Losing baby teeth to decay is no laughing matter, experts say

SINGAPORE — They may show up at the dentist with multiple cavities, some with entire rows of teeth rotted down to the gums.

But they are not elderly patients suffering from decades of dental neglect.   

Severe early childhood caries is not uncommon in young children here, and paediatric dental experts told TODAY they have seen babies as young as one year old with decaying teeth.

Local studies have reported dental caries in 40 per cent of preschoolers (aged three to six) and almost half (48 per cent) of children aged one-and-a-half to four, said Dr Bien Lai, head and consultant in the paediatric unit of National Dental Centre Singapore (NDCS).

Only 8 per cent of the preschoolers and 3 per cent of children aged 18 to 48 months received regular dental care.

Last year, the NDCS saw more than 1,800 new child cases . More than half (965) were aged one to four, and 29 were below one. According to Dr Lai, 106 patients required extraction of more than 10 baby teeth in the operating room while six required extraction of all 20 baby teeth.

Her youngest patient was an 11-month-old baby with severe decay in the two upper front teeth.

Among the one-year-olds that private paediatric dentist Rashid Tahir has seen is a 13-month old toddler whose four upper front teeth had to be extracted. The treatment was performed under general anaesthesia, said Dr Rashid of The Kids Dentist.

Treatment for dental caries may include fillings, pulp treatment, crowns and extractions. While mild dental caries can be treated with less invasive procedures, teeth are usually removed if there is a serious infection in the gums and bone and when they are decayed beyond repair, said Dr Lai.

“Many children below the age of four will find it difficult to cope with dental treatment, especially if the treatment is extensive and involves extractions, pulp treatment and stainless steel crowns.

“General anaesthesia may be needed to manage their cooperation. Older children who are anxious but are willing to cooperate can be managed with nitrous oxide, also known as laughing gas sedation,” said Dr Rashid, who is an Adjunct Associate Professor at the faculty of dentistry at National University of Singapore.

MULTIPLE FACTORS

There are multiple factors behind dental caries, which occurs when oral bacteria in the plaque biofilm that forms on the teeth feeds on sugars in the child’s diet. This produces acids around teeth that are immature and susceptible to the acid attack, said Dr Rashid.

Causes may include not brushing teeth adequately and frequent intake of sugary food and drinks in the diet.

“Even formula milk that children drink now have added sugars, and many go to bed with a milk bottle to soothe the child to fall asleep. Furthermore, many parents are not using fluoride toothpaste for children, which helps immature baby teeth be resistant to cavities,” said Dr Rashid.

While formula milk often contains additional sugars, bottle-feeding alone does not cause dental caries and there is no evidence to suggest that bottle-fed babies are more likely to develop dental caries than breastfed babies, said Dr Lai.

“The cause is multifactorial,” she said.

WHY MILK TEETH ARE IMPORTANT

Some parents and caregivers have misconceptions about the care of baby teeth, which can lead to delayed dental care.

“There are still some parents who think that baby teeth are not important because they will fall out anyway,” said Dr Rashid.

Although milk teeth will eventually drop and be replaced by adult teeth during the school-going years, they are still important for function and wellbeing.

“If too many milk teeth are lost too early, the child may have difficulties biting and chewing hard foods. Early loss of front teeth can affect aesthetics and (lead to) temporary speech issues while early loss of back teeth – depending on the tooth, and child’s jaw and dental development – may cause overcrowding of adult teeth,” said Dr Lai.

Infections from severe tooth decay may damage the adult tooth forming underneath it, said experts. In rare instances, they may be even fatal.

“Severe cases may require hospital admission and can be potentially life-threatening,” said Dr Lai, referring to a reported case in the United States where a child died after a tooth infection. She has not encountered such cases here.

Untreated dental caries may result in infections and swelling that may spread to other organs or tissue space that obstruct the airways. But such cases are extremely rare, given modern antibiotics and easy access to dental care, said Dr Rashid.

FIRST DENTAL APPOINTMENT BY AGE ONE

The dental experts advised parents to schedule their babies’ first dental appointment by age one, even if there is no sign of tooth decay.

Mdm Chris Guo, 32, was surprised to learn that her son Caleb had dental caries at the age of three-and-a-half. A dental checkup in school, in August, uncovered two cavities in his upper molars.

“He wasn’t in pain so we never suspected anything,” said Mdm Guo, a senior executive.

A two-year study on the effectiveness of an infant oral health programme at NDCS found that young children who did not see a dentist at an early age were three times more likely to develop severe early childhood caries compared to those enrolled in an infant oral health programme.

The study, published in the Singapore Medical Journal earlier this year, also found that 37.8 per cent of children in the study group had good oral hygiene, compared to 4.7 per cent in the control group.

Tailored for infants and babies up to 18 months old, NDCS’ infant oral health programme includes a caries risk assessment and oral examinations, customised prevention plan and follow-ups for babies at risk of tooth decay. Parents and caregivers are also given advice on how to monitor their babies’ oral development and care for their teeth.

“Regular dental visits from an early age also allow the dentist to train the child to be a good dental patient from the beginning. If treatment is ever needed, it’ll be easier for both the child and dentist. If the parent only takes the child to see a dentist when there are symptoms, the child may be fearful of the dentist and is less likely to cooperate for treatment,” said Dr Lai, the study’s principal investigator.

Parents and caregivers should tailor their expectations of their child’s first dental appointment. For example, babies are not expected to behave at the dental chair as they are developmentally immature, said Dr Lai.

Parents should avoid transferring their own anxiety about dental checkups to their child, said Dr Rashid.

“At that age, your child will likely cry when examined but it’s just a short examination and the child will not remember it for the rest of his life. Paediatric dentists are trained in managing behaviour and anxiety of young children,” he said.

In hindsight, Mdm Guo wished that she had started her son’s dental check-ups earlier and not waited until he required treatment.

Despite preparing him beforehand by reading to him books on the topic, Caleb was not “chair-ready”, was tearful and had a “meltdown” during treatment, she said.

However, the experience motivated him to quit his night milk feeds.

“Caleb wasn’t used to the idea of going to the dentist as I started him late. Now, I’m considering starting my younger child, who just turned one, early,” she said.