By
Dr. Fawaz Siddiqui
Specialist
Pedodontist
As healthcare providers we are
frequently asked by the patients…How to best take care of our teeth? And the universal answer is “Brush your teeth
twice a day”. Well, we are right but there are age specific oral hygiene
instructions that we commonly fail to provide.
Today
we will discuss the various age appropriate oral hygiene instruction.
To begin with, the main aim of oral hygiene
instruction is to prevent the formation of plaque on the teeth and to disrupt
the already formed plaque on the teeth. Both these objectives ultimately
prevents the harmful outcome of plaque accumulation on teeth namely, calculus
and dental caries.
Now, dental plaque is a thin tenacious, colorless,
bio-film which is not visible to the naked eye. It forms on the tooth surface
merely 4 to12 hours after brushing. If dental plaque is left undisturbed on the
teeth it gets organized and starts to initiate its harmful effects.
In order to prevent formation and
disrupt plaque structure following age specific instructions are to be given:
1.
At
Pre-natal counseling
2.
For
Infants (0 – 1 years)
3.
For
Toddlers (1 – 3 years)
4.
For
Preschooler (3 to 6 years)
5.
For
School age (6 to 12 years)
6.
For
Adolescents (12 to 19 years)
7.
For
adults (above 9 years)
Pre-natal counseling is the best time
for providing oral hygiene instructions. The first time mothers are very
receptive to healthcare advice. If they are able to follow good oral hygiene
practices they become role models for their children. The healthcare providers
should refer the pregnant patients for dental examination to the dentist.
Preventive dental services and restorative treatment can prevent painful
episodes later in the pregnancy. Also the good oral health in mothers has a
protective effect on the oral health of their children
During infancy, the first primary tooth
erupts at about 6 – 9 months. The objective of oral hygiene in this age group
is to provide healthy oral environment for the teeth to erupt. Therefore before
the teeth erupt, cleaning and massaging of gums using finger brush or muslin
cloth is recommended. Mechanical cleaning reduces the total bacterial load of
the oral cavity, thereby preventing the chances of colonization of bacteria on
newly erupted tooth. After the teeth erupt, cleaning is done using soft bristle
baby toothbrush. The oral hygiene procedure is performed once a day before
bedtime. The child has to be gently restrained to achieve this. Toothpaste is
not recommended at this age because the child would invariable swallow the
paste and its beneficial effect is not obtained. By one year of age the child
has to taken to a dentist for the first oral examination based on the concept
called as Dental Home.
Smear of toothpaste Pea size toothpaste
(Source: http://www.hallerandhug.com)
When the child is a toddler, almost full
complement of primary teeth would have erupted. To maintaining the oral hygiene,
tooth brushing with an appropriate sized toothbrush with a smear of
non-fluoridated toothpaste is recommended. Non-fluoridated tooth paste is
recommended because at this age children have not developed the neuromuscular control
of spiting and swallowing of fluoridated tooth paste can cause fluoride
toxicity. Brushing twice a day particularly at bedtime is most important. Flossing
of teeth becomes mandatory once the contacts between teeth are present because
food lodgment in-between the teeth causes interproximal caries which requires
very careful visual and radiographic diagnostic observation. Since children
tend to chew their toothbrush rather than use it, parents are responsible for brushing
and flossing. Some children are defiant to the tooth cleaning procedure and
resist the situation. Therefore at times gentle restrain or active restrain by
both the parents are required.
For preschooler, tooth brushing is again
done with appropriate size toothbrush and importantly with pea sized fluoridated
toothpaste on the tooth brush. The size of the toothpaste reduces the risk of
fluoride toxicity. Commercial toothpaste with low concentration of fluoride is also
available in the market for children. Fluoridated toothpaste offers protective
benefit against dental caries. Brushing twice a day particularly at bedtime is
necessary. It is recommended not to rinse the mouth after spiting the
toothpaste after brushing because this increases the amount of time fluoride is
present on the teeth. Flossing is again recommended at bedtime and parent’s are
required to brush and floss their children’s teeth. Floss picks are convenient
to use in children.
Floss Pick
(Source:http://labmedical.en.hisupplier.com)
For school aged children, it is assumed
that they have developed sufficient neuromuscular coordination to brush their
teeth on their own and spit when required. Since children have developed
reasoning ability a demonstration of disclosing agents increases their
motivation for brushing. Fluoridated toothpaste is recommended along with
flossing. Brushing twice a day particularly at bedtime is recommended. For
children with high caries risk or those who are undergoing orthodontic
treatment, a fluoridated mouthwash for twice a day use, is prescribed. Parents
at this stage take the role of supervision of their children’s oral hygiene.
For people in adolescent age group,
there are major changes taking place in their bodies as well as in their social
environment. On one hand they become very conscious about their appearance and
seek dental treatment, or they may neglect their oral hygiene all together.
Poor dietary habits and poor patient compliance increases the risk of
adolescent rampant caries in this age group. This stage is governed by
imaginary audience and personal fable, therefore any changes in their oral
hygiene and dietary habits may be met with resistance. Gentle reminders and
empathy is required to gain their confidence. Brushing with fluoridated
toothpaste and flossing are the main stay of the oral hygiene. Other oral
hygiene adjuncts like tongue cleaner help to reduce the total oral bacterial
load. Brushing twice a day particularly at bedtime is recommended. Addition of
antibacterial mouthwash in the regime improves the gingival health and protects
against bad breath. Fluoride mouth rinse is compulsory for those undergoing
orthodontic treatment.
For adults patients, as mentioned above
for the adolescent age group, brushing twice with fluoridated toothpaste and
flossing the teeth are compulsory. Addition of antibacterial or fluoride
mouthwash will benefit those at risk of caries for e.g. people with fixed
prosthesis, implants and dry mouth syndrome. Currently there is a new type of
caries that occurs in old age called as the senile caries. It affects the
cervical collar of the tooth weakening the tooth and ultimately tooth fracture
occurs before it is symptomatic.
Lastly, we look at the mechanism of
action of various oral hygiene tools in very brief easy to understand terms. The
tooth brush essentially disrupts the plaque structure while the tooth paste
polishes the tooth which makes retention of plaque difficult on the teeth.
Tooth paste also delivers medicaments to the teeth such as antibacterial agents
and fluoride. The tongue cleaners or brushing the tongue removes the food
debris and bacteria present on the rough surface of the tongue. This reduces
the bacterial load of the oral cavity and probably reduces halitosis as well.
The floss disrupts the plaque structure that forms in-between the teeth where
the bristles of toothbrush cannot reach. Also any food lodged in-between the
teeth can be removed by the floss. Electronic toothbrushes are innovations of
the manual tooth brushing. It is useful in young children where the parents
have to brush their child’s tooth.
A general advice for everyone is to
visit your dentist every 6 months for dental examination and follow your
dentist’s recommendations to prevent initiation of caries. For e.g. application
of pit and fissure sealants, application of in-office fluoride therapy to name
a few. Change your brush once every 3 months. Change the brand of your
toothpaste and mouth rinse often to keep your oral hygiene regime interesting.
Easier said than done, 2-5 minutes spent
on your children and yourself goes a long way in protecting one from toothache
and losing one’s tooth. As I always say to my patients
“TEETH IS A TOOL
FOR A LIFETIME”
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