Den norske tannlegeforenings Tidende
16.01.2020
Abstract Oral health of children and adolescents - factors of concern in the future In children, oral health is an integral part of general health.
Good oral health contributes to normal growth and development as well as good quality of life. Professionals working with children should be aware not only of normal growth and development, but also of the special needs of children and how to take into account all the information concerning them in dental care. Good oral health is not a given for healthy children, let alone those suffering from illness.
Caries continues to be a problem, and early childhood caries (ECC) can lead to severe oral infections and even repeated treatment requiring general anaesthesia. Today, caries is still predictive of caries. Signs of risk of periodontitis can be seen as early as during the deciduous teeth phase. Both illnesses have long-term impacts; on the other hand, both can be managed with good early diagnostics and by intervening when the disease is still preventable.
As many as one in every five children has a chronic systemic illness, the most prevalent being allergies, asthma, diabetes and autoimmune diseases, of which rheumatoid arthritis is the most common. Nearly 10 % of children suffer from mental problems. Changes in the way people eat, a more sedentary lifestyle and increased screen time have led to a rise in the prevalence of obesity among children and adolescents. While smoking has become less prevalent the use of snuff has become more common among adolescents. All this poses a threat to oral and general health in the future.
Dental practitioners must be prepared to assess whether a child's right to a safe environment, normal growth and development and good health is met. Promotion of oral health must be continuous on population as well as on individual level, and new methods to achieve this need to be developed. All children have the right to good oral health.
Introduction
The child's development and growth is a bio-psycho-social cascade where the development in all three era is necessary and problems in any of them interfere with normal growth. Parents, dental and medical professionals as well as the society are responsible for guaranteeing a healthy environment, child's undisturbed development, and health. According to The United Nations Convention on the Rights of the Child article 24 (1) every child has the right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Along with the right to evaluation and support of somatic development and health, every child and family has similar right for psychosocial development and welfare (2). Good oral health is an essential part of general health and necessary for growth and development. On the other hand, poor oral health is a risk for general health and systemic diseases may be a threat to oral health. (figure 1)
Systemic and psychiatric diseases and weight
Systemic diseases
Even one fifth of Finnish children have a chronic systemic disease with varying severity. The most common are allergies, asthma, neurodevelopmental disorders, coeliac disease, type I diabetes (DM I) and autoimmune diseases of which juvenile idiopathic arthritis (JIA) is the most common. The proportion of children diagnosed with obesity, inflammatory bowel disease (IBD), DM I, and JIA as well as with organ transplants, operated heart conditions and the survivors of childhood cancer, has been increasing in recent years (3). In Finland, 500 children (High and low BMI
In recent years snacking has replaced regular meals. Consumption of soft and energy drinks has increased, causing a threat for general as well as oral health (7). Frequent snacking and intake of sweet products are associated with overweight (8), but also with dental caries (9). Indeed, children's overweight and obesity are common in today's industrialized world (10). Simultaneously with dietary changes, time spent in front of TVs, PCs and mobile applications has increased at the expense of physical activity, in particular among the teens (11). Literature of the association between overweight and caries is contradictory; both high and low BMI have been shown to associate with decaying. The association appears different in countries of different developing stage (12). These issues need close monitoring in future.
Eating disorders, on the other hand, are common especially among girls, when approximately 7 % of Finnish women get such diagnosis before 30 years of age (13). Eating disorders threaten general as well as oral health. The most remarkable problem is dental erosion, in which teeth dissolve due to frequent vomiting or consumption of acid food and drinks (14) combined with occlusal forces. The prevalence of erosive tooth wear per se is increasing and a matter of concern especially among the young.
In all cases where a young patient has an eating disorder of any kind, possibility for professional nutritional counselling must be considered, in some cases even counselling to arrest erosive tooth wear. It is important to remember that an eating disorder may be a symptom of an underlying mental problem, which requires referral to psychiatric counselling.
Visions in child psychiatry
In a Finnish population-based study (n=2682) by Borg and coworkers (15), 17 % of children aged 4-9 years were reported to have psychiatric symptoms according to the Strength and Difficulties Questionnaire (SDQ, www.sdqinfo.com) filled in by parents and / or teachers. Based on the reports by physicians working in primary health care clinics, 12 % of children and families were evaluated to need treatment and support in primary health care and respectively 9 % (number of reports 2604) in specialized health care due to psychosocial problems.
