Optimal dental health involves the well-being of the teeth, gums, and the entire oral system, which is essential for vital functions such as chewing, smiling, and speaking. Given its significant impact on eating, communication, and overall wellness, dental health is closely connected to general bodily health. Unfortunately, there has been an increase in poor dental health among children. In this article, we will explore the potential role of genetics in the prevalence of poor dental health and overall wellness.^1,2

Statistics of dental illnesses in children

Statistics from studies carried out about dental health in children:

• 23% of children aged 2 to 5 years have dental caries in their baby teeth between  2011–2016
• Children from minority ethnic communities are more likely to have dental diseases
• Children living in low-income families are twice as likely to have decay in their milk teeth compared to children from families with higher incomes
• Children are more likely to have dental disease if a parent or a sibling has tooth decay

Dental diseases

There are diseases that affect the teeth, gums and the entire system responsible for chewing, smiling and speaking. Cavities and gum disease are both quite prevalent in children.

Cavities

Cavities (also known as tooth decay)  occur when sugar residues from foods are left on the teeth. The normal mouth flora or bacteria turn these foods into acids. The combination of the leftover sugars, acids, saliva and bacteria, forms a hard substance called plaque which sticks to the teeth. Over time, the acids eat away at the tooth enamel causing cavities.

Symptoms of cavities

Symptoms of cavities depend largely on their severity. This means that when cavities are starting, they can easily go unnoticed However, as the decay increases, it  can cause symptoms such as

• Toothache
• Sensitive teeth
• Holes in teeth
• Brown, black or white stains on teeth

Children at risk of cavities

Everyone is at risk of cavities, due to the presence of an oral microbiome and lifestyle influences.  Children however are more at risk because symptoms may easily go unnoticed. Several factors can increase the risk of cavities in children, including:

• A diet high in sugars and starchy carbohydrates
• Consumption of water with limited or no fluoride content
• Poor oral hygiene habits
• Reduced saliva flow
• Misaligned or crowded teeth
• Certain oral microbiomes that promote tooth decay

Treatment

Treatment depends on the child's age, severity of decay and general health. However, it usually involves removing the decayed tooth/part of the tooth and replacing it with a filling.^4,5

Periodontal disease

Also known as gum disease, periodontal disease is a serious bacterial infection of the gums that destroys the supporting structure of the teeth. It ranges from mild to severe. However, most children experience gingivitis which is characterised by red, swollen and sore gums.⁶

Causes of periodontal disease

This is caused by the buildup of plaque around the teeth, caused by leftover food, bacteria and saliva that is not removed.

Symptoms of periodontal disease

• Red or swollen gums
• Bleeding gums
• Receding gums
• Loss/separation of teeth
• Pus between the gums and teeth
• Mouth sores
• Bad breath

Children at risk of periodontal disease

Anyone can be at risk of periodontal disease depending on lifestyle. However, some children are more at risk because of certain factors like:⁶

• Poor diet
• Frequent mouth breathing
• Diabetes
• Medications that cause an overgrowth of bacteria on the gums

Treatment

• Plaque removal
• Antibiotics
• Surgery in severe cases

Influence of genetic factors on the susceptibility to dental disease

Dental caries is a multifactorial condition arising from the complex interaction between the tooth, substrate, microorganisms, and time. It is considered multifactorial because multiple factors contribute to its development. Research indicates that a large percentage of children aged 6 to 8 have experienced tooth decay at least once. Studies also show that children from minority and low-income families are at a higher risk. Children with similar genetic backgrounds and lifestyle habits tend to exhibit similar patterns of dental caries, suggesting a strong genetic component.

Genes play a role in tooth development, morphology, saliva composition, oral microbiome, and immune response, all of which can influence an individual's susceptibility to dental caries. However, most studies emphasise that the multifactorial nature of dental caries means that good dental health is not determined by genetics alone. These genetic factors may make some individuals more prone to dental diseases than others. Therefore, individuals who are genetically predisposed might need to be more diligent with their oral hygiene to mitigate their risk.^{3,4, 5, 6}

Good pediatric dental health

Any child can achieve good dental health, regardless of family history. Research has demonstrated that dental diseases are multifactorial, meaning their prevalence is not solely dependent on genetics. When there is a family history of dental disease, it's important for individuals to seek specialised care to prevent similar issues in their children. Early detection and intervention are crucial in addressing dental caries and other dental diseases, regardless of genetic factors. Lifestyle interventions also play a significant role in maintaining good paediatric dental health, including:

• Regular dental checkups: Consistent dental visits are essential for maintaining good oral health and catching potential issues early.
• Proper oral hygiene: The importance of good oral hygiene cannot be overstated. This includes brushing twice a day with fluoride-based toothpaste and flossing daily.
• Supervised brushing: For children under 7 years old, an adult should brush their teeth. Children over 7 should be supervised to ensure they are brushing correctly.
• Limit sugary foods: Foods high in free sugars, such as biscuits and chocolates, should be given to children sparingly and not within at least an hour before bedtime.
• Immediate brushing after sweets: To minimise the risk of plaque formation, teeth should be brushed immediately after consuming sweets and chocolates.
• Brushing technique: Teeth should be brushed for at least 2 minutes. Children should spit out the toothpaste without rinsing it with water to allow the fluoride to work effectively.^{6, 7}

Summary

Parents and guardians naturally want their children to be free from pain and disease. Although dental diseases are categorised alongside non-communicable conditions like hypertension and diabetes, research indicates that their causes are multifactorial. Family history alone does not solely determine the likelihood of dental disease in children. However, it can motivate parents and caregivers to adopt preventive measures and healthy lifestyle habits to protect their children from these conditions. Family history can reveal patterns of health issues that may indicate a higher risk for certain diseases. Ultimately, genetics, lifestyle, and environmental factors work together to influence health outcomes. Personalised care and early interventions are crucial for children who may be at higher risk of dental disease due to genetic factors.

FAQs

Can tooth decay be inherited?

Genetics significantly influences individual traits, including dental characteristics. However, the development of dental diseases is multifactorial, involving a combination of genetic, environmental, and lifestyle factors.

How can I prevent my child from tooth decay if I have a family history?

A family history of tooth decay is not the sole factor determining whether your child will experience tooth decay. However, adopting good oral hygiene practices as a family can be highly beneficial. Additionally, informing your dentist about your family history can help ensure that your child receives appropriate preventive care.

Do chocolates cause tooth decay and gum disease?

To maintain optimal health, foods high in free sugars, such as chocolates and candies, should be consumed in moderation. Sugars on the teeth, combined with oral microbes and saliva, can produce acids that erode enamel and lead to tooth decay. To prevent this, teeth should be brushed immediately after eating sugary foods with fluoride-containing toothpaste. Additionally, chocolates and candies should not be consumed within an hour before bedtime.

Can dental disease be treated?

The treatment of dental diseases largely depends on their severity. Options for treatment may include removing decayed teeth, using antibiotics, removing plaque, or performing surgery, depending on the specific case.

Is dental disease painful?

Dental disease often does not present with pain initially, making regular dental appointments crucial for early detection. As the disease progresses, however, pain may develop.