Monday, October 10, 2011

What You Should Know about Fluoride and Caring for Your Child’s Teeth

As a mom, I confess that I am less concerned with my son’s dental health as compared to other areas of his development such as physical and intellectual development.

But some things I learnt from hearing an interview with Dr Rashid Tahir, paediatric dentist from The Kids Dentist on radio Live938, made me realised that I need to start paying more attention to my son’s dental needs. I was especially intrigued by what he said about the use of fluoride toothpaste (my son is now using a non-fluoride one). So I invited Dr Rashid to share more about the use of fluoride and children’s dental health.

Copyrighted © The Kids Dentist

1. Share with us about the use of fluoride in dental health.
Many studies have shown the effectiveness of the use of fluoride in toothpastes in reducing dental caries i.e tooth decay. Toothpastes are recommended by dentist because it is an ideal vehicle for fluoride delivery to individuals every day. Therefore toothpaste is not meant just to give a nice flavour when brushing teeth.

Fluoride has also been shown in recent years to be most effective when applied topically to erupted teeth hence the effectiveness of toothpastes (it used to be thought that fluoride should be ingested to be incorporated into unerupted teeth). Now recent evidence support the minimum concentration of 1000ppm f ion in toothpastes, applied topically to be effective. The point to note about the effectiveness of fluoride in preventing tooth decay is that it is concentration dependent rather than dose (in terms of milligrams) dependent. I think this makes sense because of the topical effects of fluoride - we need a certain concentration of the ion around a tooth to promote remineralization of enamel, hence resisting dental caries.
2. At what age can children start using fluoride toothpaste?
When teeth first erupt, they have immature enamel which makes them prone to dissolution from acids caused by plaque bacteria leading to dental caries. That's the best time to have fluoride around the teeth as soon as the tooth erupts. If you ask fluoride experts, they will say use fluoride right from the start when the teeth erupt. If you look at fluoride guideline in UK and US, they will say that too.

I normally say that parents should clean the gum pads of babies without teeth with a towel and when the first teeth erupt, they can use the towel or finger brush. At this stage, I don't always insist on toothpaste. I ask parents to use a toothbrush from about one year old. That's when I recommend using fluoride toothpaste.

3. What should parents know about using fluoride toothpaste?
When your child starts brushing with bristle toothbrush, usually from one year old, my recommendation is to use a 1000ppm f ion toothpaste and just use only a smear so it minimizes undesirable effects of using fluoride.

However, it is now very difficult to get 1000ppm f ion toothpaste in Singapore. Children's fluoride toothpaste in Singapore has a concentration of 500 ppm f ion (almost all adult toothpastes are 1450 or 1500 ppm f ion) - which recent evidence has shown to be ineffective. If you pick up children's fluoride toothpaste in the UK, US and Australia, most now have minimum concentration of 1000ppm f ion. In my practice I have stopped asking the use of these low-fluoride toothpastes because firstly, evidence says they are not effective (in preventing caries). Secondly, the kids will swallow them and the fluoride swallowed is cumulative and can have undesirable effect.

4. What undesirable effect is there with the excessive use of fluoride in young children?
Fluorosis, which are white opaque spots on teeth. Some parents are not even aware of these opaque fluorosis spots if not highlighted by the dentist.

However, we should note that excessive consumption of fluoride is dose dependent i.e. amount milligrams of fluoride swallowed on daily basis, and this can be easily controlled in young children by using only a smear. Also, after 30 months old, the risk of a child having fluorosis is minimal as all the front incisors are fully developed (exposure to excessive fluoride while the teeth are forming under the gums can cause fluorosis, which usually appears on front incisors rather than molars).

Dental caries in permanent teeth for children at 12 years old in Singapore is one of the lowest in the world. In contrast, we have high decay rate for primary teeth - 26% in children ages three to four. Why is this so? The avoidance and use of low fluoride toothpaste - which has been prevalent for the last 15 to 20 years.

So we need to compare the risk of having dental caries in very young children and the risk of fluorosis. The problem of having young children with diseased teeth who need dental treatment is that they cannot cooperate and will most likely need to be managed in the operating room under general anaesthesia.

5. What do you think of the use of non-fluoride, nicely flavoured toothpaste?
I don’t support the use of nicely flavoured, non-fluoride toothpaste in children. First, it defeats the purpose of using toothpaste i.e. to protect teeth. Second, you are teaching your child to swallow toothpaste because of the nice flavour. Third, they cost a lot and do nothing for your kid’s teeth.
6. Is there a toothpaste you know that has concentration of 1000ppm f ion?The Elgydium Junior toothpaste for ages 7-12 years. It is available in some pharmacies in Singapore. Parents will also be able to get other 1000 ppm F ion toothpaste locally but they will need to look for them. Remember to just use smear for very young children and never buy toothpaste when the fluoride concentration is not clearly stated on the packaging.
7. What can parents do to protect their children's teeth against tooth decay?
Prevention of tooth decay basically involves three areas. First, reduce the plaque bacteria around teeth e.g. through brushing and flossing (but this is often challenging for parents of young children ages 1.5 to 3 years old). Second, reduce sugar frequency. Think of how often a child gets sugar a day - morning breakfast of cereal or bread with jam, and Milo or formula milk; mid-morning snack of cookies; after school candies; afternoon tea of cakes or biscuits with drinks like soya bean or vitagen; bedtime drink of Milo or formula milk. See how many times a child gets sugar a day! Third, increase the resistance of teeth to decay by using fluoride.

Thank you, Dr Rashid!

About Dr Rashid Tahir
Dr Rashid Tahir is a trained paediatric dentist and has been providing oral health care solely for children since 1997.

Dr Rashid completed his graduate training at the University of London in 1998 when he was conferred a Master of Science with Distinction in Children’s Dentistry (Pedodontics). He also won the 3M Dental Postgraduate Prize for being the best student in his cohort.

He was an Assistant Professor at the Faculty of Dentistry, National University of Singapore (NUS) and consultant at the National University Hospital Dental Centre from 2002 to 2006, before setting up The Kids Dentist at Camden Medical Centre. He still enjoys teaching paediatric dentistry to dental undergraduates and goes back to NUS as an Adjunct Senior Lecturer.

He is the founding and current President of the Society for Paediatric Dentistry (Singapore) and continues to be dedicated to the advancement in the field of paediatric dentistry.

He is the proud father of 2 beautiful young daughters and aims at making dentistry fun for kids!

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