Introduction

The treatment of dental decay is the fourth most capital-intensive disease in the world. The well-being of oral health and oral-related tissues significantly contributes to the overall state of health and well-being of individuals. It is involved in their ability to eat wholesome diets, speaking, mental health well-being, as well as socialising. The status of oral health can be measured by evaluation of caries prevalence, malocclusion, orofacial and periodontal diseases, hypodontia, and fluorosis among others. There are four main fields used to quantify the oral health-related quality of life (OHRQoL), namely, functional limitations, emotional well-being, social well-being, and oral symptoms. These are interrelated and interdependent and tend to affect an individual’s psychological state and functionality among both young children and adults.¹

Prevalence of dental diseases in children

A high number of children in England suffer from dental caries. A lot of such children, particularly those from lower socioeconomic status are eventually subject to tooth extraction procedures to manage their dental health. About a quarter of these children may require repeat treatments in future and this may involve the use of general anaesthesia due to the anxiety experienced by the children. Post-surgery care and insufficient health assessments predispose children to recurring challenges with their oral health. Dental caries in children is a global challenge. In many developing countries, the prevalence is even higher, up to 70 % are predisposed to oral diseases. 

Findings have shown that there is insufficient focus on preventive dental health programs and services as well as oral health promotion exercises including public education, economic, and environmental interventions. Studies have shown that programs and services such as these tend to prevent or reduce the chances of developing oral diseases, they also slow down the progression and/or recurrence of dental diseases. Studies have confirmed that the knowledge and parenting skills of parents on oral health are potent determinants of the oral health status of their children.^2,3

Dental caries have been shown to be contagious and transmissible diseases. This can be transmitted from a caregiver to their children, causing damage to their primary teeth- a phenomenon also known as the window of infectivity. One of the reasons why children of low-income communities, lower socio-economic status, as well as children with special healthcare needs, are poor accessibility to dental healthcare. Most dental caries are caused by the colonisation of the oral cavity by Streptococcus mutans and Streptococcus sobrinus. Their mechanism of action is the synthesis of glucans with the aid of sucrose, this consequently leads to the formulation of plaque and the production of tooth demineralisation acids which develop into the decay of the tooth. Among children between six and thirty months old, the child’s mother or their caregiver is the likely source of these bacteria. The diet (including excessive access to sugars and/or fermentable carbohydrates), oral hygiene, and access to dental healthcare services solely rely on the child’s caregiver or parents.⁴

Despite the efforts of the dental healthcare systems to reduce the prevalence of dental caries and improve overall dental healthcare through the utilisation of topical and systemic fluorides-containing products, health education programs on an improved diet, oral healthcare service utilisation, recent findings have shown that there is a worrying rise in the prevalence of dental caries in children’s temporary and permanent teeth, affecting both the surfaces and their roots as well. This finding has been replicated across different populations all over the world. It is therefore a public health emergency and must be treated as such. 

Efforts need to be increased in addressing oral health disease prevention especially among children because of their degenerative consequences and complications. The public health strategies that were successful in the past must be re-adopted. These include school public health education and dental health promotion programs, especially on appropriate diet and campaigns for a more routine dental examination, water fluoridation, and improved sensitisation on the benefits of topical application of fluoride such as appropriate toothpastes and oral rinses. A failure to do this could lead to complications that could put a strain on dental care services available as well as systemic, psychological and social health complications.⁵

Influence of parents and caregivers on children’s dental health

Dental health service providers need to provide dental education to both their paediatric patients and just as importantly, their parents and caregivers. Many scientists argue that children benefit more when their caregivers are well-educated in dental disease prevention and oral health promotion efforts. An increase in dental health awareness among parents and caregivers has been shown to significantly ensure they acquire the needed skills required to ensure optimal oral health behaviours for the well-being of the children.⁶

According to the United Nations Convention on the Rights of the Child (UNCRC), children have the right to be included and heard in healthcare.  Even though it may be limited, evidence suggests that children should be encouraged to interact with their healthcare professionals. Health professionals are encouraged to use their communication skills to reduce the anxieties and confusion children may feel during consultations or before, during, and after procedures.⁷

