Promoting Gum Health In Children

Introduction

Maintaining good oral health is essential for individuals of all ages, including children. While most parents are focused on teaching their children how to brush and floss their teeth, they often overlook the importance of gum health. Healthy gums are a foundation for strong teeth, proper development and oral health.¹

The Early Year Foundation Stage (EYFS) framework states that early-year providers must promote the good oral health of children who attend their setting. Oral health is essential even with baby teeth. This is because of children’s baby teeth:

• Helps them to bite and chew 
• Support their speech and language development 
• Boosts their confidence when they smile
• Make good space for and help guide adult teeth

Good oral health also keeps children from toothache, infection, and gum disease.²

Common gum health issues in children

Gingivitis is the mildest form of gum disease, causing redness, swelling, and soreness. It is common in children and usually not painful. Gingival diseases affect children enormously. Poor brushing and flossing habits and the diet that fuels harmful bacteria can contribute to this buildup. Genetic factors, hormones and conditions like diabetes can also play a role.⁴

Unlike severe gum disease, gingivitis doesn't cause permanent damage to gum or bone tissues. It is considered a mild or early form of gum disease.³

Symptoms of gingivitis include:

• Bleeding on probing 
• Dusk or dark red gums 
• Swelling 
• Tender or puffy gums 
• Gums that bleed when brushing or flossing 
• Bad breath that remains after brushing teeth.

With the proper treatment, gingivitis is reversible. If your child has symptoms of gingivitis, guiding them to observe good oral hygiene can help manage the condition. If your child has gingivitis, you can treat or reverse it by removing buildup tartar and keeping new plaque at bay with good oral hygiene.⁴ This includes:

• Brushing your teeth twice a day, including along the gum line 
• Flossing once a day to avoid plaque and debris accumulation between the teeth 
• Avoiding excess amounts of sugar foods and drinks that promote plaque growth.³

Periodontal disease in children 

Periodontal disease is a severe bacterial infection of the gums that destroys the gum and the supporting structure of the teeth. It is also called gum disease.

Plaque buildup on teeth is the leading cause of periodontal disease - bacteria on plaque stick to the teeth. If plaque is not removed, it hardens and develops into calculus or tartar. Poor oral hygiene causes plaque to grow in the mouth.

Symptoms of periodontal disease in children:

• Bleeding while brushing/flossing
• Red swollen gums 
• Gums that pull away from the teeth
• Push between gum and teeth
• A change in bite and jaw alignment 
• Loose or separating teeth that show greater space than normal
• Bad breath even after brushing 

These symptoms may seem like any other symptoms. It is important to see the dentist regularly for proper diagnosis.^5,6

Factors contributing to gum health problems

Poor oral hygiene can contribute to the development of gum disease. Making sure children observe hygiene routines, such as regular brushing and flossing, prevents plaque from continuing to form and spread. Poor brushing and flossing result hygiene in the accumulation of debris, which eventually forms tartar.

• Poor diet: Unhealthy food can contribute to gum disease in numerous ways. Firstly, it can stimulate the growth of bacteria. Secondly, it suppresses a child's immune system. Food high in sugar and processed food can promote the development of destructive bacteria and is often low in essential nutrients.
• Crooked teeth: Children with crooked teeth are more likely to experience gum disease. This is likely because misaligned teeth affect oral hygiene. Crooked teeth are also harder to brush and floss, resulting in the accumulation of food and plaque.⁷
• Genetics: Genetics can also affect the development of gum disease. A child's immune system, hormones and various systemic health conditions can be affected by their genes. 
• Puberty: Changing hormones during puberty can cause gum sensitivity and increased inflammation in the gum. This is known as puberty-associated gingivitis. Females with gingivitis may experience their symptoms getting worse around the start of their periods.⁷

Preventing gum disease in children

Regular brushing and flossing can reduce the risks of possible gum diseases, but it cannot completely eliminate it. The risk of developing gum diseases can be reduced by: 

