Delightful Dentistry!

I've just had the most pleasant experience at the dentist!  Granted, I wasn't being treated, but it was my two-year old son so it could have been very different.

Having registered in Denmark, we were automatically put into the Healthcare system.  We were all called for various health checks and our two-year old was called to visit the dentist.  I was surprised as he was so young, given that in Ireland children are not seen until much later.

Childhood dentists are something with which I’m very familiar.  Two years ago, I noticed a chip in my five-year old daughter’s tooth.  It turned out to be an advanced cavity, of which she had four.  We were devastated.  We eat well and clean our children’s teeth, how could this have happened? 

I brought her to the HSE dentist, who ordinarily doesn't see children until they are eight years old.  I was told that we should leave the cavities to develop until such a time as they needed to be removed, at which time we could have the extractions done free of charge in St James’ Hospital, under general anaesthetic. 

I was horrified.  We will allow children to damage their teeth to such an extent as to need extractions before we will intervene on the public system?  Luckily, we were in a position to avail of a private dentist, but we hoped to claim back some of the treatment cost from our Health Insurer.  This turned out not to be possible.  There is an obvious hole in the healthcare system when it comes to paediatric dentistry. 

We visited Castleknock Orthodontics, who had a wonderful Paediatric Dentist at the time (she has since joined Crumlin Hospital to treat patients there).  My daughter was made to feel welcome and comfortable before any treatment was attempted.  In order to treat her four cavities, she would need two extractions - as the cavities were too advanced to treat – one filling and the other cavity was in her front milk tooth that would soon fall out.  Ironically, the waiting list for our dentist to take a place in a private hospital to carry out the extractions was so long that we were better going to St James’ Hospital on the public system.

I remember the morning we travelled there by bus.  My daughter was nervous, but not overwhelmingly so.  We arrived into the hospital, where there was already a queue of parents with their children.  During the time we waited, patients were being brought into the treatment room very quickly, with no child in there longer than four or five minutes.  The doctors and nurses were well used to performing these extractions and made the children feel very comfortable.  But what was shocking to me was the numbers of children being treated.  There must have been about thirty children being treated that morning.

On discussing this with our dentist, she recalled a two-year old patient on which twenty extractions had to be carried out – every single tooth that the child had was so decayed that they could not be saved.

So what is wrong with our dental system?  Firstly, not seeing children until they are eight years old is too late.  Bad practices have had so long to develop that it is almost impossible to correct any damage done.  In countries such as the US and Denmark, children are seen from birth, in order to educate children and parents, therefore reducing the need for treatment.  People’s teeth are so good in these countries and it makes such a huge difference to their appearance.  Have you seen the clever Colgate campaign? http://www.dentistryiq.com/articles/2013/01/colgate-dental-floss-ad-campaign.html

Secondly, the education for parents regarding care of their children’s teeth is almost non-existent.  Every now and again there might be a poster outlining a key point with regard to teeth care, but nothing substantial.

I learned so much about teeth care through our experience with my daughter –

Cavities develop at the rate of about 1mm per year – in our case, the dentist could tell that the damage had occurred to my daughter’s molars at about eighteen months.  It was done by falling asleep with a bottle.  Leaving a coating of milk on teeth overnight is as bad as sucking a hard sweet through the whole night!  She also loved raisins, which are notorious for damaging teeth.

Toothpaste with a fluoride count of less than 1450ppm (parts per million) will not be effective in cleaning and protecting teeth – this information is written in small print on the back of the toothpaste tube.

Children should not be allowed to brush their own teeth up to the age of eight.  It’s OK to allow them to brush their teeth, but then lay them down with their head on your lap (it’s easier to see into their mouths this way) and gently brush all faces of their teeth.  Lift their lips out of the way to get to their molars.

There appears to be a complete lack of focus on children’s teeth which is leading to misunderstandings, even within the dental profession.  When my daughter was one, I brought her along to my own checkup.  I expressed concern that it was difficult to clean her teeth as she didn't enjoy having it done and cried a lot when I tried.  I was told that it was not important to clean her teeth very well, that it was more important not to turn her off brushing.  My experiences since then have shown me that although it is important that children enjoy brushing, it is more important that their teeth are cleaned properly, especially in the evening.  Small children do not like having their teeth brushed, so laying them down to do it may make it easier. 

Playing games and telling stories about ‘who can we see inside your mouth’ may also help. 

Let them have their own brush that they can chew and wave about, but also have a brush that you can use to clean properly.

Here in Denmark, entering the dentist’s office was like going into a nursery.  Everyone smiled and chatted to my son and there were toys everywhere.  Everything was focused on helping the child feel at ease and he played and sat on my knee during the entire process, right up until he was handed a bag of small toys and stickers to take away with him!  We were given lots of practical advice about his teeth and my son got to choose a new toothbrush to take away with him. 

It really gives you food for thought, when you imagine the HSE clinics in Dublin, with mildew on the walls, staff trying their best to be happy and help people in pretty poor working conditions….