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How to prevent caries
1 How To Prevent Caries By Joylyn Fowler Garden Grove CA USA From NEW BEGINNINGS, Vol. 19 No. 5, September-October 2002, p Vanya was almost 2 years old when his mother Olga noticed a brown speck on one of the chewing teeth, like a sticky food. When Olga failed to clean the stain with a brush, she took her son to the dentist. The doctor managed to examine the oral cavity, only having made the boy anesthesia. During the examination, the dentist discovered that all the teeth, except one, are affected by caries. Four front teeth had to be removed, two crowns were put in, and the rest, except for one healthy tooth, were sealed. The dentist told Olga that breastfeeding at night is the same as bottle feeding. To save the teeth will have to stop feeding at night. Olga doubted the recommendation of the dentist. "It can not be! People fed children for millennia, and their teeth were fine, she thought. Olga decided to continue feeding Vanya at night, as the family was preparing for the move, which, even without a night of weaning, was quite a stress for the boy. Mom tried to wipe her teeth with a soft cloth after each night feeding, but Vanya woke up during this procedure. For several months, Olga gradually stopped feeding her son at night. Why did the dentist decide that breastfeeding, especially at night, could cause caries? Human milk contains lactose sugar. It is well known that food and drinks containing sugar often cause tooth decay. Some studies have traced the relationship of feeding and caries, while others argue that there is no connection. The American Academy of Children's Dentists recommends not to feed the child at night after the first teeth appear (Pediatric Dentistry magazine). Many dentists agree with this recommendation, both in the US and outside. Let's understand the existing contradictions among the data on children's caries. Analysis of research results Dr. Joyce Sinton and her colleagues conducted a comparative analysis of research on feeding methods and caries, trying to determine why researchers disagree on the effect of breastfeeding on teeth. They concluded that in many studies, during which the connection between breastfeeding and caries was found, the research methodology did not meet the standards, and the researchers came to contradictory results. Most of the articles found by researchers were not included in the final review, because they were merely descriptions of particular cases: it was about one or more infants who were already found to have caries at the time of the study. In these cases, it was assumed that tooth decay was caused by breastfeeding, but no evidence of this was given. The researchers stated that in fact they had to exclude most of the "classic" articles about the relationship of caries and breastfeeding. The remaining studies were very carefully compared, and concluded that the results were often inconsistent due to the neglect of other factors affecting
2 on the occurrence of caries: for example, the fluoridation of water or components of the infant diet in addition to breast milk. Also, the researchers did not give clear definitions of the concepts “breastfeeding” and “effective care of teeth”. So, children in mixed feeding are considered breastfed in one study and artificially in another. Confusion in the definitions leads to deceptive results, since exclusive breast and mixed feeding affect the body in different ways. The use of such inaccurate definitions indicates an unscientific approach to the study of the issue. Reliable information about caries and breastfeeding is very important, as recently, early childhood caries is widespread. The high cost of treatment even more draws attention to the problem. Researchers claim that in some countries, the prevalence of caries at an early age has taken on epidemic proportions (Tinanoff, O'Sullivan 1997). The cost of caries treatment in children in the United States costs in dollars for treatment and for medicines (Erickson, 1999). One can only guess about moral damage both for the child and for the parents - especially if it is a question of sharp weaning. Evidence for breastfeeding Not all dentists and scientists believe that breastfeeding, including at night, leads to tooth decay. The data of Dr. Harold Slavkin showed that "studies based on a population survey did not reveal a link between long-term breastfeeding and caries." Dr. Konstantin Oulis and his colleagues concluded that breastfeeding can "have a preventive effect and inhibit the development of caries in children." Dr. Harry Torney examined 107 children who had breastfed for at least two years (about half of them were not weaned at the time of the study). He found no evidence to suggest that prolonged breastfeeding on demand leads to caries (Torney, 1992). Dr. Brian Palmer is one of the most active supporters and zealous advocates of breastfeeding in the fight against tooth decay. He is confident that caries in young children is a relatively new phenomenon. Palmer studied ancient children's skulls from various museums. Signs of destruction were found on less than 1.4 percent of the teeth. In total, Palmer examined 1344 baby teeth, of which 19 were slightly affected by caries and only 4 (0.3 percent) had serious damage. Anthropologists believe that