The “Let’s Talk about Teeth”

KEY QUESTIONS

FOR FOSTER

CARERS

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What is this booklet about?

This booklet is designed to answer the most common questions asked by foster carers during the “Let’s Talk about Teeth” project in Tower Hamlets.

It covers a range of topics to help foster carers and Looked after Children (LAC) about:

Q Healthy eating

Q Toothbrushing and toothpastes

Q How to identify other common dental problems

Q Helping foster children with special needs

Q Visiting the dentist

Q Tackling children’s fears about going to the dentist

Q Tooth fractures and injuries

Q Orthodontic treatment

Q Helping LAC to quit smoking

Q Where do I go for more information?

Let’s talk about teeth – ten key questions for foster carers

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Spring

Water

What is the best diet for children’s teeth?

Eating lots of foods and drinks that contain added sugars, especially throughout the day, increases the risk of tooth decay. Chocolates, pastries, cakes, biscuits, breakfast cereals, squashes, fizzy drinks, fruit juices and smoothies all contain added sugars that can cause tooth decay. Even dried fruits and honey have the type of sugar that causes tooth decay.

Eating a healthy and balanced diet will help your foster child stay healthy and also reduce their chances of having tooth decay.

This means encouraging LAC to:

Q Eat lots of fruit and vegetables (at least five portions of a variety every day)

Q Eat starchy foods, such as bread, rice, potatoes, and pasta, choosing wholegrain varieties and potatoes with their skins on whenever possible

Q Eat some milk and dairy foods

Q Eat meat, fish, eggs, beans and other non-dairy sources of protein

Q Drink plenty of water rather than fizzy drinks and acidic fruit juices

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Try to help your LAC:

Q Cut down on the amount and the number of times a day that they eat and drink sugary foods and drinks (best limited to meal times)

Q Avoid sugary food and drinks before bed time when the protective effects of saliva are reduced

Other ways to help your foster child’s diet are:

Q To check the sugar content on food labels and opt for low sugar options

Q Choose healthy snacks for children from the sugar swaps website: http://www.nhs.uk/Change4Life/Pages/sugar-swap-ideas.aspx

Let’s talk about teeth – ten key questions for foster carers

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What toothpaste should children use to prevent tooth decay?

Toothpastes containing fluoride are the best toothpastes to use to prevent tooth decay. You should use toothpastes containing different amounts of fluoride depending on the age of your foster child. You can find this information on the side of the tube of toothpaste.

For children aged:

Q 0-3 years – use a smear of fluoride toothpaste with no less than 1000ppm of fluoride

Q 3-6 years – use a pea-sized amount of toothpaste containing more than 1000ppm of fluoride

Q 7 years and above – use fluoride toothpaste with 1350 to 1500ppm of fluoride

Q 0-6 years who are increased risk of developing tooth decay may need high concentrated fluoride toothpaste prescribed by their dentist

Brushing can start as soon as the first baby come through, usually from 6 months.

It is best to help your LAC to brush their teeth until they are aged seven to make sure that they brush properly and that they do not eat or lick the toothpaste from the tube.

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The best time for toothbrushing is before bed time and at least one other time.

Encourage children to spit out the extra toothpaste and not to rinse out with water or mouthwash after brushing. This helps the fluoride stay on the teeth for longer.

Toothbrushing also removes plaque and helps the gums stay healthy.

Children can use an electric or ordinary toothbrush. It is more important that child brush their teeth effectively twice a day for at least two minutes regardless of what toothbrush they use. But electric toothbrushes that rotate may be better for children with special needs or for children who have problems using their hands.

It is best to change your foster child’s toothbrush every three months or when the bristles become frayed, whichever happens first.

Let’s talk about teeth – ten key questions for foster carers

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How do I know if my LAC has dental problems?

“Look and see” – signs to look out for when you check your foster child’s face, mouth, teeth and gums when brushing their teeth

Q Outside the mouth – swelling and/or redness around the face

Q Inside the mouth – black/brown marks on the teeth, discoloured teeth, loose teeth, broken or sharp teeth, redness or swelling around the teeth or tongue and inside mouth, ulcers, “gumboils” (swellings with a yellow discharge), bad breath, food stuck between or inside teeth

Q Red/swollen gums and gums that bleed when brushed, tartar which forms where teeth meet the gum

Q Food and stains left on teeth and gums after brushing (for unsupervised older children)

Q Not enough space for teeth to come through or very crowded teeth, or front teeth that stick out a long way

You can also look out for any changes in your child’s behaviour such as waking up at night, poor concentration at school, loss of appetite, avoiding certain foods (e.g. hard or very cold food), only eating on one side of the mouth, avoiding tooth brushing, grinding or clenching their teeth together (especially when they sleep).

