Tuesday, April 22, 2008

the power to choose

As parents, we always wants the best for our children, and we always wonder whether the things we did is the best for them. We always choose the best milk formula ‘with highest content of AHA,DHA, so forth’; the best diapers ‘that can stand up to 7-8 wets’, the best shoes that ‘allows the feet to grow’,.. the list goes on. Same goes when it comes to choosing dental products. The best toothpaste for our toddler must be the one with highest concentration of fluoride, since fluoride can help fight tooth decay, right?


The actual fact is, while fluoride does help in fighting tooth decay, our body (also our children’s) only need about 0.05-0.07mg fluoride /kg body weight. This can easily be achieved by drinking plain water or eating food cooked using water. In Malaysia, water fluoridation (putting fluoride into our water supply) started in Johor in 1966 and becomes a nationwide policy in 1972; and it has been significant in reducing tooth decay by strengthening the enamel (the outer layer of the tooth).

The fluoride level in our commercially available toothpaste are being regulated in between 550 – 1500 ppm (parts per million) and it is safe to be used by us, adults, for 2 reason:

- the fluoride will act as a topical supplement; i.e. it will only makes contact to the tooth surface since we do not swallow the toothpaste

- our average body weight (50-70kg) can sustain up to 0.10mg of fluoride/kg body weight, and one pea-sized toothpaste contains about 1mg of 1000 ppm fluoride. Confused? Let’s just say it’s safe for us to swallow one whole tube of toothpaste without risking any side effect.

Unfortunately, both reason is exactly why our children (age 6 months to 6 years) should not use fluoridated toothpaste. Pray tell, how can you confirm your child would not ‘accidentally’ swallow the yummy orange-flavoured toothpaste? Even though we have told them not to?

The next question you would ask would be: how does excessive fluoride consumption affects our children?

Let me introduce you to a new vocabulary:

It is a damage in tooth development, occurs between the ages of 6 months to 5 years, from the overexposure to fluoride. It will present itself as intrinsic (read: internal) staining of the permanent teeth, so the teeth will have whitish specks (mild fluorosis) up to brownish black (severe fluorosis).

Besides fluorosis, which is a known and proven side effect of excessive fluoride intake, the less known side effect is more worrisome, such as effects to their IQ and also to the kidneys and liver function in children. However, these side effects are very much debatable and more questionable. We should just leave the issue to the experts, I guess.

Trouble is, there is not many kids toothpaste that does not contain fluoride. I can introduce some brands that are available commercially, but please share with me if you know of others.

Pureen fluoride free kids toothpaste, retail at RM3.50

First Teeth A Natural Enzyme Baby Toothpaste, retail at RM35.00, available only at selected pharmacies (and a tad too expensive, if I may add)

ProdentalB children’s toothpaste, retail at RM4.00 though it’s really difficult to get this in stores. I have no idea why, maybe their distribution is limited.

Don’t get me wrong here. I’m not saying that you should ban fluoridated toothpaste from your household, okay. Fluoride is extremely important in remineralizing (strengthening) tooth surface that might have early signs of decay, and the side effects are relatively small compared to the positive effects. Plus, there are treatments available for those who have fluorosis. But prevention is much better, isn’t it?

For me, I keep both fluoridated and nonfluoridated toothpaste for my daughter. I use the nonfluoridated one daily and the fluoridated one like once in 2-3 weeks. Besides that you can always monitor or help your children while they are brushing their teeth, make sure they did not swallow any of the toothpaste if you are using the fluoridated ones. Also your dentist can give your child what we call ‘fluoride therapy’- which can be done once every 3-6 months, and very beneficial for sweet-toothed children. For babies, you can opt for the First Teeth toothpaste, or your dentist should be able to prescribe your child a suitable alternative. Or you can always not use anything, the wet towel can already do wonders.


Pakcik Ini Huruf M said...

oooo pakcik baru tau! really nice. senang paham. keep it up ;-)

Shahid Anwar said...

well argued about tooth pastes for children. But can I suggest that what I would recommend in line with SIGN (http://www.sign.ac.uk/pdf/sign83.pdf)and English oral Health Plan (Delivering better oral health: An evidence-based toolkit for prevention, is putting a smear of tooth paste (fluoridated for children between 1-3 yearsof age), pea size for children aged 3-9 and carrying on with pea size tooth paste for ever, twice a day every day.
Of course the parents put the paste and supervise tooth brushing upto the gae of 6 years.
And ofcourse the picture of severe fluorosis you have shown is not a norm with fluoridated water supply and tooth paste use, rather it is from drinking wtaer from a supply high in natural fluoride.


mrs hzefah said...

to mr pakcik huruf m: tq very much..
to mr shahid: thank you for your recommendation, it will surely help give some insight to my patients in choosing what is best for their children. although for me prevention is still better even for a mild case, and furthermore i myself still unable to prevent my child from swallowing her toothpaste..

p/s i caught my daughter heavenly LICKING her toothpaste out of her hand and the tube the other day; so i am thankful its the nonfluoridated one..

Chan said...

Dear "A Dentist in BBB",

This is Chan, I am from Kajang. I have been looking for First Teeth baby toothpaste from a few local pharmacies but couldn't get it. Could you please tell me where can I get it?

Thank you very much.

best wishes,

mrs hzefah said...

dear chan, you can get the toothpaste from guardian pharmacy. it is difficult to get, apparently they don't keep much of the stock. good luck.

Anonymous said...

doc, anak saya 5 yrs old, 2 btg gigi susu atas depan dah rosak teruk. semalam saya perasan ada gigi kekal kot dah terjulur keluar kat gusi dia. saya nak rujuk dentist, tapi soalan saya, apa dentist akan buat ye. sakit tak nanti treatment nye pada anak saya?
yg terjulur keluar tu kat gusi pulak tu.

mrs hzefah said...

dear anonymous,
bila kita nampak ada benda terjulur pada gusi anak kita yang berumur 5 tahun, benda tu ada dua kemungkinan: samada gigi kekal yang sedang tumbuh atau akar gigi susu yang rosak tu yang terkeluar dekat gusi. jika ianya gigi kekal, menandakan gigi susu tersebut perlu dicabut, dan kita biasanya akan bubuh bius dulu supaya anak kita tak sakit. jika itu adalah akar gigi susu dan ianya tidak mengganggu anak puan saya cadangkan supaya dibiarkan, tunggu hingga ianya longgar. dengan cara itu anak puan tidak akan merasa sakit. saya cadangkan agar puan membawa anak puan ke klinik supaya dapat explaination dengan lebih baik dan puan boleh refuse treatment sekiranya tidak mahu apa-apa rawatan.

pijapijot said...

salam doc,
macam mana nak treat flourosis tu?
saya rasa saya adela,
whitish coloured thingy ontop of my teeth.
got it since i was young.
hate it.