anatomically modern man has been around for years, despite the fact that modern humans appeared about 30,000 years ago. At the same time, studies of skulls indicate the occurrence of caries at an early age only 8-10 thousand years ago, which means that the previous 92 thousand years had no caries in young children (Palmer, 2000). What happened 8-10 thousand years ago? Humanity has learned to process food and eat differently. Presumably, babies in prehistoric times sucked their breasts at night for 2-3 years or longer. On this basis, the idea that breast milk leads to tooth decay seems implausible. If this were so, traces of caries would be found on teeth older than 10 thousand years. In addition, as Dr. Palmer says, "if breast milk resulted in tooth decay, it would be an evolutionary suicide." There are data from two more studies that compared the influence of modern
3 artificial breast milk substitutes (mixes) and breast milk itself for factors that are considered to cause caries. These studies revealed significant differences between human milk and most blends. First, it was found that breast milk has virtually no effect on the acid-base balance in the oral cavity, while almost all brands of mixtures make the medium more acidic. Streptococcal bacterium, which is blamed for the destructive effect on the teeth, best reproduces in an acidic environment. Secondly, most of the mixtures contributed to the active growth of bacteria, and in breast milk, this growth was much slower. Thirdly, it turned out that the mixture dissolves tooth enamel, while breast milk, on the contrary, remineralizes it (ie, “supplies” calcium and phosphorus to teeth). The researchers also came to the conclusion that human milk, washing the teeth, does not lead to caries, if there is no other source of carbohydrates on the teeth that are necessary for bacteria to reproduce. Most of the artificial mixtures tested cause caries. (Erickson, 1999) These studies show how important the accuracy of definitions is. A mixed-feeding baby should be treated separately from infants in studies on children's caries, since the mixture dissolves tooth enamel, while breast milk, on the contrary, remineralizes it. Streptococcus mutans Most often, children become infected with Streptococcus mutans (a type of streptococcal bacteria) from parents or other people caring for children. Infection occurs through kisses, playing with the parental toothbrush, or using common forks. Once in the baby’s mouth, Streptococcus mutans (S. mutans) begins to multiply rapidly. This bacterium has properties that prevent the growth of similar bacteria and many other microorganisms, and thus can become the predominant bacterium in a child’s mouth (Slavkin, 1999). S. mutans can be controlled by preventive methods. One study found that “if pregnant women, starting from the seventh month of pregnancy, rinse their mouths daily with sodium fluoride solution and chlorhexidine, bacterial colonization of the mouth of their children is delayed by an average of 4 months” (Slavkin, 1999). As with all drugs, both sodium fluoride and chlorhexidine should be prescribed by a doctor. However, the use of these drugs is associated with certain side effects, so the need for these tools is questionable. Before taking medications, you should consult with your doctor and weigh the balance of benefits and risks. The later the child encounters S. mutans, the less likely it is the occurrence of caries at an early age. Use individual toothbrushes and cutlery. Never lick artificial nipples or pacifiers. Knowing that S. mutans breeds best in an acidic environment, maintain a neutral environment in the mouth. This will help maintain a healthy bacterial flora in the mouth (Slavkin, 1999). As mentioned above, the mixture, in contrast to breast milk, creates a more acidic environment in the oral cavity, so it is better not to feed the children with the mixture. If supplementation is unavoidable, be sure to brush your baby immediately after feeding the mixture. In the process of digestion, the acid-base balance is restored, and as a result of swallowing food, the environment becomes neutral. When we eat or drink, saliva
4 begins splitting food into simpler sugars that are contained in the entire meal. Sugars, in turn, fall on the teeth, feeding the bacteria, promoting their reproduction and creating an acidic environment in the mouth. In an acidic environment, minerals are washed out of the tooth enamel. Between meals, saliva restores normal acid-base balance. As already mentioned, breast milk remineralizes tooth enamel, strengthens children's teeth and helps prevent tooth decay. Dr. Palmer notes that “some components of breast milk can also protect teeth from caries. Thus, IgA and IgG immunoglobulins are able to inhibit the growth of S. mutans. Also, S. mutans is very sensitive to the bactericidal effect of lactoferrin of one of the main components of breast milk. ” The process of sucking Breast milk is not long in the mouth in the process of sucking the breast. When the baby sucks the breast, the nipple is deep in the baby's mouth, and the milk is injected practically into the throat. In addition, the sucking process includes mandatory swallowing - before the child continues to suck, the baby must first swallow the milk. If a baby drinks milk, juice or a mixture from a bottle, the