Nurseries are being urged to teach children to ‘spit don’t rinse’ when they are brushing their teeth, by the British Society of Paediatric Dentistry (BSPD), which says early years settings have a vital role to play in tackling toddler tooth decay.
Claire Stevens, president for the BSPD, says early years practitioners are ‘a trusted source of information’ for parents, and can help challenge any long-held dental care beliefs which may be out of date.
Cut down on snacking
We have all been told for so many years we should rinse our teeth after brushing, but the BSPD states that this is actually detrimental to good dental healthcare as the effects of the fluoride in the toothpaste are then diminished.
The best way to keep the fluoride at work and protecting teeth is to ‘Spit don’t rinse’, it advises.
In addition to this, the BSPD instructs: “Once teeth have been brushed, children should spit out the toothpaste but not rinse their mouth and, in the evening have nothing more to eat or drink before going to bed.”
Toothpastes containing no less than 1000ppm (parts per million) fluoride are recommended as soon as the first teeth come through. Once a child has reached their 3rd birthday, toothpastes of between 1000ppm and 1500ppm can be used.*
Informing parents about diet and helping toddlers cut down on snacking is another way that early years practitioners can help reduce dental decay for under-5s.
As well as being a child dental expert, Ms Stevens is also a parent, and her blog, the ToothFairyBlog.org, reflects this. She now finds that being a parent gives her work a new perspective. She says: “Becoming a parent, I do see things in a different way, and I now give more pragmatic advice.
“My little boy is very active, and he would eat all day if he had the chance, but actually, we have four meals rather than three. His four intakes are then very controlled. Before this he’d be, ‘can I have this, and can I have that’. It’s better to have a proper intake rather than just a snack”. She adds: “The grazing thing is the worst thing you can do for teeth.”
Tooth decay: ‘One of the main reasons for school absence’
More often than not, toddler tooth decay occurs in regions that have a lot of poverty, as Ms Stevens explains: “Decay is very closely linked to socio-economic deprivation, which is really sad, and you will see these inequalities, very obviously in terms of the finances that a family have.”
There are, however, early years schemes out there trying to lessen the poverty gap in terms of dental care and oral hygiene awareness, such as the Teeth Team programme, which involves supervised tooth brushing in nurseries and schools. It grew organically from the earlier “Brush Bus” programme which was aimed at early years settings and then rolled out to include schools, becoming a much bigger entity; it has been such a success there’s now been significant geographic and demographic rollout.
The Teeth Team was set up in 2010 in a deprived area of Hull which doesn’t have fluorinated drinking water, but there are too many children under five being admitted to hospital because of tooth decay, and the reasons are varied.
According to Chris Groombridge, chair of the Teeth Team Programme: “The number one reason why a child aged five to nine enters hospital is tooth decay and it is one of the main reasons for school absence. Twice as many under 10-year-olds are received in hospital for tooth decay than for broken arms.
‘Come back when your child is three’
Catching tooth decay as early as possible is imperative to dentists, and nurseries are in a really good position to help make sure parents don’t wait too long before they take infants to the dentist for the first time.
In April 2018 a Royal College of Paediatrics and Child Health (RCPCH) survey of Mumsnet readers found many mums were unsure of when they should first go to the dentist with their child. Ms Stevens agrees that there has been conflicting advice. She says: “We know from talking to parents, that they are often confused about when they should first take their child to the dentist.”
She continues: “And also, as a profession, the dental profession sometimes is not giving out consistent messaging. I know some families have gone to a dentist and been told ‘come back when your child is three’”. However, she states that the national advice has always been ‘take your child to a dentist as soon as their first teeth come through’.
Their Dental Check by One campaign aims to simplify things to ensure parents are taking their child to the dentist before the age of one.
According to Ms Stevens, nurseries can ask parents if they have taken their child for their first dental visit via registration forms, or they can have advice boards for parents within the provision, or both.
The paediatric dental expert also thinks nursery staff need to feel supported when there are safeguarding issues. What should a nursery worker do when a child is regularly coming into class with chronic tooth pain? Practitioners need to have a connection with local dentists and frontline social services, and BSPD can support a ‘buddies scheme’ or a similar network.
* – our emphasis, Fluoride Action Network.