Tooth decay in 6yr old

[Cherry85]

Our 6yr old has cone home with an nhs letter from school saying they have tooth decay and I feel absolutely sick/like i have let them down.

We have a new baby so we probably have been pandering the last few months with too many sweets and not as focused on tooth brushing g as we shoukd have been.

How bad or common is this?

My mum hasn't helped as I asked her and she started talking about my cousins kid needing 8 teeth out?!

We had the same op, my dd had a load of back teeth out when she was only 6. The dentist (we always went without fail) said it was likely linked the the glue ear she suffered with at the time. Milk intolerance also meant she had the juice option at school, which would have also caused damaged. At least if they do have to come out, then you can start again and it will prevent the adult teeth from becoming rotten.

Having teeth extracted is the number 1 reason for children having a GA in England.

When did your child last see a dentist? What did the dentist say?

Does it go straight to extraction? Or are there less serious scenarios?

Surely they didn't get tooth decay I. 6 months??

When's the last visit to the dentist before this one?

@Rainraingoawaydontcomeback it was December 24 and all was fine. We were meant to go before xmas but had new baby so going end of march

IDK if this will make you feel better but DS7 has multiple caps/fillings (no extractions) and up until Halloween last year basically had eaten only a handful of sweets in his life (we're actually still working through the halloween stash, but does mean they've been had more regularly than at any other time) usually only if it was a special occasion or we wanted something chewy for take off/landing on a plane. Rare occurrence!

He always had minimal fruit/juice/squash as well, no fizzy or sugary drinks, we have greek yogurt rather than petit filous or anything like that, hot on teeth brushing with an electric toothbrush....yet his back teeth are basically non existent, they've eroded away so much.

The dentist just says he has weak enamel and it's not uncommon in baby teeth. We were recommended when he was small to give him an alternative to cows milk as dairy aggravated his eczema, and I will always wonder if the milk alternative was a contributing factor as it's probably the only high sugar thing (in comparison to the rest of his diet) he's had regularly. However, he has regular dental checkups and they're always reassuringly relaxed about it and sure it won't be an issue with adult teeth. So perhaps they'll also say similar here?

Don't beat yourself up about it basically, it can happen very quickly even without the sweets and with tooth brushing and regular dentist visits!

Your child has probably been seen on one of the dental epidemiology programmes,
if they’ve come home from school with one of those letters.
Don’t fret too much at this point. Make an appointment with your regular dentist for a check up and take
it from there. There is no way of knowing from that type of letter whether the caries
is
early ie enamel, significant or gross. So
noone can say what the
treatment modality will be. Fluoride varnish & monitor 3/12, simple fills or Hall crowns or extraction-there is no way of knowing until your regular dentist sees your DC. Yes teeth can deteriorate absolutely within 6 months. As little as 6 weeks if the conditions are right, ie frequent intake of refined sugar, is all it takes for caries to begin in enamel and expose right through to pulp.

One of my four kids had awful baby teeth and lots of decay. Same diet and habits as the others. Had no problems with adult teeth at all, so it must have been poor enamel on the baby teeth. I was devastated at the time and banned all fruit juice and squash etc from the house. We all drank tap water and milk only after that ... which was a good thing and must have saved me a fortune!

She hasn't been for over a year?

Blimey. My 6yo goes every 6 months.

is this a helpful comment? OP is clearly worried and it’s not as if she has never taken her child to the dentist.

Soya milks and all non dairy milks are high in sugar to make them palatable . They will quickly decay teeth , particularly if given in a bottle .

To get decay all you need is to have anything sugary or starchy more than three times a day, even if it’s just a sip or a bite and even if you brush teeth afterwards .

That’s not just sweets but non dairy milks , yoghurts , raisins , flapjacks, smoothies, fruit juice etc

My daughter developed a cavity in one of her molars and she had staining with on two other molars which were at risk of developing cavities when she was 3. I was heartbroken.
She had severe silent reflux and it had gone out of control again. She was relfuxing for hours at a time every night and often chewing on it which was how the damage was caused. We ended up under two paediatrician trying to find the right treatment.

The dentist recommended fluoride treatment every 3 months to hopefully protect the enamel and we had some tweaks to our brushing routine. He said hopefully that the damage would progress too quickly and that we could get caps if she needed and the worst case scenario would having them removed.

We moved to an NHS dentist and she continued this plan. Once she was 5 there was no active decay in the molar and she was able to do a no drill filling and hasn't had further issues with her teeth and we got her reflux back under control when she was 3 and a half.

