A Focus on Kids Oral Health

Children’s dental health in Aotearoa New Zealand is considered poor. Alarmingly, over half of kids under the age of five have tooth decay¹. Tooth decay is the most chronic childhood disease in New Zealand and more and more children are actually being hospitalised due to the severity of their tooth decay. What can we do about this?

Baby teeth and how to look after them

Good oral health begins even before a child’s first teeth appear. Getting your baby used to you touching their mouth and gums is a great start so that they are comfortable with this before you need to start brushing their teeth. Clean baby gums by wiping with a warm cloth.

Baby teeth usually start to pop up from about six to ten months of age. Start brushing as soon as your baby’s teeth start to show. Use a brush with a small toothbrush head and very soft bristles and a fluoride toothpaste. In New Zealand the Ministry of Health recommends that everyone (including babies) should use toothpaste that contains a fluoride content of at least 1000 parts per million (ppm) to prevent tooth decay.² For babies and children aged 0 to 5 years apply a half-pea-sized amount of toothpaste to the brush, and for kids aged six and over apply a pea-sized amount of toothpaste.

Brush gently twice a day for babies and children. Once your child is over one year old, brushing time should be two minutes each session including brushing the front and backs of teeth, the gums and tongue. You can use an electric toothbrush on a baby.

Not rinsing after brushing helps the fluoride in the toothpaste to stay on the teeth and continue to protect them during the day.

Keep on top of kids’ oral health

We are lucky in Aotearoa New Zealand that dental care for children and young people is publicly funded until the age of 18. Enrol your child in the free Community Oral Health Service (0800 TALK TEETH 0800 825 583) at an early age. A first visit for a check-up will happen when your child is between one and two years of age. This service covers examinations to check for tooth decay, mouth and gum problems, perform x-rays, apply fluoride treatment (to help make the tooth surface more resistant to decay), apply fissure seals (a protective paint is applied to the teeth surface to help prevent decay), clean plaque, tartar, stains, perform fillings and extractions, and make referrals to other dental services for extra or more complex treatments when needed.

Other tips for good dental care:

• Attend regular dental check-ups.
• Check for signs of tooth decay.
• Give kids healthy snacks.
• Drink water or milk only.
• Gently discourage thumb-sucking from around age 5 or six. While thumb-sucking is a natural reflex for babies and small children, it can cause tooth movement and abnormal bite if continued after the permanent teeth start to appear.

Don’t forget toothbrush care!

A toothbrush can grow unhealthy bacteria if stored in a closed container. Let brushes air dry to keep them germ-free.

Replace every three to four months or sooner if the bristles look worn.

Consider replacing a toothbrush if your child has a cold/flu or an infectious disease.

Fluoride….why it is added to water supplies

New Zealand has a high prevalence of poor oral health within some of our communities, and public water fluoridation prevents the potential impacts of lifelong poor oral health.

Fluoride is a repair kit for teeth by:

• strengthening tooth enamel
• repairing early stages of tooth decay
• neutralising mouth acid
• disrupting the growth of bacteria in the mouth.

Fluoride is a chemical element found in the earth’s crust. It is released from this as a natural process into our air and water. Fluoride is naturally found in fresh water (usually within the ranges of 0.01 to 100ppm). We have it in our bodies too in our bones and teeth.

In New Zealand, our natural water supply doesn’t have enough fluoride to have any positive effect on oral health so it is added to some public water supplies. The goal of adding fluoride to drinking water is to decrease the risk of tooth decay. The science over the last 60 years consistently shows that there is a big decrease in dental caries (cavities) because of water fluoridation – a 30 to 40% reduction in primary (baby) teeth, and 40 to 49% reduction in permanent teeth.³ An evidence update undertaken by the Ministry of Health in 2024 concluded that “water fluoridation is a safe and effective health intervention to prevent dental caries.”⁴

Fluoridation of water supplies is seen as an effective public health measure and important for preventative care because dental treatment can be expensive and out of reach for many people. The amount of fluoride added to public drinking water is kept within the range of 0.7 to 1.0mg/ml to provide safe levels for cavity prevention, but to minimise any chance of overexposure.⁵

The other side of the fluoride debate

While safe in small doses (the doses added to our water are considered very small), like almost all of the chemical elements found in nature, fluoride is toxic in overdose. Acute toxicity causes nausea, vomiting and diarrhoea and can lead to cardiac and renal dysfunction. Worldwide, over 80% of cases of fluoride toxicity are seen in children under the age of six who have eaten large amounts of fluoride toothpaste or drunk fluoride-containing mouthwash.⁶

Opponents of public water fluoridation have raised concerns about:

• Tooth decay also being caused by poor hygiene and lack of dental care, not just low fluoride levels.
• The potential toxic effects of fluoride on the brain and kidney.
• The benefit of fluoride is when used topically so it would be better to be applied directly to teeth not ingest it.
• Excess fluoride causes fluorosis (mottling and staining of permanent teeth).
• Fluoridation is seen as a medical intervention and takes away personal choice.
• If fluoride is in the water, the amount people ingest will be different for each person as different people drink different amounts of water per day.

Good oral health has a direct impact on speech development, chewing and eating properly as well as smiling with confidence. While baby teeth are eventually replaced by permanent teeth, they must still be looked after properly to avoid any issues with permanent teeth like pain, infection and poor self-esteem. No matter your view on water fluoridation, there is no argument that looking after children’s teeth lays a good foundation for good oral health over a lifetime.