Why your toddler is due a trip to the dentist

He says our fluoride guidelines need an update. “We are at risk of having recommendations much weaker than the rest of the world.”

Even when you are doing your best, it’s not always perfect. Jill Tomlinson, the immediate past president of the Australian Medical Association of Victoria, is a hand surgeon and mother of three kids: Anna, 7, Emily, 5 and Leo, 20 months. She and her husband always supervise tooth brushing.

“Tooth brushing and kids is something that falls into the ‘we do the best we can’ type of category, not the ‘we’re confident we’re nailing it all the time’,” she says. “But isn’t that the case for most aspects of parenting for most parents?”

One of her children had a hole in her tooth picked up during a routine dental check as a preschooler.

“My initial thoughts were of guilt and of distress for what she’d have to go through to treat it. It helped that the dentist said something about the tooth being not perfectly formed, and not having normal enamel – which likely made it more susceptible.

“A bad tooth rather than a bad parent,” Tomlinson says. She still felt somewhat responsible, nonetheless.

“I certainly reflected on the fact that no kids in my family home when I was growing up needed fillings,” she says.

Cost is a factor. Australia is no closer to getting every kid to a dentist by school age. Medicare coverage is available for very few Australian children. Every year, a politician somewhere says more coverage is coming.

Harleen Kumar, head of paediatric dentistry at Sydney Dental Hospital and clinical associate professor of dentistry at the University of Sydney, says: “The diet of our children has changed quite significantly. There are more added sugars, more hidden sugars.”

Those pouches of flavoured yoghurts? Teaspoons of sugar per mouthful. Nothing could be worse, Kumar says. But she gets it. We are all so busy that sometimes it’s easier to pack that pouch instead of making a chicken and salad sandwich.

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That’s not the only problem. It’s juices and cordials too: “These are very cariogenic – likely to cause tooth decay.” Then she mentions cereals with added sugars.

She won’t name brands, but says: “The sweetened cereals are very high in sugar, and so we shouldn’t be having them for breakfast.”

Kumar is calling for easier-to-understand nutritional information on the back of cereal boxes (and anywhere really).

“I wish we had better guidelines as to what the total daily intake of sugar should be for children and adults,” Kumar says. She suggests a more visual approach, to show how many teaspoons of sugar are in a 100g bowl of cereal, for example.

From available figures, a little more than 40 per cent of all Australian children develop cavities by the time they are school age, says Jilen Patel, academic at the University of Western Australia and consultant paediatric dentist at Perth Children’s Hospital. But actual rates are difficult to track, and he is confident the number is far higher: “Forty-two per cent is conservative.” Patel also says the worst 10 per cent of the population have almost half their teeth affected by tooth decay.

“Year on year, we are seeing an increase in emergency dental hospitalisations. On some days, we can have up to 25 children hospitalised for emergency extractions.

“It’s a national problem, we have two- or three-year-old children with tooth decay – at that stage we’ve lost the battle for prevention,” he says.

Who is helping children brush their teeth? And how well are we doing it?

Kumar says that children are not ready to brush their own teeth until they can tie their own shoelaces. That’s the level of hand co-ordination needed to do a good job of cleaning their teeth. Electric toothbrushes do a better job than manual toothbrushes, but then every tooth surface needs two to three seconds. Parents need to be there to supervise to make sure it’s done thoroughly.

But of all the toothy surprises Kumar reveals, this is the one that amazes:

Do not rinse after tooth brushing: “Spit, don’t rinse.”

Topical fluoride from the toothpaste provides extra protection, she says. How much? A rice grain of toothpaste for the under 6s and pea-sized for six and over.

Kumar has first-hand knowledge of how tough it is to get kids to brush their teeth. She stopped checking her own 10-year-old’s teeth. “And then I noticed there were areas she’d been skipping.”

Turns out even 10-year-olds need reminding. Kids take the easy way out, do a quick brush and move on.

“And we forget to check, especially if we have more than one child.”

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