Are parents failing children in upholding proper dental hygiene?

NAIROBI: Poor oral health hygiene is plaguing the next generation of Kenya’s workforce, says the country’s first ever Dental Health Report.

Released in November 2015, the Kenya National Oral Health Survey found that Kenyans have a long way to go before they achieve recommended standards of dental hygiene and sadly, the future already looks bleak for children who will be adults by the year 2030.

The research, conducted by University of Nairobi’s Dental School, found that nearly all (99.6 per cent) children aged five have bleeding gums while three in every four children aged between 5 and 15 were found to suffer from gum disease due to poor oral hygiene practices.

The researchers identified low frequency of brushing as the main reason for the poor dental health. At least 47.6 per cent of children interviewed adhered to brushing once a day while 16.6 per cent said brushing teeth was a ritual they performed after every few days or even after a week.

According to dental surgeon Dr Kisia Mitch, this is contrary to the recommended practise which says teeth ought to be brushed twice a day - in the morning and before going to sleep.

“It is not enough that a child brushes their teeth. Every child below ten years should be assisted by an older person to brush their teeth as they are yet to master the proper way of doing it. If children in this age bracket are left to brush on their own and they are not doing it well, they will still suffer from cavities, bleeding gums and decay,” Mitch says.

The survey established that 95.5 per cent of children brushed their teeth themselves while the rest got assistance from their mothers, fathers or close relatives. At least 86 per cent of those aged 5 years brushed their teeth by themselves.

Dental cavities had a prevalence rate of 23.9 per cent among all children involved in the survey with some having cavities in half (14) of their teeth. Among the five year olds, 46.3 per cent were found to have cavities while 3.4 per cent already had missing teeth.

“Proper oral hygiene starts after six months,” says Dr Supa Tonje, a paediatrician at Adora Children’s clinic in Kitengela. “This is the time children begin growing teeth and exclusive breastfeeding ends.”

She says brushing teeth should start as soon as the first incisor appears adding that as long as proper oral hygiene is maintained the child can feed on sweet food provided it is in moderation.

“In principle everything, whether good or bad, is harmful when administered in excess. Parents should ensure their child brushes at least twice a day with each session lasting approximately five minutes and covering all surfaces and spaces,” says Dr Supa.

The researchers also found that sweet drinks were playing a huge part in affecting children’s teeth. Twenty four per cent of the interviewees said they take soft drinks once a week. Some 6.2 per cent said they indulge in this on a daily basis, 40.8 per cent admitted to drinking several times in a month while 60.9 per cent said they drink tea with sugar every day.

It was also found that where the teeth have cavities or are decayed, the main form of treatment is to have them filled followed by extraction. Further clinical examination found that 3.2 per cent of the children had oral mucosal lesions, 1.5 per cent had oral ulcerations and abscesses were present among 0.9 per cent.

Dental fluorosis, the browning of teeth due to high fluoride amounts in drinking water, was at 41.4 per cent. Twelve-year-olds and rural residents had a higher prevalence of fluorosis. The high occurrence of fluorisis is because Kenya lies astride the Great Rift Valley which has been found to harbour high amounts of fluoride.

A study in the early nineties by University of Nairobi’s Department of Dental Surgery and Faculty of Engineering found fluoride levels in Kenya at between 5 and 10 milligrams per litre (mg/l). This is way above World Health Organisation’s recommendation of 1.5mg/l

Smoking and substance abuse is also known to have a direct impact on oral hygiene and while one does not expect a child to be abusing drugs or smoking cigarettes, the reality in Kenya is quite different.

Among the 12 to 15 years old bracket, 0.7 per cent were found to be already smoking, 0.6 per cent ingesting tobacco while 4.1 per cent are miraa chewers.

“All these habits are not good for oral health, especially for a child whose teeth are still forming. Nicotine from cigarettes causes staining and increases susceptibility to lesions and bacterial activity,” says Dr Supa.

Kenyan parents are also yet to see the importance of frequent dental check-ups. Dental visits for routine check-ups were found to be low at 9.9 per cent while 70.2 per cent of dental visits were found to be after a child has already complained of pain.

According to Dr Kisia it is recommended that by the time a child is two years old, they should have had the first dental visit which should be followed up with check-ups at least every six months.

“This ensures problems with the teeth are detected early,” he says.

He says children develop 20 milk teeth which start falling off at the age of five and onwards.

“What falls off is the crown of the teeth. The root remains. A root that has been affected cannot regrow healthy teeth,” he cautions.