Siti Rose Khairina Tay is not scared of dentists nor intimidated by dental instruments like mouth mirrors and periodontal probes.

She is only three years old and has visited the dentist four times, probably more times than most children twice her age.

Unlike most Malaysian parents, Siti Rose’s mother Dr Siti Salmiah Awang started teaching her children about oral hygiene almost as soon as they had teeth.

When Siti Rose was just a year old, her mother taught her how to brush her teeth and started taking her for her bi-annual dental check ups.

“Oral care in children is vital from the moment their teeth start to erupt at about six months. It prevents early caries development and avoids other abnormal conditions concerning teeth development,” says Dr Siti Salmiah, 45.

At home, the PJ-based family physician gets her five daughters – aged three to 12 – to brush their teeth twice a day.

Toothbrushes are replaced every six months (or sooner) to ensure the bristles are in good condition. She is slowly training her girls to get into the habit of flossing.

Siti Rose and her sisters undergo dental check-ups every six months. Their mother says dental visits help the girls familiarise themselves with dentists and dental clinics.

The secret to wonderful pearly whites? Ensure children brush their teeth at least twice a day. – Photo: The Star/Art Chen

“I encourage my girls to build a closer rapport with these medical professionals. At the clinic, the nurses teach them about the do’s and don’ts about oral care too. They have become so at ease with dentists and don’t mind going for regular check-ups,” says Dr Siti Salmiah.

Oral care is one of the important foundations for healthy permanent teeth. Therefore, it is essential to establish a proper oral hygiene routine early in life to help ensure the development of strong and healthy teeth.

Thanks to modern technology, patients can watch their favourite movie while the dentist works his magic. – Photos: The Star/Samuel Ong

Mother-of-one Prof Ammu Kutty G.K.Radhakrishnan thinks children should be taught that dentists are “superheroes” who help protect their pearly whites.

Six years ago, her daughter Akshainie developed a cavity in her tooth. Like most children, she was nervous about the dental visit, fearing her tooth would be extracted.

“Thankfully, Akshainie’s dentist was trained to treat children. She was allowed to play on the dental chair as well as handle some of the safer instruments like hand-held mirror. After calming her down, the dentist started the check-up and the procedure went on with ease,” says Prof Ammu, 55, who takes Akshainie for dental check-ups on a yearly basis.

The associate dean at a private medical university in KL added it was initially difficult to train Akshainie to get into the routine of brushing her teeth regularly. But that changed after finding the suitable toothpaste and tooth brush.

“The toothpaste needs to have a pleasant taste that would encourage children to brush their teeth.

“It is equally vital that the ingredients in children’s toothpaste are safe and effective,” says Prof Ammu, who encourages her 10-year-old daughter to watch videos on oral hygiene on YouTube.

Brushing your teeth regularly gets rid of plaque and other nasties, Prof Dr Ammu Kutty G.K.Radhakrishnan tells her daughter, Akshainie.

Akshanie’s dentist, IMU Oral Health Centre clinician in-charge Dr Hussein Al-Wakeel, says parents play an important role in instilling good oral care in their children.

“Parents, as consistent role models, are key to making their children understand the importance of oral hygiene.

“Tooth brushing should be presented as a habit and an integral part of the daily hygiene routine. Children are very sensitive to social stimuli such as praise and affection, and learn best by imitating their parents,” explains Dr Hussein, adding the foundation for healthy permanent teeth in children and teenagers is laid during the first years of life.

To avoid tooth decay, children should eat healthily, make smart food choices and practise good toothbrushing habits, Dr Hussein advises.

“Save treats like candy and cookies after mealtime, since this is when the amount of saliva produced is greater and helps protect children’s teeth.

“Flossing can help remove the candy particles. To make flossing fun, use flossers with your child’s favourite character,” says Dr Hussein, who encourages children to drink more water to help prevent tooth decay.

Prevention is better than cure

In the early 1970s, the Ministry of Health launched its School Dental Service (SDS) to ensure optimal oral health among students.

This service is provided in school dental clinics and dental clinics, and complemented by mobile dental clinics.

The programme has managed to reach almost 98.2% of primary and 84.0% of secondary schoolchildren in 2009, according to the ministry’s Oral Health Program’s official portal.

While oral health awareness among school children has improved, the National Oral Health Survey of Adults showed that oral health of preschool children is of concern with an increase of caries (tooth decay).

The report states children who have caries in their milk teeth were found to be three times more likely to develop caries in their permanent teeth.

Dr Ng advises parents to ensure their children go for regular routine dental check-up and preventive care. Photo: The Star/Ronnie Chin

To address this problem, Malaysian Dental Association president Dr Ng Woan Tyng advises parents and children to place more emphasis on the need for routine dental check-ups and preventive care.

“Regular dental check-ups can help lessen the need for invasive procedures like injections and extractions. Routine visits are a method to acclimatise children to the dental environment and to instil a positive mindset on seeing a dentist.”

Dr Ng says dentists practise many behaviour management methods to overcome an anxious child.

Some patients are given audio visual eyeglasses during treatment. This helps keep patients still and distracted while dentists are performing their work.

“Behaviour management techniques can be broadly divided into two groups – pharmacological (using medicines for sedation or general anaesthesia) and non-pharmacological (such as ‘tell-show-do’, role modelling or positive reinforcement).

“Sometimes, when all methods fail, the last resort will be to subject the child to general anaesthesia for a comprehensive dental treatment.”

Ipoh-based Dr Ng encourages parents to make dental visits part and parcel of a child’s formative years. “Children need to understand the need to an start early in oral hygiene care. This basic care is the same as any other routine self-daily care. Oral care from young sets the mindset of these children that routine dental care is important.”

As a rule of thumb, everyone should brush their teeth twice a day, with brushing before bedtime a must.

“During sleep, salivation is minimal and food debris or plaque will be retained on the tooth surface for a long period of time.

“This can lead to an increased chance of demineralisation of the tooth surface that could eventually lead to cavities.

“In general, cavities are a result of an acidic condition caused by oral bacteria acting on substrates in the mouth.”

She adds early oral health care helps prevent dental related problems including toothache, dental related infection, and malocclusion, misalignment between teeth and dental arches.

“Consequences of untreated dental disease can lead to disturbed sleep, difficulty in eating, and absence from school.

“Severe untreated dental disease may put the child at risk of being teased because of poor dental appearance and repeated prescription of antibiotics,” says Dr Ng, who recommends that children visit dentists as early as a year old.

She explained dental visits allow dentists to monitor the dental development of the child and identify dental related problems in the early stages.

“Often, children are brought in to see a dentist when there is a problem. Hence, children have the impression that the dentist may do something ‘painful’ to them,” says Dr Ng who adds children need to see the dentist at least once a year.