liquid continues to flow into the mouth, even if the child sucks the bottle inactively. If the child does not swallow, fluid accumulates in the mouth, washing the front teeth. The liquid entering through the short nipple also washes the teeth before getting into the throat. Dry mouth is another cause of tooth decay in young children. Saliva maintains a neutral environment in the mouth. At night, salivation decreases, especially if the person breathes through his mouth. This is one explanation why brushing your teeth before bedtime reduces the risk of caries. If the baby sucks often at night, he continues to produce enough saliva to prevent the mouth from drying out. Family matters Heredity plays a significant role in the occurrence of caries. We cannot change the genes of a child, but it is important for parents to pay attention to the prevalence of caries and other dental problems in the family. Armed with the necessary information, parents can engage in the prevention of children's caries already during pregnancy. Oral hygiene plays an important role in the prevention of caries. Parents who regularly brush their teeth not only set a good example for their children, but also reduce the number of bacteria in their mouths, thereby reducing the likelihood of transmitting S. mutans. Joint visits to the dentist allow you to get used to the situation of the dental office from early childhood and get acquainted with what happens during preventive visits. In families with a genetic predisposition to caries of children, it is recommended to show the dentist every six months from the time the first teeth appear. An early visit to the dentist will also help detect any defects in the enamel. Brushing your teeth baby needs to start as soon as they appear. At first it can be done with a piece of gauze or a soft cloth. Children should learn to brush their teeth as early as possible, but at the same time, parents should continue to brush their teeth themselves at least 2 times a day until the child can do it himself. A full and varied diet is an important component of caries prevention.
5 A healthy diet increases the body's resistance to microbes and bacteria. Give your child to drink water, not juice or other liquids. Water does not make the environment in the mouth acidic, and there is no sugar in the water, which has a destructive effect on the teeth. Avoid foods that are long in the mouth or stick to the teeth. For example, when a child sucks a lollipop for a long time, during all this time the level of acidity in the mouth rises. Sugar gets on the teeth, bacteria begin to multiply actively, enamel demineralization begins. Until the child brushes his teeth or saliva does not wash away all the sugar from the teeth and restores the neutral environment, the teeth are at risk of destruction. But if a child eats an apple, chewing and swallowing promotes the washing of teeth with saliva. However, some useful products, such as dried fruits, stick to the teeth and can begin demineralization. Dr. Palmer believes that heredity is not the only factor influencing the development of caries. Parents can take care of dental health long before the baby is born. According to Palmer, there are four factors that increase the risk of children's caries: stress during pregnancy, especially associated with the loss of a loved one; lack of dairy products in the mother’s diet; serious maternal illness or taking antibiotics during pregnancy. Of course, not all of the above circumstances can be controlled by a woman. People get sick and die, and this is not under our control. A reduction in the overall level of stress is subject to much and has a positive effect on both the mother and the child. Regular monitoring of a woman during pregnancy helps to improve maternal nutrition and reduces the likelihood of illness. If you happen to get sick, sometimes you need to resort to antibiotics. In this case, each woman should assess her specific situation and discuss with her doctor how much the benefits of taking antibiotics exceed the risk. It is impossible to foresee and avoid all risk factors for caries, but, having all the necessary information, a woman can make the maximum possible efforts to prevent the disease. Treatment The treatment regimen depends on the parents: it is easier for them to decide which methods are acceptable for their child. This article describes several possible treatment options. Additional options were published in the Toddler Tips section of the New Beginnings magazine (July-August 2000 issue). In the early stage of damage, teeth can be remineralized with food additives and the use of fluoride. That is why children at risk are particularly recommended early prevention, diagnosis and treatment. Regular brushing reduces the number of bacteria in the mouth. Recently, an article about a study appeared in Mothering magazine, which states: “The first attempts of scientists to destroy S. mutans with antibacterial mouthwash were successful” (Raegan, 2000). If the teeth are already affected by caries, the choice may be limited by filling or extraction of the tooth. In case of need for general anesthesia, parents should learn more about preoperative fasting as applied to breast milk. Together with the anesthesiologist, you can develop the most gentle abstinence for the child before the operation.
