toddler's teeth (291HFig. 7.6). Supervision of toothbrushing is also important to avoid
overingestion of toothpaste.
Key Points
- Preschool children need help with toothbrushing.
- Parents should help with brushing to ensure effective cleaning and avoid
overingestion of fluoride toothpaste.
292H
Fig. 7.6 Standing or kneeling behind the
child in front of the sink or mirror is often
the easiest way to effectively brush a
young toddler's teeth.7.6.5 Diet
Frequent consumption of drinks and food containing sugars is a key aetiological
feature in many preschool children who present with caries. Hence, reducing the
frequency of sugar-containing food and drinks is a key dietary message to deliver to
parents. However, for such advice to be effective, it must be delivered in an
understanding way and should take into account some of the difficulties parents may
face in making such changes to their child's diet. Young children have a high
metabolic rate and their dietary calorific requirements are high. Many young children
with early childhood caries are also 'poor eaters', their parents often reporting that the
child does not eat well at meal times. Such children often make up the calories missed
at meal times by consuming fruit-based drinks between meals, which are high in
calories. As well as helping to meet the child's nutritional requirements this also
suppresses the appetite so that when the next mealtime approaches the child is not
very hungry. Parents frequently misinterpret this, and think the child asks for drinks
because of thirst. A history of poor sleeping is also common, with parents relating that
the child 'will not sleep without the bottle'.
Once established, such cycles of behaviour can be difficult to break and many parents
have a sense of guilt that their child has dental decay, feeling that they must have
done something wrong. For counselling to be effective it is essential to avoid making
the parent feel excessively guilty, but to concentrate on the aetiology of the condition
and practical strategies to deal with these problems. Stopping a night-time bottle habit
can be achieved quickly by some parents, but can prove difficult for others. The idea
of leaving the child to cry rather than giving it a bottle might seem a good idea whilst
in the dental surgery, but is a more challenging proposition at three o'clock in the
morning! Weaning children from a night or daytime bottle of juice can often be
achieved by gradually making the juice in the bottle more dilute over a period of a
few weeks until the contents become just water. At this point the child will either
discard the bottle or will continue to suckle on water alone, which is, of course, non-
cariogenic. Thirsty children will always drink water.