Wednesday's article ("One in two S'pore kids has rotten teeth: Report") shows that traditional cavity prevention methods are falling behind.
Dental decay is one of the most prevalent but preventable infectious diseases in the world. There is no cure, and treatment may be painful and expensive.
Unfortunately, many Singaporeans still accept tooth decay as part of life. Many patients I see in general dental practice do not ask why they develop cavities. They are overly concerned with treatment and not prevention, and there is little understanding of the biology of tooth decay among the public and even doctors.
A child's caries risk is decided before birth. There is plenty of evidence proving that a child born to a woman with a high decay rate will almost certainly develop caries in the primary teeth. This is due to transmission of the cavity-causing bacterium, S. mutans, from the mother's saliva to the child's mouth.
The "infective window" is from the ages of 19 months to 31 months, when these bacteria can colonise the child's mouth. We need to delay or prevent this process to reduce the child's lifetime risk of decay.
Traditional cavity prevention focuses on modifying risk factors - mainly diet and fluoride exposure - in S. mutans-positive patients. Preventive efforts should really include women planning to conceive and expecting mothers.
Cavities should be filled, infected teeth should be removed or root-treated, and oral hygiene and diet counselling should ideally be done even before conception.
Maintenance with anti-bacterial agents like fluoride, chlorhexidine and xylitol should be continued into the postnatal period. This will reduce salivary bacterial concentration and, hence, the chances of transmission to the newborn baby and the mother's other children.
Regular dental check-ups should become part of routine prenatal care or pre-conception medical screening. A potential mother's dental treatment should be started early, as conditions like gum disease may also have a negative impact on her pregnancy.
Medical general practitioners, obstetricians, gynaecologists and nurses who have regular contact with mothers before and during their pregnancy should reassure them that dental treatment during pregnancy is safe. This approach is compatible with diet management and fluoride use, which remain the fundamentals of cavity prevention.
I urge my medical colleagues to work with the dental profession towards a cavity-free future for Singapore.
Letter by Jaclyn Toh Ai Lin (Dr)
This article was published on May 16 in The Straits Times.
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