Across the world, each society varies in its beliefs, and practices with respect to dental health care. This variation is further influenced by education, socio-economic status, and religion and these must be put into consideration when considering the effects on the healthcare of that population. As earlier stated, there is a disproportionate decline in early child dental health among ethnic minorities and racial groups with dental caries being more predominant in these groups. This even becomes more pronounced with every decline in socio-economic status. Access of children to dental care is obstructed by many challenges, these include an unaffordable cost of service, lack of dental insurance, proximity to care or unavailability of service providers, level of knowledge and awareness, fear, diet, and child feeding practices among many others.

It is therefore essential to intensify public knowledge through health education and health promotion activities to improve awareness of the importance of dental care especially in early childhood because in some populations where it is endemic, it may be normalised and not considered to be an ailment. Provisions should also be made to make the services more affordable and accessible. The extended families have also been found to be influential and must therefore be involved in dental health education. Carers in some societies such as the African-American, Latino, Chinese, and Filipino groups have been known to act as barriers to healthcare of the children due to fear as well as an inaccurate belief that the primary teeth have limited functionalities and have a lower value- therefore, loss of the primary teeth is considered an acceptable occurrence. Additionally, the fear of dental service procedures from past experiences of carers and parents was also projected onto the children, hindering them from seeking preventive healthcare as well as treatment. It is therefore important to address common concerns during the dental health education programs, educate on the importance of appropriate diet, lead by example and involve children in family dental routines to make it fun and sustainable to ensure a preventative lifestyle is adopted.⁸

The opinion of parents is important when assessing the condition of a child’s dental health. A child’s tooth brushing habits (especially between the ages of 7 and 8 when their fine motor skills are developed) have been strongly associated with the parent’s attitude towards oral hygiene practices. The beneficial habit of brushing first thing in the morning and last thing after the last drink at night to ensure adequate plaque control. Moreover, mouth rinsing after meals to prevent food lodging in between the teeth has been found to prevent bacterial growth. Parents should lead by example and encourage their children to swish water around the mouth after each meal and spit it out. Parents and caregivers should also encourage the practice of replacing toothbrushes every 3 months to maintain the efficacy of the brushing practice. Where the toothbrush bristles wear earlier than 3 months, it may be due to excessive pressure being applied during brushing which may erode the protective enamel of the teeth as well as the gum line leading to tooth sensitivity and other undesirable conditions, hence, children must be shown appropriate brushing techniques which must be between 2 to 3 minutes for adequate cleaning. Flossing, tongue cleaning, and mouthwashing are also dental hygiene practices that must be encouraged. Educated mothers are able to effectively train and supervise their kids on dental care practices essential for optimal dental health.⁹

Summary

This article highlights the significance of dental decay in the world. It emphasises its implications for the overall well-being of individuals, this may include their eating habits, speech, mental health, and social confidence. It influences the quality of life of people because of its ability to alter the functionality and emotional well-being of people.

There is a high prevalence of dental diseases, particularly, dental caries among children in many countries of the world. The socioeconomic status of their parents or caregivers has a strong correlation with this and consequently, these populations have poor access to dental care and have to undergo tooth extraction treatments and sometimes, recurrent treatments.

Despite the efforts channelled into reducing the prevalence of dental caries, such as fluoridation programs, health education and dental health promotion, there is still a rise in the prevalence of dental diseases, and it has become a public health emergency. Efforts need to be intensified and strategies such as school education, water fluoridation, and topical application of fluoride among others need to be re-adopted. Failure to address the emergence of these diseases could lead to undesirable consequences such as overall systemic and physical health, and psychological, and social health complications.

Parents and caregivers have a significant role to play in getting children involved in their own dental health care. They must be role models and lead by example for the child to learn. Improved education of caregivers, culturally sensitive strategies, improvement of access to care, addressing common misconceptions and encouraging a preventative lifestyle from a young age would go a long way in tackling this public health challenge.