In the last 30 years, he said, the dental health of under-5s had not improved. ‘We are still seeing the same problems.’ He added that dental decay in young children not only caused pain, but also damaged their ability to learn due to loss of sleep, led to sufferers missing school and also meant parents had to take time off work to be with their child.
What’s more, the situation was worsening, he believed. Figures from the Royal College of Surgeons from 2017 showed a 24% increase in tooth extractions under general anaesthetic in children aged 0-4, something he was seeing reflected in his own clinics. ‘Even with improvements in dental health, it’s not enough. A large number of preschool children are being affected by dental caries,’ he said.
The primary stage involved reduction of foods and drinks containing sugar, regular toothbrushing and visits to the dentist, but this was not straightforward. ‘Changing dietary behaviour is a big cultural change,’ he said, and currently visiting the dentist was not possible, other than for emergencies. Encouraging regular toothbrushing with fluoride toothpaste was central, but he felt that conventional fluoride toothpaste, containing soluble fluoride, had limitations, and was a simplistic tool. It was also rinsed away very quickly.
Professor Wong was excited by the introduction of BioMin® F, a toothpaste that contains not only fluoride, but also calcium and phosphate ions. These are incorporated into the structure of a bioactive glass, which dissolves gradually over several hours, releasing the ions to act in concert with saliva to resist acid attack and remineralise lost tooth enamel.
He was aware that there was still suspicion of fluoride in some people’s eyes, but BioMin® C, which contains calcium and phosphate, without fluoride, could ‘tip the balance’ and would still offer the controlled release protection from remineralising calcium and phosphate, he said.
There may be a further use for BioMin F, he said. In his clinic, Professor Wong sees children with developmental decay or enamel hypomineralisation (MIH) and has noted anecdotally that BioMin F has been effective in reducing these patients’ extreme dentine sensitivity. ‘It may not be able to repair their tooth enamel, but we have seen that the hypersensitivity is decreased, and that makes it much easier for me, as a clinician, to repair the damage,’ he said. ‘BioMin toothpaste may be able to help even in this kind of case.’ In response to a question, he said that he would like to see a controlled clinical trial of BioMin in treating MIH.
Another question, relating to the current COVID-19 crisis, was how dentists could work with children while wearing PPE. ‘Anything that puts a barrier between a child and a clinician is difficult,’ he said, as it stops the child from seeing the clinician’s mouth or reading non-verbal signals. He suggested that fun masks with cartoons and images on might help, and as more was discovered about the disease and levels of infectivity, the situation would continue to evolve. In any case, it might not be such a problem as we envisage, he said. ‘Children are used to Darth Vader!’
Next time: Professor Robert Hill – The science behind BioMin F