Twenty-month-old Sandy came in for his first dental checkup. His mom Cris was expecting a routine inspection of her son’s cute smile. Instead, she was shocked at the pediatric dentist’s diagnosis: dental caries and possible fracture due to brittle teeth.
As the treatment would require Sandy to be under sedation, Cris was advised to get clearance from Sandy’s pediatrician before proceeding. It would also cost about P18,000.
The next day, Sandy’s front teeth broke in half. “They have their ways of coping with toothache,” explained pediatric dentist Mary Lynn M. Roxas-Abellera, D.M.D. “The complaints will be obvious only when the pain is already severe, or when the child has fever or infection.”
“Tooth decay due to frequent snacking and milk feeding at night is the usual dental problem children face beyond the first year,” confirmed pediatrician Dr. Jose Clemente.
Sandy’s teeth were also being brushed with non-fluoride toothpaste.
Non-fluoride toothpastes are marketed to parents who fear that their babies might swallow fluoride toothpaste.
“Studies have shown that excessive ingestion of fluoride by children during their teethforming years causes dental fluorosis, an irregular mineralization of the tooth enamel marked by white spots,” explained one brand on its website.
Abellera said, “In the most recent National Monitoring and Evaluation Dental Survey (2011), 87.7 percent of 5-year-olds have dental caries. I’m trying to look for dental fluorosis figures, but in my nine years of practice, I have encountered only two patients with dental fluorosis; 90 percent have dental caries, and the rest have other concerns such as trauma and routine oral prophylaxis.”
Who can develop dental fluorosis?
“Children 8 years old and below, because they still have developing permanent teeth,” she said.
All toothpastes approved by the American Dental Association (ADA) have fluoride. On its website, ADA explained, “Fluoride toothpaste helps remove plaque, a film of bacteria that forms on teeth and gums every day. Plaque can cause gum disease and tooth decay. Fluoride helps prevent tooth decay by strengthening tooth enamel.”
The Philippine Dental Association (PDA) also promotes and supports fluoridated toothpaste and treatments.
Abellera added: “Toothpastes are not the sole source of fluoride; it can also be found in drinking water in certain communities, beverages and food products, dietary supplements, vitamins, mouth rinses and mouth gels.”
So, why do parents use non-fluoridated toothpaste on their children?
Abellera thinks parents buy into the effective marketing of non-fluoridated toothpastes. “Perhaps they have an impression that fluoride toothpaste shouldn’t be given to babies, since they don’t know how to spit and would just swallow it,” she said.
“Dental fluorosis is a change in appearance in the tooth’s enamel (Center for Disease Control and Prevention, August 2015). It is caused by taking too much fluoride over a long period of time when teeth are forming under the gums,” Abellera said.
“On the other hand, dental caries can cause pain, infection, malnutrition and misaligned teeth because of premature tooth loss. It can lead to a child’s trauma with dentists because their first experience with a dentist will be for extraction or because of pain.”
She also learned from her patients’ parents that a number of them give the toothbrush to the baby. “Of course, babies don’t have the skill and dexterity to clean their own teeth,” said Abellera.
What are the risks of using fluoride toothpaste, anyway? “Too much fluoride will cause gastrointestinal pain, nausea, headaches and dental fluorosis,” said Abellera. “Fluoride toxicity is 5 mg/kg so if your child weighs 11 kg, multiplying by 5 equals 55 mg. They’d need to swallow about half a tube of toothpaste.”
By using non-fluoridated toothpaste, children run the risk of developing cavities, which can eventually lead to pain, tooth loss and infection.
“As a dentist practicing pediatrics, the most common problem is stubborn parents,” admitted Abellera. “Pediatric dentistry is more of parental management rather than treating children. I do not expect kids to follow my instructions if I say they have to brush their teeth twice a day with mommy’s toothpaste. It is more of convincing the parents.”
What are the most important things she wishes parents knew about how to care for their children’s teeth? “I wish they would see dental situations not only as cosmetic issues but also as health issues, she says. “Parents are more scared of dental fluorosis than dental caries!”
She also wishes that children be brought to a dentist every three months if they are at high risk of developing cavities, and every six months for low-risk patients.
“Lastly, I wish parents brush the teeth of children below 4 years old. Five- to 8-year-olds should still be supervised when brushing. The goal is to have parents monitor the amount of toothpaste and to assist the child in brushing. Children cannot properly brush until they have the dexterity to tie their shoelaces,” said Abellera.
Abellera advises new parents with babies who:
Have no teeth: “After feeding, wipe or massage the gum pads, palate and tongue of infants with a gauze or clean cloth. It helps them get used to cleaning their mouth.”
Have one tooth out: “Introduce a smear amount (as small as a grain of rice) of fluoridated toothpaste in cleaning their baby’s mouth.”
Have turned 1 year old: “By this time, the child should have at least eight teeth. Start using a toothbrush with the fluoridated toothpaste (check the label: the recommended amount of fluoride is 1,000 to 1, 500 ppm F). The child should see a dentist for cleaning and fluoride treatment.”