6 Often, parents of breastfed babies have to look for an understanding pediatric dentist. If your dentist is not familiar with the physiological characteristics of infants, try providing your doctor with information about breastfeeding and caries research. Conclusion on the key points of the research: breastfeeding and caries. Was it really necessary to wean Vanya from the chest? According to Dr. Palmer, there is no, and he is not the only doctor who holds this opinion. - Surveys based on population surveys have not established a link between long-term breastfeeding and caries (Slavkin, 1999) - Long-term breastfeeding on demand does not lead to the spread of caries (Weerheijm, 1998) - Breastfeeding can prevent and inhibit the development of caries in children ( Oulis, 1999) - Lactose to a lesser extent than sucrose serves as a food source for bacteria that cause tooth decay (Rugg-Gunn, 1985). Conclusion Mom Vanya is not the only one who was told to wean the baby from the breast. Catherine feeds the 18-month-old daughter Yulya. The children's dentist insisted on an immediate cessation of feeding prior to the start of caries treatment. Catherine found a dentist who is more knowledgeable about breastfeeding and continues to feed Yulia with confidence that not only did feeding not cause tooth decay, but, perhaps, reduced the rate of caries spread. And, of course, feeding helps to calm Julia after unpleasant dental procedures! References AAP. Breastfeeding policy statement. Pediatrics 1997; 100 (6): Clinical guideline for early childhood caries and breastfeeding. Pediatr Dent: Erickson, PR & Mazhari, E.E. Pediatr Dent 1999; 21 (2): Erickson, P., McClintock, KL, Green, N. et al. Estimation of the caries is associated with infant formulas. Pediatr Dent 1998; 20 (7): Oulis, C. et al. Feeding practices for children with and without nursing caries. Pediatr Dent 1999; 21 (7): Palmer, B. Breastfeeding and infant caries. ABM News and Views 2000 Dec; 6 (4): Palmer, B. "Infant Dental Decay Is It Related To Breastfeeding." A Presentation, Reagan, L. Big bad cavities, breastfeeding is not the cause. Mothering 2002 Jul-Aug; 113. Rugg-Gunn. A. et al. In vitro and enamel dissolution in vitro compared with bovine milk, lactose and sucrose. Caries Res 1985; 19 (4):
7 Sinton, J. et al. A systematic overview of the relationship between infant feeding and breast feeding. Ont Dent 1998; 75 (9): Slavkin, H. Streptococcus mutans: early childhood caries and new opportunities. JADA 1999; 130: Torney, H. "Prolonged, On-Demand Breastfeeding and Dental Caries-An Investigation" [unpublished MDS thesis]. Dublin, Ireland, Tinanoff, N. & O'Sullivan, DM Early childhood caries: overview and recent findings. Pediatr Dent 1997; 19 (1), Weerheijm, KL Prolonged demand breastfeeding and nursing caries. Caries 1998, 32 (1): Informative website Prevention of caries during pregnancy: - Eat foods rich in calcium - Try to be as little nervous as possible - Take care of yourself, see your doctor, treat all diseases in a timely manner - If possible, try to avoid taking antibiotics Prevention of caries in children - Do not administer supplements until signs of readiness for it appear (6 months and older). - Do not eat with a baby with one spoon and do not give him anything from your mouth; The child’s toothbrush should have its own. - If you use nipples or pacifiers, do not lick them. - Set a good example for your child: brush your teeth often and carefully. - Brush your child's teeth with the appearance of the first teeth, especially after he ate or drank anything besides breast milk or water. - Try to cook nutritious and varied food, with lots of whole foods and natural sugar. - When giving sweets to your child, choose those that are smaller in the mouth. - At night, breastfeed your baby or offer water to prevent dry mouth. Causes of caries: - Streptococcal bacteria transmitted from parents to children. - Transferred diseases and stress during pregnancy, taking antibiotics. - Malnutrition. - Poor oral care. - Dry mouth. - Frequent and long-term use of sweet. Anna Novikova Translation
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