If you saw Channel 4's latest expose on childhood obesity, Junk Food Kids, you might have been struck by one aspect of it: dental decay. Indeed, in among the talk of overweight children and gastric bands lay a vast number of rotten teeth.
But the problem is not exclusive to the UK. “The anecdotal evidence is that we’re seeing dramatic surges in prevalence of dental decay in young children,” says Dr Michael Crowe of Ganter Crowe dentists in Dublin.
Indeed, while figures on the levels of extractions undergone by Irish children are hard to come by, Crowe points to the example of the now-closed primary dental care unit at St James's Hospital. In 2013, some 50 children aged between two and five had more than eight teeth removed each. And in the UK, dental extractions are now the main reason for the use of general anaesthetic.
“Children at a very young age are getting general anaesthetic for dental disease, which is preventable,” says Crowe, noting that it’s a very expensive procedure at such a young age.
“If you put the same resources into prevention, you wouldn’t have the same problem,” he argues.
Dr Margaret Tuite, who moved back to Ireland from the US in 1993, has noticed a significant increase in problems with tooth decay since her return.
“The thing I’ve noticed most is the increase in the use of fruit juices and dairy drinks, such as yogurt drinks. A lot of parents buy into the advertising that their children are getting extra vitamins and calcium, but it’s a large contributor to decay.”
So-called “baby-bottle syndrome” is another issue, whereby an infant is put to sleep with a bottle in their mouth.
“The formula then rests on the teeth for a prolonged period and it’s really a very common way of initiating early childhood decay,” says Crowe.
Another problem is the “but they’re just baby teeth” mode of thinking.
“There is an inherent understanding that it’s not as important for baby teeth,” says Crowe, but he argues that there can be serious consequences of not taking care of these teeth, including losing baby teeth earlier and crowding the new teeth as they arrive.
It comes down to two things, says Tuite: taking care of teeth, and diet.
“Two minutes is enough cleaning: not two minutes walking round the bathroom with a brush, but full-on, concentrated brushing,” she says, adding that children should be offered only plain water or milk to drink, with even sparkling water containing acid that can strip enamel from teeth.
Going to the dentist
Another issue is the limited public dental system. The HSE Public Dental Service currently provides dental services for children but, due to cutbacks, its priorities are emergency care, special needs and screening of children aged from 11 to 13 years. After that, “the HSE will seek to provide screening to children between the ages of six and eight years”.
This means that if a parent is depending on access to free dental care, their child may be in fourth or sixth class by the time they get seen. But that’s too late, argues Tuite. “Waiting to get to school is far too late,” she says, adding that the child’s mindset and routines will already be established by then.
“It’s a much better use of public funding to prevent problems and have less intervention as it’s less expensive,” she says.
Tuite recommends that parents bring their children to a dentist from as young as 12 months, as per American guidelines, and that parents should help their children to brush their teeth up to the age of nine.
Crowe agrees that the earlier a child attends a dentist the better.
“If you wait until [they are] four or five, then the damage is done,” he says, citing the example of a five-year-old who, on their recent first visit, he had to refer for multiple extractions.
And for parents who feel that regularly forking out money for their child to see the dentist is something they can’t afford, Tuite cautions that it may end up being the cheaper route. “It’s more costly to fix a problem; preventative care costs relatively little,” she says.
Orthodontics
A lack of sufficient public care for older children is another factor that might inhibit appropriate treatment.
At the sixth-class school screening, children will be assessed for whether they need braces, and this is the only route to receiving free orthodontic care.
Those who are deemed to be in need of braces are referred to their local HSE orthodontic clinic, and will be seen based on how urgently they need treatment.
The HSE uses a system based on the Index of Orthodontic Treatment Needs, in order to determine whether a child should benefit from free orthodontics.
It involves a score of one to five, and grades four and five are eligible for treatment. Typically, a child will qualify if they have conditions such as: their front teeth are buried and fail to erupt; multiple missing teeth; very prominent front teeth; or severe problems with the bite or jaw development.
But even if your child has a grade four or five indication, they will still have to wait to get treatment. According to the latest figures for public orthodontic care in Ireland, about 17,000 children were on a waiting list last year.
And even if your child is eligible for public treatment, waiting can diminish the benefits of this treatment, with Tuite noting that intervention at an earlier age can be more beneficial.
Where there’s an opportunity to do early orthodontic treatment, it can help to correct a child’s jaw position and establish a better biting position, but as the child gets older, the opportunity to correct this is lessened, she says, adding that orthodontic treatment can start on a child as young as eight or nine.
Of course, the cost of such treatment can be difficult for many parents. Crowe says that parents should expect to budget for about €4,500 for train tracks on the top and bottom teeth, but it could be as low as €3,000.
This expenditure is eligible for tax relief at a rate of 20 per cent and it won’t have to be paid all in one go, with dentists working out payment plans over 18 months to two years of treatment.
And while Hollywood and magazines might lead us to believe that invisible braces are the way to go, dentists don’t agree.
“In my experience, [brands such as] Invisalign are very useful for mild cases, be they adult or children, but the majority of young children are suitable for train track braces,” Crowe says, arguing that train tracks are more effective and allow for better control.
Brace yourself: school screenings and private treatment
Living in the US meant that dental care started early for Pamela O’Neill’s three children. Her daughter, Laragh, first visited the dentist at the age of three.
“It helps with the nervousness of going to the dentist; [if they are older] , they can get a bit anxious about it,” O’Neill says.
When the family returned home to Dublin, Laragh continued to visit the dentist through the school screening service.
At one of these screenings, O’Neill learned that her daughter was likely to need some orthodontic treatment, as the eye tooth at the side of her mouth was coming out the side of her gum and was twisted, and her bottom teeth were quite crowded.
However, she also learned that Laragh would not qualify for free treatment with the HSE. “I was told that there was not a chance and that she would have to go privately,” says O’Neill.
So Laragh attended Dr Michael Crowe of Ganter Crowe in Dublin, where she had to get four teeth taken out because of overcrowding and had train tracks fitted on her top and bottom teeth.
Now aged 15, Laragh no longer wears braces but still has retainers fitted to the back of her top and bottom teeth.
Overall, O’Neill is happy with the treatment but, like any family, found the costs very hefty.
“I wish that I didn’t have to go down the private route but we didn’t have a choice. It wasn’t just pure vanity; it had to be done because her teeth were quite bad.”
Luckily, Laragh is the only one of her children who needed braces, but O’Neill is nonetheless paying out steep sums for her sons’ root canals; this is all the more painful because her husband received similar treatment at a much lower cost in Spain.