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“Ask and Listen” – Encourage your child to talk about their dental problems

Do they have any of the following dental problems?

Q Swollen, red or sore face

Q Painful or sore mouth or teeth – this may be at night or during day

Q Discomfort or sensitivity when eating, drinking or brushing their teeth

Q Ulcers, lumps, sore patches in their mouth

Q Bad taste in their mouth or bad breath

Q Loose, broken or sharp teeth

Q Bleeding gums when they brush

Q Stained or discoloured teeth

Q Unhappiness about the look of their teeth

If you are worried, please contact your child’s dentist for more advice.

Let’s talk about teeth – ten key questions for foster carers

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My child has special needs. What should I do to help his dental health?

The best way to help your LAC if they have special needs is to keep their teeth and mouth healthy to prevent dental problems from occurring. Some LAC with special needs may not be able to let you know if their mouth or teeth are hurting. You may want to look out for signs of any dental problems (see pages 7-8 of this booklet). They may find it difficult to cope with dental treatment.

Your foster child’s dentist can help you make a dental care plan for your LAC. This could include advice about how to brush their teeth – which may be difficult for you and your LAC; how to limit the damage from their medication and diet, and how to help them to feel happy and comfortable when visiting the dental clinic.

Your foster child’s dentist may also recommend that your LAC sees a specialist in the Community Dental Service or Hospital. You can also contact Barts Health NHS Trust Community Dental Service directly to make a dental appointment (see page 19).

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My dentist refuses to see my three-year-old foster child saying she is too young and will not see my older teenager foster child because he missed his appointments. What should I do?

We advise foster carers to take LAC for their first dental check-up as soon as their first teeth have come through the gums (usually 6 months). The dentist should see your child and give you advice about how to look after their teeth, and let you know how often you should take them to the dentist – this will be at least once a year. Regular dental check-ups help your foster child get used to visiting the dental clinic and feel more confident about letting the dentist check their teeth.

We know that many teenagers are anxious about visiting the dentist and may miss appointments. If your foster child’s dentist refuses to book further appointments for your LAC, contact the Barts Health NHS Trust Community Dental Service (see page 19). They will work closely with you and your LAC, their social worker and health team, to make sure that they can get the dental care they need.

Let’s talk about teeth – ten key questions for foster carers

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My foster child is very nervous about going to the dentist and is scared about having treatment. What should I do?

Being nervous about going to the dentist is normal. It happens to many children and even adults. But it’s still important for your LAC to visit the dentist regularly. Most dentists know that some children are nervous about having treatment and will try to take your LAC feel as comfortable as possible.

Your foster child’s dentist can use different ways to help your foster child relax if they need simple treatment (such as talking or using distraction). They might have to “numb” a tooth or use ‘sleepy juice’ (local anaesthetic) if your child needs more complicated treatment. If your child is very nervous, the dentist can also refer your child to the Barts Dental hospital or to Barts Health NHS Trust Community Dental Service to have a special “gas.” Your child will still be awake but the gas will help

them to relax so that they can cope with the injection and treatment. Some children who need a lot of treatment may have to be put to sleep (general anaesthetic) in a hospital. If you are worried, talk to your child’s dentist about the different options.

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My foster child has injured her front tooth. What should I do?

First check to see if there are any signs of concussion, nausea or double vision. If there are signs, take your LAC to the Accident and Emergency department.

If the tooth is broken and is still inside their mouth, find the broken piece, keep it safe and take it and your foster child to the dentist as soon as possible.

If the tooth has come out of the mouth completely and the tooth is:

Q A baby tooth – Keep the tooth, get your foster child to bite on child on a dry handkerchief to stop the bleeding and take them to the dentist.

Q An adult (permanent) tooth and you feel comfortable about putting it back in the mouth – Lightly rinse the tooth in cold water but do not scrub the tooth, put the tooth back into the space in the mouth where it came out from. Ask your child to bite light on the tooth, then go to see a dentist IMMEDIATELY.