@Lollygaggle We did a LOT of research into milks. Looked at the calcium content, protein, sugars, the lot. I know all about maltose vs lactose and the different effects it has on the body, the teeth and all the rest of it. Glucose spikes were a concern, but extreme eczema isn't fun either. We researched the best way to drink it (as you say, bottles aren't the best so we had open cups once we'd switched from breastmilk). We looked at the recommendations on how long after eating to wait before brushing teeth. We started going to the dentist as soon as the kid had teeth. I read a lot, it's basically my entire parenting style. We did the best we could in the circumstances with the information that was available to us. It's not an easy win win.

However some people have horrifically sugary diets and fine teeth. I've never really given too much thought to my dental health and I don't have any fillings, didn't as a child either. So the make up of your body is very likely to also play a factor.

My DD had terrible weak baby teeth and has to have all sorts of work done on them. Our other kids are fine and did the same diet and oral care. Apparently DH milk teeth were rubbish too, despite MIL spending lots of time and money on them. DD adult teeth are all strong and healthy and never needed anything done thank goodness.

Having to use non dairy milks is very difficult and you’ve obviously done what you could.

There are some very rare disorders that cause weaker teeth , there are some disorders like reflux that cause problems with teeth, there are some medications that cause problems. There are some problems like ARFID that make dietary choices difficult .

However for the vast,vast,vast majority of children and adults it is diet that’s the problem. The average U.K. child eats 7 times a day and eats two to three times the recommended amount of sugar daily. Much of that in the form of snacks and drinks https://www.dentalhealth.org/news/uk-sugar-consumption-alarming-says-oral-health-foundation

Dental decay is the number one reason for a young child to need a hospital visit in the U.K. and that number is rising year on year. https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/dental-stats-sept-25/

The heart breaking thing is the vast majority of this is preventable for most people . Change your diet so you are consuming something sugary or starchy no more than three times a day.

However the research shows that for the majority the child who is having extractions at three and four goes on to be the child and adult who needs more and more treatment. https://www.nature.com/articles/sj.bdj.2017.175

The message for most people is that that yours and your child’s dental health rests in your hands . For the vast majority of people you can make the changes to stop needing more treatment , these changes are simple and don’t mean eliminating foods/drinks from diet. For the vast majority of children “weak teeth” are not a cause of dental problems .

I know there is a problem with NHS dental access but dentists do not prevent decay , it’s what goes on at home that makes the difference.

keep sugary/starchy foods to meal times only
dairy milk/water only between meals
limit snacks to tooth safe options
brush your child’s teeth with a fluoride containing toothpaste twice a day but this won’t help much if you don’t follow dietary advice

@Lollygaggle my daughter is dairy free due to multiple food allergies. We are very mindful about when we give it and how we give it. For us it was very much the uncontrolled reflux that damaged her teeth. The repeated exposure to the acidic stomach contents every night for months was far worse than any component of her diet.

We had a conversation about it with the dentist and they were advocating drinking only water for teeth. The problem with that was they weren't looking at the whole child. If we removed the oat milk she would have had no sources of calcium or iodine in her diet. Water has 0 calories and 0 fat and as someone that has a limited diet and a poor appetite she really needed the calories and fat for growth. It is hard to keep oat milk to meal times as she would then fill up on oat milk and not eat the meal and her diet needs food and oat milk or at her most picky only have one meal in two days. In the last 18 months she has dropped two percentiles in weight.

We had developmental delays when she was having dairy as she was so distressed every from the pain it also caused her reflux to be worst which would be more damaging for her teeth. Her diet is carefully controlled by dieticians to ensure that we aren't storing up more problems in the long term. For us using dairy free milks wasn't a difficult decision. It was our only option

Yes medical dietary restrictions are very difficult and medical nutritional advice is paramount. Reflux is very difficult to deal with.

However the vast majority of children needing dental extractions do not have these problems and 98% of all dental treatment is avoidable.

The heartbreaking thing is research shows us the majority of children needing dental extractions at a young age go on to have high dental needs for the rest of their life.

The idea that simple dietary changes could stop any need for dental treatment for the vast majority of children and adults is not a concept the UK public has yet taken on and acted on. Indeed since Covid rates of snacking have increased and rates of dental decay in children have increased .

@Lollygaggle100% agree. Week in, week out, hundreds of children’s teeth -both deciduous and permanent- are extracted under GA in our service. Simple dietary changes are all that are needed in the overwhelming majority of cases.

It is heart breaking , yet there is still the general opinion that childhood decay is down to

weak teeth
lack of NHS dentists

when the fact is the few minutes a year spent in the dental chair don’t change your oral health , it’s the every day decisions that are made in the home that count . Your oral health is , by and large , in your hands .

There are very rare occaisions when teeth are weak and yet the most common cause of enamel mal development MIH (molar incisal hypoplasia) does not make the tooth weaker in the majority of cases it is a cosmetic problem only.

