Preventing tooth decay in children and teenagers

Tooth decay is mainly caused by bacteria in the plaque that coats your teeth, and by too much sugar in your diet. So limiting your consumption of sugary foods, drinks, candies and other sweets is one way to prevent tooth decay. Eating sweet things sometimes is perfectly fine, though, as long as you still take good care of your teeth.

The trouble starts when teeth are frequently exposed to sugary foods and drinks. Babies and toddlers may develop tooth decay faster if their bottle often contains sugary drinks or fruit juice. Unsweetened fruit teas or water are good alternatives. It's also important to use the bottle only for drinking and not as a pacifier or dummy.

Using salt with fluoride when cooking and seasoning your food also helps to strengthen your teeth. Experts recommend that young children also eat fluoridated salt as soon as they start having regular meals with the rest of the family.

Brushing your teeth gets rid of plaque and keeps your teeth looking and feeling clean. Fluoride toothpaste is especially good at helping to prevent tooth decay: Your teeth absorb the fluoride in the toothpaste, making them stronger.

Research has shown that brushing with fluoride toothpaste every day can help prevent tooth decay in children and teenagers. Children need adults to show them how to brush properly, and very young children need hands-on help. Even if a preschool child is able to brush their teeth, an adult may need to help by touching up afterwards. If you're not sure how to go about it, you can get some practical advice from your dentist. Children generally start to brush their teeth properly on their own after they start school, around the time they can write well. It is important to brush the teeth thoroughly but also carefully, to avoid damaging the gums.

Pediatricians and dentists recommend already starting to give children fluoride tablets at the age of one week. These tablets also contain vitamin D to prevent rickets. Parents can start brushing once the first baby tooth comes in.

Before the child turns one year old, parents should only do one of these two things: either give the baby fluoride tablets or use fluoride toothpaste. If you give your child fluoride tablets, then don't use fluoride toothpaste to brush their teeth.

These are the recommendations on the use of fluoride toothpaste and fluoride tablets, depending on the age of the child:

The reason why different doses (size of a grain or rice or of a pea) are recommended is because of the possible side effects: Too much fluoride can cause white spots or stripes to form on the teeth as they develop. But it doesn’t usually have any other negative effects. In rare cases, too much fluoride can affect the development of the tooth enamel, increasing the risk of tooth decay. Whitish spots can also be an early sign of tooth decay.

It is especially important to get the fluoride dose right in young children under the age of two years, because they often swallow their toothpaste. So it's advisable to not use additional fluoride tablets if they use fluoride toothpaste and if salt with added fluoride is also used at home.

Older children and teenagers can brush their teeth like adults.

In order to prevent the gums from becoming inflamed (gingivitis), it may be a good idea to remove plaque that forms between your teeth by using dental floss, interdental brushes, dental care sticks (also called interdental sticks or dental floss sticks, sometimes made of bamboo) or toothpicks.

These things haven’t been proven to prevent tooth decay, though. It is important to be careful when removing plaque, because it’s easy to hurt your gums with floss, interdental brushes, or toothpicks.

Mouthwash is another commonly used dental hygiene product. Some types of mouthwash contain fluoride. Regularly rinsing with fluoride mouthwashes can effectively prevent tooth decay too.

Mouthwash, interdental brushes, dental sticks and toothpicks are only options for older children and teenagers, though. Younger children can’t use them properly, and may swallow mouthwash.

To prevent tooth decay, fluoride can be applied directly to the teeth in the form of a varnish or gel. Fluoride gel is also available from pharmacies without a prescription and can be put on once a week. Most fluoride gels are applied once a week – it's best to check the package insert to see exactly how they are used and for which ages they are suitable. They should be left on the teeth for a few minutes and then spat out. Fluoride varnishes contain a higher concentration of fluoride. They are a applied by a dentist or dental assistant and harden immediately when they make contact with saliva. This is a particular advantage in toddlers because they don't have to spit out the varnish after a certain amount of time. Varnishes and gels can't replace regular tooth brushing or a tooth-friendly diet, though.

Research suggests that fluoride varnish can prevent tooth decay in baby teeth better than regular dental care (without any special use of fluoride). Permanent teeth can also benefit from the use of fluoride varnishes or gels.

In Germany, statutory health insurers cover the costs of fluoride varnishing

• four times a year between the ages of 6 months and six years, and
• twice a year between the ages of 6 years and 18 years (or four times a year if there's a greater risk of tooth decay).

Up to the age of twelve years, children can take part in group prevention programs at day care and in schools. This involves a dentist coming in to check their teeth and mouth, see how their bite is developing and offer fluoride varnish to harden the dental enamel. Permission from the parents is needed before any fluoride is applied. This treatment is offered free of charge. But it may not be necessary if the child is already having regular fluoride varnish treatments at the dentist.

Children's back teeth (molars) are particularly prone to tooth decay. Bacteria can settle in the fissures, grooves and pits of these teeth. In children who have teeth that are prone to decay, the dentist can put a plastic sealant on the molars in order to stop bacteria from growing there. Applying the sealant doesn’t hurt or take very long, and it can lower the risk of tooth decay. Sealants usually last for several years. The dentist will check whether they are still intact during check-ups. In Germany, statutory health insurers cover the costs of this treatment on the permanent back teeth (molars) of children between the ages of 6 and 17 years.

In Germany, children who are covered by statutory health insurance are eligible for dental check-ups from an early age. A total of six dental screening tests are offered between the ages of 6 months and 6 years. After that, it's still a good idea for the child to go in for a check-up every six months.

If any of the standard childhood check-ups (in U5, U6 or U7) show anything abnormal on the child's teeth or in their mouth, their dentist can take a closer look.

Some experts believe that regular dental check-ups can help to detect tooth problems earlier, leading to faster treatment. These check-ups also aim to help children and teenagers to take better care of their teeth and gums. But so far, studies have not shown that having a check-up every six months is better for your overall dental health.