Q An adult (permanent tooth), and you are not comfortable about putting it back in the mouth – safely store the tooth in milk, do not rinse the tooth in tap water and go and see a dentist IMMEDIATELY.

Let’s talk about teeth – ten key questions for foster carers

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What should I do if my foster child has crooked and crowded teeth?

It’s very common for children to have crooked or crowded teeth. Roughly one in three children need orthodontic treatment (or braces). The best thing to do if you think that your LAC may need braces is to see your foster child’s normal dentist. The dentist will look at your LAC and if needed, refer them to see an orthodontist. The orthodontist will take a closer look, give you advice and provide orthodontic treatment, if they think your foster child needs it.

The orthodontist will also check your child’s diet and toothbrushing to make sure their mouth is clean before starting orthodontic treatment. This is because eating lots of sugar and not brushing your teeth properly when you wear braces can damage your teeth and gums. Most children who need orthodontic treatment have fixed ‘train-track’ braces to straighten their teeth. This usually takes 12 months to two years. Your foster child will also need to see the orthodontist regularly to check and adjust their brace. They may also have to have teeth taken out (extracted) to make more room for the teeth as they move. The orthodontist will let you know if this needs to be done.

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How can I help my foster child to quit smoking?

Many foster carers are trying to help their LAC to quit smoking. You are not alone.

Did you know…

Q Two-thirds of young people in England start smoking before the age of 18

Q Smokers who start smoking at a young age are 50% more likely to die at an early age

Q Smoking can affect:

l Your skin and appearance

l Your teeth, gums and breath

l Your breathing, asthma and hearing

Understanding why young people smoke

Cigarettes contain Nicotine which is very addictive. Smoking at a young age can affect how the brain develops. This can mean that young people have a life-long craving for cigarettes and make it more difficult for LAC to stop smoking without extra support. Some young people smoke to cope with stress. It may be a good time to talk to your LAC about issues that may be worrying them if they start smoking or seem to be smoking more. Stopping smoking can also make LAC feel more stressed. They may need extra support during this time.

Let’s talk about teeth – ten key questions for foster carers

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Getting help

Here are a list of places where your LAC can get help to stop smoking in Tower Hamlets (in addition to seeing their GP).

“You’re Welcome” chemists provide “teenager friendly” confidential advice and support.

Mile End, Globe Town, Weavers and Bethnal Green Northl Bee Chemist, 517 Hackney Road, E2 9EDl Borno Chemists Ltd, 204 Cambridge Heath Road, E2 9NQl Britannia Pharmacy (Roman Rd), 80 Roman Road, E2 0PGl Columbia Pharmacy, 104 Columbia Road, E2 7QBl Florida Pharmacy, 307 Bethnal Green Road, E2 6AHl Massingham (Sonrak Ltd),197 Roman Road, E2 0QYl Medichem (Bright Bridge Ltd),100 Whitehorse Lane, Stepney, E1 4LR

Bethnal Green South, Spitalfields and Banglatownl ABC Drug stores (Day Lewis), 12-14 Montague Street, E1 5PBl Beck & Sherman (Day Lewis Ltd), 195 Whitechapel Road, Stepney, E1 1DEl Boots the Chemist – Bethnal Green Rd, 426-428 Bethnal Green Road, E2 0DJl Fairdale, 360 Bethnal Green Road, E2 0AHl Old Maids Pharmacy, 321 Bethnal Green Road, E2 6AHl Regionchoice Ltd, 68 Cambridge Heath Road, Stepney, E1 5QJl Sainsbury’s Pharmacy, The Albion Brewery, Cambridge Heath Road, E1 5SDl Shantys, 253 Whitechapel Road, Stepney, E1 1DB

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Whitechapel, St Dunstans, Stepney Greenl Chapel (Patel P.B.), 139 Cannon Street, E1 2LXl Greenlight Pharmacy @Harfords Health Centre, 115 Harford Street, E1 4FGl Jaypharm (Patel P.B.), 4 Brayford Square, Exmouth Estate, E1 0SGl Sai Chemist (Cordeve Ltd), 56 Hessel Street, Corner of Bursham Street, E1 2LPl Sinclair (Ben Johnson Rd), 50-52 Ben Johnson Road, E1 3NNl Sinclairs Pharmacy (Lyngold/Roman Rd), 557-559 Roman Road, E3 5EL

