Understanding Dental Decay

Dental decay is caused by bacteria on the teeth converting sugars that we have eaten, to produce acid. This acid then acts on the teeth, which are mainly made of minerals, to cause demineralisation of the tooth, which then causes the breakdown of the tooth structure, producing a hole in the tooth. This, left unchecked will continue to destroy the tooth and the cavity (hole) will eventually reach the pulp (living tissue in the tooth). This is usually associated with pain often initially stimulated with hot and cold, but as the process progresses the pain can come on by its self and be quite severe.

The end result is the death of the living tissue in the tooth and the formation of a dental abscess under the tooth. This again is often associated with pain, especially when biting on the tooth. It can also be associated with swelling, discharge of puss and the loosening of the tooth.

Children 0-3 years

• Breast feeding provides the best nutrition for babies
• From six months of age infants should be introduced to drinking from a cup, and from age one year feeding from a bottle should be discouraged
• Sugar should not be added to weaning foods
• Parents should brush or supervise tooth brushing
• Use only a smear of toothpaste containing no less than 1,000 ppm fluoride
• As soon as teeth erupt in the mouth brush them twice daily
• The frequency and amount of sugary food and drinks should be reduced and, when consumed it should be limited to mealtimes.
• Sugars should not be consumed more than four times per day
• Sugar-free medicines should be used

Children 3-6 years

• Brush last thing at night and on one other occasion
• Brushing should be supervised by an adult
• Use a pea-sized amount of toothpaste containing 1,350–1,500 ppm fluoride
• Spit out after brushing and do not rinse
• The frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes. Sugars should not be consumed more than four times per day
• Sugar-free medicines should be used
• Fluoride varnish should be applied to all child patients 3 and above twice a year

Children 3-6 years giving particular cause for concern we will

• We will apply fluoride varnish to teeth 3–4 times yearly (2.2% F–)
• Reduce recall interval
• Investigate diet and assist to adopt good dietary practice
• Ensure medication is sugar free or given to minimise cariogenic effect
• Parents will be made aware of the cariogenicity of sugar and glucose polymers supplements and ways of minimising their risk

Children 7 and above should

• Brush twice daily
• Brush last thing at night and on one other occasion
• Use fluoridated toothpaste (1,350 ppm fluoride or above)
• Spit out after brushing and do not rinse
• The frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes.
• Sugars should not be consumed more than four times per day
• We will apply fluoride varnish to teeth twice yearly (2.2% F–)

Children 7 and above and giving concern (eg those likely to develop caries, those undergoing orthodontic treatment, those with special needs)

• All advice above plus
• Use a fluoride mouth rinse daily (0.05% NaF) at a different time to brushing
• Fissure seal permanent molars with resin sealant
• Apply fluoride varnish to teeth 3–4 times yearly (2.2% F–)
• For those 8+ years with active caries we will prescribe daily fluoride rinse
• For those 10+ years with active caries we will prescribe 2,800 ppm toothpaste
• For those 16+ years with active disease we will prescription of 5,000 ppm toothpaste
• Investigate diet and assist adoption of good dietary practice

To learn more about dental health for children see the British Society of Paediatric Dentistry

Adult patients

• Brush twice daily with fluoridated toothpaste
• Use fluoridated toothpaste at least 1350ppm fluoride
• Brush last thing at night and at one other occasion
• Spit out after brushing and do not rinse
• The frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes.

Adult patients giving particular concern (e.g. with obvious current active caries, dry mouth, other predisposing factors, those with special needs)

• We will apply fluoride varnish to teeth twice yearly (2.2% F–)
• Use a fluoride mouth rinse daily (0.05% NaF) at a different time to brushing
• For those with active caries we will prescribe 2,800 ppm or 5,000 ppm toothpaste
• Investigate diet and assist adoption of good dietary practice

To book a dentist appointment at Dental Care with Jill Cooper in Lymm Warrington call 01925 758 616