Smile without fear: Why a child's first trip to the dentist should be pleasant
WHEN it comes to oral care in children, dentists are unanimous: One of the biggest mistakes parents make is not bringing their toddlers and children in for regular check-ups early.

Most of the time, they say, a child's first trip to the dentist happens only when they complain of a toothache or dental discomfort and more often than not, this is too late.

"When a child comes in for treatment or extraction due to dental caries, the experience will be unpleasant and he or she will develop a fear of dentists," says Malaysian Society of Periodontology (MSP) president Dr Mohd Faizal Hafez Hidayat, adding that "... this trauma can be lifelong.

"Also known as tooth decay or dental cavities, the World Health Organisation (WHO) characterised the condition as "the most common noncommunicable disease worldwide." Severe dental caries will affect health and cause pain, and may result in tooth extraction.

Dr Mohd Faizal, who is also the head of Centre of Periodontology Studies at Universiti Teknologi MARA (UiTM) says the issue can also be generational. "Young parents don't bring their young children early because their parents didn't being them early either," he says.

Dr Mohd Faizal says losing milk teeth too early could lead to misalignment of permanent teeth. — Photos: Systema

Breaking the cycle

Dentist Dr Kayla Teh says this cycle needs to be broken if parents want the younger generation to have excellent dental health which will help delay tooth decay and its complications, including gum disease.

"In urban areas, kids are exposed to ultra processed foods, including gums and sweets. This, coupled with ineffective dental care, fast-tracks tooth decay. I see kids as young as four needing tooth extraction," she says.

The ideal age of losing milk teeth, she says, begins around six and seven years old, when the front teeth start becoming loose as the permanent teeth push their way up to replace milk teeth.

Dr Kayla says ultra processed foods coupled with ineffective dental care, fast-track tooth decay.

"This replacement process continues until the child is 12 or 13 years old, with wisdom tooth being the last one to be replaced, between the age of 18 to 25," she adds.

Dr Faizal says another factor that delays dental visit is the myth surrounding milk teeth. "Some parents believe losing milk teeth is fine because the kids have another set of teeth. But what some of them fail to realise is that when you lose a milk tooth before the permanent tooth is ready to come out, the space might be filled by the two flanking milk teeth and the permanent tooth won't have adequate space for itself," he says.

"This results in teeth misalignment when the child is older and this takes effort and cost a lot to fix," he says.

Dr Teh says there are gaps in-between milk teeth. "This is normal because permanent teeth are wider. The milk teeth's role is to retain the position for permanent teeth so you need to look after milk teeth the best you can," she says.

Sem arranges dental appointments for her children when they were between one and one-and-a-half years old. — SEM XIAO HUI

Very early start

Dr Teh says good dental care starts at infancy, with adults wiping babies' gum with gauze and water after bottle feeding. "This is especially important if the baby is fed with formula milk, which is sweeter than breast milk,"

Once the first tooth is out, parents need to brush their child's teeth with an age-appropriate toothbrush. Between the ages of three and six, children can use pea-sized toothpaste and they should be taught to gargle and spit out the excess toothpaste after brushing.

When the child is six, he or she can start using fluoridated toothpaste. "During this time, the child can brush his or her own teeth but parents should closely supervise to make sure the child brushes properly, especially his or her back teeth," she says.

Global public health researcher Sem Xiao Hui, 40, understands the need for early dental exposure for her children Yee Chern, eight, Yee Faye, five, and Yee Hann, one.

"I arrange their dental appointments as early as when their first few tooth have appeared and when they understand instructions," she says, adding that this took place when her children were between one to one-and-a-half years old.

To ease any apprehension each child may have, Sem either looked for a kids dental clinic or a clinic which is kid-friendly. "I also prepare them by reading to them picture books depicting dental visits and why they should not be afraid of it," she says.

With her preparation, all her children had a very pleasant first visit, which laid the good foundation for future dental check-ups.

None of her children has lost any of their milk teeth and Sem attributes this to regular check-up. "If anything was wrong, I would have known early before any dental issue causes pain in my kids," she says.

"The other benefit of having regular check-up is that kids tend to look after their teeth better because if they don't, then the dentist would know a few months down the road.

"Parents should not be misinformed and a lack of awareness and dental education have led parents to believe that it's okay if a child loses milk teeth prematurely. If milk teeth drop prematurely, this will cause more problems when adult teeth sprout," she says.

Cham with her daughter Foong. — CHAM YIN HWA

Childhood practice

Policy analyst Cham Yin Hwa, 38, has her mother to thank when it comes to her dental habits and how she is shaping the habits of her family.

"I have always had my regular dental check-up every six months since my school days. When I was small, I was always afraid of the dental nurses who would come to school for students' dental check-up," she says.

"But I credit my mother, who despite her working schedule, still made time to bring my siblings and I for regular check-up," she adds. From then on, she said, Cham and her siblings always made sure they flossed their teeth daily before bed. "It is that habit that I have cultivated that helps me establish an oral care routine for my kids," she says,

When her daughter, Foong Chin Wen, 15 months, had her first tooth, Cham took her for a dental check-up. "That's in accordance to the guidelines by the Ministry of Health (MOH) on its website under 'Pertumbuhan Gigi Si Comel Anda'. I did the same for my older son too," she says.

"While many people feel that it's weird or too 'kiasu' to bring your baby to the dentist that young, but going to the dentist shouldn't happen only when you face issues or have problems with your teeth. It could also uncover other underlying dental issues so preventive measures could be taken," she adds.

Regular dental check-up allows kids to associate dental visit positively. — Filepic

Food for teeth

Dr Teh says fibrous foods are good for teeth. "When you eat, an apple, for example, or other hard fibrous fruits, salivation is increased which helps clean your teeth and neutralises the acids left in your mouth," she says.

"Drinking apple juice, on the other hand, may contribute to tooth decay as there is no chewing involved," she says.

As the place on which teeth grow, gum health is directly correlated to tooth health. When you don't brush, floss and use mouthwash – the three steps for holistic at-home dental care – a food residue and bacteria combination called plaque builds up around your teeth. The plaque's acids attacks the teeth and causes decay. Over time, the plaque hardens top become tartar and consequent buildup inflames your gums."This is why you need to regularly see the dentist; so any dental issues can be nipped in the bud,"

Dr Mohd Faizal says, adding that for this year's Gum Health Day 2024 celebration on May 12, the European Federation of Periodontology (EFP) launched its Gums Rock! Keep Them Safe! campaign, targeted at Gen Z with TikTok being the main platform to disseminate information.

Dr Mohd Faizal and Dr Teh were at Systema's #GumHealthFirst campaign launch, with MSP and the Health Ministry to help tackle the country's gum disease issue and raise awareness about the critical role healthy gums play in a person's overall wellness.

"Gum disease was once a problem of the elderly, but with a less tooth-friendly diet coupled with a lackadaisical attitude in dental care, the condition is affecting younger people," Dr Mohd Faizal adds.

Dr Mohd Faizal says a reversal of this trend requires everyone's efforts. "It all goes back to knowing the importance of early dental care and this starts from home, with parents taking a proactive measure for the toddlers' dental health long before they complain of toothache," he concludes.
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When a child comes in for treatment or extraction due to dental caries, the experience will be unpleasant and he or she will develop a fear of dentists.