Shadwell, St Katherine’s and Wappingl Ali’s Pharmacy (also known as Rigcharm Ltd), 93 Watney Street, Stepney, E1 2QEl Alliance Pharmacy, 382 Commercial Road, Stepney, E1 0LBl DMB Chemist, 4 Watney Street, Shopping Centre Stepney, E1 2PRl Tower Pharmacy, 50 Wapping Lane, Wapping, E1 9RL

Bow East, Bow Westl ABC Drug Stores, 520 Roman Road, E3 5LXl Bell Pharmacy (100hr), 534 Roman Road, E3 5ESl Mayors Pharmacy, 51-53 Bow Road, E3 2ADl Parnell Chemist (HT Pharm Ltd), 625 Roman Road, E3 2RNl Tesco Superstore (100hr), Hancock Road, Bow, E3 3DA

Let’s talk about teeth – ten key questions for foster carers

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Mile End East, Bromley by Bowl Bow Pharmacy (Waremoss Ltd), 18 Stroudley Walk, E3 3EWl Chrischem (Francis) Pharmacy, 578 Mile End Road, E3 4PHl Forward Pharmacy, 648 Mile end Road, E3 4LRl Greenlight Pharmacy @ St Andrew’s Health Centre, 2 Hannaford Walk, E3 3FPl Lincoln Pharmacy (Mildcare Ltd.), 60 St. Paul’s Way, E3 4AL

Limehouse, East India, Lansburyl Feldy Pharmacy, 35 Aberfeldy Street, E14 0NUl Lansbury Chemist. 85 Chrisp Street, E14 6GG l Nash Chemist, 817 Commercial Road, E14 7HG

Millwall, Blackwall and Cubitt Townl Allens, 19 Castalia Square, London, E14 3PQl Arms Chemist, 259 Poplar High Street, E14 0BEl Barkantine Pharmacy, Barkantine Medical Centre, 121 Westferry Road, E14 8JHl Boots the Chemist – Cabot Square, Ground Floor, Cabot Square, E14 4QSl Boots the Chemist – Canada Square, 14 Canada Square, Canary Wharf, E14 4AXl Boots the Chemist – Jubilee Place, Unit 15, Jubilee Place, Canary Wharf, E14 5NYl Boots the Chemist – Vassey Path, 18-20 The Vassey Path, E14 6BTl Britannia (Perimart) Pharmacy – ASDA, Unit 9, ASDA Precinct, East Ferry Road, E14 3BTl Cubitt Town, 143 Manchester Road, Isle of Dogs, E14 3DNl Docklands Pharmacy, 100 Spindrift Avenue, E14 9WU

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There are also stop smoking services offered by:

Specialist smoking cessation service (Royal London)

Tel: 0800 169 1943 or 020 7882 8230 Fax: 020 7882 5071

BME Stop Tobacco Project – Offers culturally sensitive advice for the Black and Minority Ethnic community who smoke cigarettes or chew paan with tobacco.

Tel (men): 020 7882 8660 Tel (women): 020 7882 8669 Email: bstptowerhamlets@gmail.com Fax: 020 7882 5060

Pregnancy stop smoking service – All pregnant women who smoke should be referred to this service.

Tel: 0800 169 1943 or 020 7882 8230 Fax: 020 7882 5071

Let’s talk about teeth – ten key questions for foster carers

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Where can I go for more information?

For more information about dental treatment:

Q Visit your foster child’s own dentist

Looking for a dentist in your area?

Search for a dentist using your postcode by visiting the NHS Choices Website:

http://www.nhs.uk/Service-Search/Dentist/LocationSearch/3

Contact the Barts Health NHS Community Dental Service:

St Leonard’s Primary Care Centre 3rd Floor, ‘B’ Block, Nuttall Street, London N1 5LZ Tel: 020 7683 4433

For general advice about healthy eating, toothbrushing or other questions

Contact Manuwuba Eke Manuwuba.Eke@towerhamlets.gov.uk Tel: 020 7364 7169

List of Contributors:

Aditi Mondkar

Dr Padhraig Fleming

Dr Paddy Evans

Dr Abimbola Giwa

Professor Ferranti Wong

Jane Stephenson-Glynn

Dr Desmond Wright

Dr Vanessa Muirhead (Editor)

Published by Tower Hamlets Council’s Communications Unit • 13.79 • May 2015