|
Dental disease, though of low morbidity and mortality impacts quality of life and many hours are spent in the dentist’s clinic repairing the ravages of dental decay and gum disease. Such treatment is costly especially when it occurs in young children, as several resources need to be marshalled to treat the pre-cooperative or often uncooperative child.
 
The concept of prevention, though well accepted in the medical and dental fraternity, does not translate into behavioural change in Singaporeans. In 2006, an oral health survey of 6000 adult Singaporeans indicated that only 45.5% visited the dentist once a year for a check up. 31% of Singaporeans will only visit a dentist when there is pain. The survey revealed gaps in the knowledge and practices of Singaporeans regarding dental health. Though no survey was done on Singaporeans’ knowledge, attitude and behaviour on their children’s teeth, it is safe to assume that parents are even less likely to bring their children for check up than they would themselves. This is regretful as 40% of preschool children in Singapore have a severe form of decay called Early Childhood Caries (ECC ).2
This low attendance rate can be attributed to the misconception (even in the medical community) concerning primary teeth i.e., they can be left to rot, as they will drop out anyway. This could not be further from the truth. Primary teeth are replaced slowly between the ages of 6-12 years. During this time, they are needed for function, speech and aesthetics. Primary teeth can get infected, which can affect the development or eruption of the permanent teeth. Rotten primary teeth pave the way for rotten permanent teeth. From a moralistic and legal standpoint, the child has a right to a pain free dentition. In America, dental neglect is ranked closely to child abuse and is a reportable crime.
In the 1900s, the American Academy of Paediatric Dentists recommended the child’s first dental visit to be at age 2-3 years. This age was arbitrarily chosen because it was thought that by 3 years, the child would be able to cope socially in a dental setting. However, by then, many children had developed ECC. In fact extensive dental treatment rather than preventive work was needed. A better understanding of the aetiological factors to ECC has prompted the Academy to change its recommendation that the child’s first dental visit should be by age 1 year or shortly after the first tooth erupts. The considerations that led to this change are:
1. ECC is an infectious disease, the infective agent is strep.mutans, an oral bacteria.
2. Infants are infected with strep.mutans by their parent (usually mother) or caregiver through saliva.
3. Mothers who have high levels of strep. mutans in their saliva are more likely to infect their infants.
4. Early infection of strep.mutans increases the risk of ECC. High levels of strep.mutans have been detected in
children as early as 9 months of age.
5. It is possible to assess an infant’s risk of developing ECC through clinical examination, salivary test and lifestyle
questionnaire.
 Infant Oral Health Clinic at NDC
The Infant Oral Health Clinic at NDC is the first in Singapore that runs a preventive oral health program for mothers and their infants. Taking prevention seriously, Paediatric Dentists assess infants’ caries risk, which includes identifying risk of strep.mutans infection from their mother, monitor oral development and customise a preventive treatment plan based on the risks identified.
Each year, NDC treats 500 preschoolers for ECC. Their treatment ranges from total extraction of all primary teeth, to full mouth restorations. Parental ignorance on infant dental care is the incriminating factor. We hope that with concerted efforts of medical and paramedical professionals and all professionals who deal with children, we can reduce the prevalence of ECC. Education and timely referral is a first start in this direction.
For more information on ECC, go to www.ndc.com.sg/EarlyChildhoodCaries
GP enquiries: capp@ndc.com.sg
References
1) Wong Mun Loke, Chan Siew Pang. What do Singaporean adults know, feel and do about oral health? Singapore Dent J 2006;28:54-60
2) Gao XL, Kol D, Hwarng HB, Loh T, Xu YJ, Hsu C.Y. Caries status and risk assessment for preschoolers in Singapore. 2006, Poster presentation FDI World Dental Federation Congress, Abstract #1496
|