Sunstar Conversations

HIGHLIGHTS – SUNSTAR Conversations PRO – caries prevention and management in children.

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Once every month,  SUNSTAR hosts a  webinar for health care professionals with 2 leading experts who converse about one specific life stage and its different oral care needs. The 1st webinar focused on the bi-directional relationship between pregnancy and oral health, and how pregnancy can turn into a unique opportunity to achieve long-lasting behavior change (re-watch here). During the 2nd edition, streamed on April 1st, 2021, we discussed caries prevention and management in children and the foundation of long-lasting oral well-being. Find out below what the experts, Ms. Lesley Tuomi, a hygienist in the US, and Professor Dr. Svante Twetman, professor in pediatric dentistry in Denmark, had to say.

How big is the problem with caries in children?

Oral diseases including both caries and periodontal conditions still weigh around €93 billion reaching the 3rd position in the ranking of the global financial burden of diseases in Europe, only behind diabetes and cardio-vascular diseases, according to data showed by Professor Twetman (data from Platform for better Oral health in Europe). It is sad to observe that caries still affects more than 50% of children, especially since it is a preventable disease, as Ms. Tuomi and Professor Twetman concur.

Beyond the overall investment oral diseases represent for the society, the burden also falls into the personal sphere, with individual financial efforts as well as indirect non-economic costs of higher severity. Concerning caries specifically, Ms Tuomi mentions for example that in her district where impoverished families live, caries affects the development of young children. Without the ability to verbalize the pain, the prolonged suffering impacts the brain’s chemistry and anatomy of the children. This may cause an inability to manage food control, increased anxiety, stress, impaired memory, damaged learning ability, and, eventually, it may also lead to label these children with behavior management issues. Conversely, after treatment, she witnessed a complete change in the personality of those children who became calmer and able to better learn and function in school.

Oral diseases weigh around €93 billion in Europe, reaching the 3rd position in the Ranking of the Global Financial Burden Diseases, only behind diabetes and cardiovascular diseases

The etiology of caries

As Professor Twetman reminds us, it has been known for decades that an overconsumption of carbohydrates with improper daily cleaning and a suboptimal exposure to fluoride provokes a shift of the oral microbiome. Previously only seen as a disease linked to caries pathogens like Streptococcusmutans, caries is now also seen through a new, wider lens: biofilm imbalance. “As long as the composition of the biofilm is diverse and stable, it is associated with good health. But when stressed by sugar or improper cleaning, the composition shifts to an unhealthy state with an overabundance of bad bacteria in clusters. The diversity reduces, the conditions become unstable and this dysbiosis results in decay.”, as Professor Twetman puts it.

Screenshot from the webinar – adapted from Twetman, 2018, Prevention of dental caries as a non‐communicable disease

As such, Professor Twetman stresses out the non-transmittable feature of caries, and implies that this condition has common risk factors (behavioral, socio-economic, lifestyle) with many other non-communicable diseases like overweight and diabetes. Consequently, oral care professionals deal with more than just a mouth but also with the general health: joined efforts between different professional groups to mix skills for a holistic approach will allow to better combat the caries disease as well.

Prevention and its key measures

The 4 pillars of prevention are based on regular oral hygiene to disrupt the biofilm, reducing sugar intake, fluoride implementation and education. Although evidence slants towards fluoride as the key measure, Ms Tuomi and Dr Twetman, unfortunately, deal with an increasing number of parents who, influenced by the bad press fluoride has, are now refusing it. However, to have an empathetic discussion with the parents, Dr Twetman suggests using this position as a lever: parents can skip fluoride only if they keep the free sugar intake below 5% of the total energy intake, as per the recommendations from the WHO guidelines (Twetman, 2018). This may then open the discussion to an adapted individualized solution.

Both lecturers agree that in any case, education remains a key component. “We hold the education that we learned at dental school and as such, we need to educate other professionals, in health but also in every other areas of our society, who can make the changes happen. The majority of society doesn’t understand dental diseases. Constant education around [us] is needed”, Ms Tuomi said, illustrating this with the example of the soda-filled vending machines she had removed from a high school in her neighborhood. Beyond the dental office setting, oral care professionals can indeed spread the message and reach more people in their community. Plenty of actions can be devised: volunteering at local events, giving away toothbrushes, working with policy makers to implement dental screenings alongside the vision or hearing screenings in schools, etc.Dr Twetman agrees with education at all levels and with all means possible but also reminds that it is not “one-size-fits-all”: if education is a global need, measures require a “glocal” interpretation and must be adapted to the target group, be it from a geographical, socio-economic or an age-group aspect.

Key takeaways:

Caries is a preventable, non-communicable disease linked to a dysbiotic imbalance of the biofilm

Fluoride remains the n°1 key preventative measure, but education about caries and its prevention, tailored to local circumstances and societies, is paramount

If you are interested in learning more about this topic, you can re-watch the entire webinar here.

Our next webinar in the Sunstar Conversations PRO series will tackle oral hygiene during orthodontic treatment and how to make it attractive for teenagers. It will take place on May 6th, 2021 at 3.30pm CET. Make sure to join by registering now via this link. See you there!

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