There is no evidence of substantial increase in children ?s mental health problems in Finland between 1989 and 2013; however, the use of mental health services has constantly increased (16). The number of referrals indicates better detection of children ?s mental health
Gå til medietCaries continues to be a problem, and early childhood caries (ECC) can lead to severe oral infections and even repeated treatment requiring general anaesthesia. Today, caries is still predictive of caries. Signs of risk of periodontitis can be seen as early as during the deciduous teeth phase. Both illnesses have long-term impacts; on the other hand, both can be managed with good early diagnostics and by intervening when the disease is still preventable.
As many as one in every five children has a chronic systemic illness, the most prevalent being allergies, asthma, diabetes and autoimmune diseases, of which rheumatoid arthritis is the most common. Nearly 10 % of children suffer from mental problems. Changes in the way people eat, a more sedentary lifestyle and increased screen time have led to a rise in the prevalence of obesity among children and adolescents. While smoking has become less prevalent the use of snuff has become more common among adolescents. All this poses a threat to oral and general health in the future.
Dental practitioners must be prepared to assess whether a child's right to a safe environment, normal growth and development and good health is met. Promotion of oral health must be continuous on population as well as on individual level, and new methods to achieve this need to be developed. All children have the right to good oral health.
Introduction
The child's development and growth is a bio-psycho-social cascade where the development in all three era is necessary and problems in any of them interfere with normal growth. Parents, dental and medical professionals as well as the society are responsible for guaranteeing a healthy environment, child's undisturbed development, and health. According to The United Nations Convention on the Rights of the Child article 24 (1) every child has the right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Along with the right to evaluation and support of somatic development and health, every child and family has similar right for psychosocial development and welfare (2). Good oral health is an essential part of general health and necessary for growth and development. On the other hand, poor oral health is a risk for general health and systemic diseases may be a threat to oral health. (figure 1)
Systemic and psychiatric diseases and weight
Systemic diseases
Even one fifth of Finnish children have a chronic systemic disease with varying severity. The most common are allergies, asthma, neurodevelopmental disorders, coeliac disease, type I diabetes (DM I) and autoimmune diseases of which juvenile idiopathic arthritis (JIA) is the most common. The proportion of children diagnosed with obesity, inflammatory bowel disease (IBD), DM I, and JIA as well as with organ transplants, operated heart conditions and the survivors of childhood cancer, has been increasing in recent years (3). In Finland, 500 children (High and low BMI
In recent years snacking has replaced regular meals. Consumption of soft and energy drinks has increased, causing a threat for general as well as oral health (7). Frequent snacking and intake of sweet products are associated with overweight (8), but also with dental caries (9). Indeed, children's overweight and obesity are common in today's industrialized world (10). Simultaneously with dietary changes, time spent in front of TVs, PCs and mobile applications has increased at the expense of physical activity, in particular among the teens (11). Literature of the association between overweight and caries is contradictory; both high and low BMI have been shown to associate with decaying. The association appears different in countries of different developing stage (12). These issues need close monitoring in future.
Eating disorders, on the other hand, are common especially among girls, when approximately 7 % of Finnish women get such diagnosis before 30 years of age (13). Eating disorders threaten general as well as oral health. The most remarkable problem is dental erosion, in which teeth dissolve due to frequent vomiting or consumption of acid food and drinks (14) combined with occlusal forces. The prevalence of erosive tooth wear per se is increasing and a matter of concern especially among the young.
In all cases where a young patient has an eating disorder of any kind, possibility for professional nutritional counselling must be considered, in some cases even counselling to arrest erosive tooth wear. It is important to remember that an eating disorder may be a symptom of an underlying mental problem, which requires referral to psychiatric counselling.
Visions in child psychiatry
In a Finnish population-based study (n=2682) by Borg and coworkers (15), 17 % of children aged 4-9 years were reported to have psychiatric symptoms according to the Strength and Difficulties Questionnaire (SDQ, www.sdqinfo.com) filled in by parents and / or teachers. Based on the reports by physicians working in primary health care clinics, 12 % of children and families were evaluated to need treatment and support in primary health care and respectively 9 % (number of reports 2604) in specialized health care due to psychosocial problems.
There is no evidence of substantial increase in children ?s mental health problems in Finland between 1989 and 2013; however, the use of mental health services has constantly increased (16). The number of referrals indicates better detection of children ?s mental health
