmless except for poorer aesthetics.

Fluoride toxicity occurs at a dose of 5mg/kg. The risk of fluoride toxicity resulting from ingesting toothpaste is very low as a child would have to swallow 50g of 1,000ppmF toothpaste (or 1/4 of a tube) to reach this dosage. A normal dose of toothpaste does not pose serious toxicity.

Parental brushing, close supervision and using an appropriate amount of toothpaste are important to minimise toothpaste consumption in children younger than six years.

Fissure sealants

What are fissure sealants?

Fissure sealants are resins bonded to the pits and fissures of teeth to seal them off from bacteria and food. There have been no reported adverse reactions to sealants.

The chewing surfaces of our back teeth contains deep pits and grooves (also known as fissures), where most cavities in children are found. Fissures are so narrow that you are unable to clean them effectively with proper tooth brushing and flossing. These form a conducive environment for bacteria to fluorish, often resulting in tooth decay.

Children who have deep pits and fissures on the chewing surfaces of their molars will benefit from sealants, especially if he or she has a high risk for decay.

Fissures are so narrow that you are unable to clean them effectively by the National Dental Centre Singapore

How effective are fissure sealants?

 Sealants can last many years but may be damaged or lost through use, therefore they need to be maintained and checked regularly by your dentist. Lost or damaged sealants can be repaired easily.

How are sealants applied?

Sealant application is quick, easy and painless. No drilling of the tooth is required. The tooth is properly cleaned, dried and the sealant is painted on. A light is shone to harden the sealant, which forms a protective coating over the fissures of the tooth. Your child can eat immediately after sealant placement.

Does my child still need to brush or floss their teeth after having sealants?

Regular dental visits

Regular dental visits will enable your dentist to pick up signs of decay, defective restorations and infections in their early stages. This allows prompt treatment before dental problems become serious and require invasive management. Depending on his or her dietary habits and oral hygiene practices, your child's risk for decay will also change over time. Your dentist can recommend the appropriate preventive measures and advise on the frequency of follow-up reviews.

Regular dental visits allow prompt treatment before dental problems become serious by the National Dental Centre Singapore 

Preventing Early Childhood Caries - Causes and Risk Factors

Preventing Early Childhood Caries - Diagnosis

Preventing Early Childhood Caries - Treatments

Preventing Early Childhood Caries - Preparing for surgery

Preventing Early Childhood Caries - Post-surgery care

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