• Ensuring good oral hygiene: Regular and proper brushing and flossing will remove and disrupt oral bacteria, preventing plaque and tartar from accumulating. 
• Encouraging a balanced diet: A diet rich in whole foods and low in added sugar will support healthy immune function while providing less fuel for oral bacteria.
• Investing in orthodontic treatment: Crooked teeth make oral hygiene more difficult, so correcting any teeth alignment issues can improve your child's oral health.⁷ Parents must be encouraged to monitor and record children's oral health within the personal child health record book.⁸

Treatment for paediatric gum disease 

Treatment for dental diseases included surgical and non-surgical options, depending on the type and severity of the condition. Your child may need to see a dentist specialising in gum health. Common treatments include:

• Scaling and root planing 
• Antibiotics 
• Gum graft
• Bone graft
• Flap surgery

Importance of promoting gum health in children

Gums play a vital role in promoting teeth development. Healthy gums keep teeth in place and prevent them from becoming loose and shifting. Proper gum care reduces the risks of gum disease, which could lead to tooth loss if left untreated. Healthy gums also lead to proper bite alignment, ensuring teeth fit together correctly.² Being playful with children can help to promote good oral health. You can use several activities to teach them for both brushing and care.

• Dentist role-play: Try holding a dentist role-play in your setting. This familiarises children with the dentist's environment, equipment, and process.
• Practice toothbrushing on dolls and toys: First, show children how to do this yourself to model effective tooth brushing. 
• Stories and discussions: You can read children stories about teeth and smiles. These can cover essential topics like visiting the dentist and brushing your teeth. You should also discuss the food and drinks that do and do not help to grow healthy, strong teeth with children. 

Talking tubs are an excellent way to promote conversation in children. Placing oral health-related toys in the bathtub and letting the children explore and talk about them can also be an excellent way to get children involved in the conversation.

• Visits with a dentist: You can contact your local dental surgeon and ask if it is possible to show the children around. This will help the children's environment in the dentist's office. Invite dental team members to talk about their jobs and demonstrate the importance of good oral health. 
• Supervised toothbrushing programs: Supervised brushing may be suitable in your setting. These programs have been found to prevent tooth decay by teaching children how to brush their teeth and encouraging tooth brushing routines at home. Children also benefit from brushing their teeth with fluoride toothpaste once a day in their early years. 

This is especially important for those children who may not regularly brush their teeth at home. Different schemes support supervised toothbrushing. Speak to your local authority to see what may be on offer in your local area.⁹

FAQs

How can you prevent gum disease in children?

Good oral hygiene can prevent gum disease. Make sure your child:

• Brush their teeth twice a day 
• Use a toothbrush that is age appropriate and the right size 
• See the dentist regularly 
• Floss daily 
• Eating healthy food, limiting sugars and starch.⁵

What can health professionals do about it?

All children's healthcare providers include oral health assessment as an essential part of children's all-around health (Red Book). Important tips which may be useful for families include:

• Brush with fluoride toothpaste as soon as the teeth erupt.
• Control intake of sugary food and drinks 
• Attend the dentist regularly for preventive advice and care.⁸

How can dental care be improved for children?

Start early and let children choose a toothbrush and toothpaste of their favourite colour. Read books and watch videos that talk about dental care. Use a timer to encourage brushing for at least 2 minutes. Encourage them to brush twice a day. Reward children for good oral health. 

Summary

Gum disease refers to various conditions, ranging from mild gingivitis to severe form that can result in significant and irreversible damage. Regular brushing and flossing prevent plaque accumulation. Plaque is less likely to develop into tartar, an important factor in gum inflammation. Feeding your children a diet low in sodium and sugar can help keep the plaque level in control. Another major factor is puberty; changing hormones can make their gums more sensitive to plaque and food debris. Visiting your paediatric dentist twice a year for a regular oral health and hygiene routine can also help prevent oral health problems from arising.