It is an utter delight when , on the very rare occaisions it happens , a parent takes on board the dietary advice given and changes their child’s diet . All of a sudden the “weak teeth” are no longer weak! Unfortunately though statistics show the child who comes in for GA extractions is very, very likely to continue that poor dental health for life .

Yes some of those poor dietary choices are in low socio economic populations , but there are also many “health led” families who have cut out refined sugar who refuse to see that fruit based sugars, agave syrup, honey etc cause decay just as easily and often compound the problem by not using fluoride containing toothpastes.

Dentists don’t cure decay , they just repair the damage , dietary choices made at home cure decay,

@Lollygaggle when we first saw our dentist we were looking probably needing treatment in 3 of my daughters molars. The 1 with the cavity and the two that were showing signs of acid damage as well. It has been a real sense of pride that we have managed to save her other teeth from damage.

The change in her reflux medication but we didn't introduce sweets until her teeth were stable (she had never had them when she got her cavity), only had juice on her birthday and at Christmas, citrus fruits once a month, no more than 2 portions of fruit a day, no dried fruit. The oat milk we couldn't do much about but we knew that we had to be extra keen with everything else.

Our town doesn't even have space in the private dentists and there isn't an NHS dentist at all. We paid privately for her to see a dentist in a different town. I would say that access to dentists does have an impact, we got advice on toothpastes and wouldn't have put the pastes on the teeth overnight without the dentist suggesting this. She has had fluoride paste put in her molars every 3 months to help protect her teeth. Getting in early whilst it was a small cavity and having the evidence of the tooth damage helped prove her case to the paediatrician and they significantly increased her medication on the back of this which managed the reflux and prevented further damage.

Many of the most in need families wouldn't have the £45 per child to see a private dentist. We did get her in an NHS dentist but it's two towns away and many of the most disadvantaged children at biggest risk of tooth decay this would be prohibitive. £3 /1.50 each way for the bus per adult /child is more than many can afford. It's a cascades effect - the children living in the poorest communities often have worse diets and less access to help and support. The cavity in the OPs child was picked up a school but most councils no longer do dental, eye or hearing tests.

The children we are talking about , though, are those who are having treatment for decay as they are having a general anaesthetic . To have got that far they will have seen several dentists and had multiple contacts with dental health professionals who will have given dietary advice.

However the sad fact remains that lifestyle change is a very difficult health change to effect and , statistically these children will remain needing dental interventions for the rest of their lives .

People , such as yourself , who actively are interested and make interventions at home remain very much in the minority . Yes the fluoride will have helped but your dietary decisions and cleaning habits will have made the biggest difference.

Although lower socio economic groups remain at highest risk, this is not exclusive with between 30 to 45% of 5 year old children experiencing decay in, on average , 3.5 teeth.

This is hardly surprising when the average 5 year old U.K. child eats over double the daily recommended amount of free sugar , let alone the sugars in fruit juices , raisins etc which are not counted in this statistic.

Your experience shows that taking on board advice about cleaning and diet , alongside medical changes (which will not be the case in the vast majority of child decay cases) can make a huge difference . Sad experience shows that even when families have contact with dental health professionals and are given that advice it is , in the majority of cases , not acted on.

Yep, happened to us. Felt mortified…one small cavity discovered age 3. They referred them for it to be treated under anaesthetic due to their age and SEND. Mislaid referrals and long waiting lists meant they weren’t seen until they were 8. The decay had spread to other teeth so three were extracted under GA. We brushed regularly, avoided sugar etc and the dentists said it might be just that their enamel is weaker.

My DS had teeth extracted at a young age. My dentist is adamant that snacking between meals is a huge no-no, even healthy snacks. My youngest is eats similar diet, and no decay at all, so it’s possible he’s right but I don’t know for sure. Also, I don’t know how I can get my kids to never snack!

Tooth decay generally happens during, and for 20-60 minutes after, consuming food, while your mouth PH is acidic and your enamel demineralises.

After 30 minutes, saliva restores the alkaline balance in the mouth and saliva contains small quantities of calcium, phosphate and fluoride which helps your enamel remineralise.

The type of food is often less relevant than how frequently it is eaten. You can eat cake for dessert after every meal and have great teeth.

If you sip oat milk for 3 hours per day your teeth will decay as you are bathing them in an acidic environment with no recovery.

That's not to say that brushing is not important, it is, and sweets are terrible as they stick to teeth and keep the mouth acidic for longer... but the exposure time is critical and not well appreciated.

@Superscientist interesting!! He had terrible reflux ×when he was younger - it hadnt even occurred to me!