“The development of children's dentistry as a dental speciality is essential” 

Dr. Paloma Planells is a professor of Paediatric Dentistry at the Universidad Complutense de Madrid (UCM) and director of the UCM-specific Master’s Degree in “Specialisation in integrated dental care for children with special needs.” She is also a member of the editorial boards of national and international scientific journals and editor of the journal Odontología Pediátrica [Paediatric Dentistry]. 

What is the state of our children’s oral health in Spain? 

The two main pathologies that we encounter in Spanish children are tooth decay and dental trauma. With regard to the former, it should be noted that although the figures for the general population have shown improvement over recent years, paediatric dentists are seeing decay re-emerging extensively among very young children, with a broad general impact. It would be interesting to gather data at the national level for decay at an early age in order to establish preventive programmes benefitting the quality of life of these children. These issues raise serious concern for paediatric dentists. 

With regard to pathologies derived from dental trauma, our statistics point to figures similar to those of children in neighbouring countries. In order to prevent these pathologies, we have promoted outreach campaigns aimed at professionals, educators and sports centres in order to increase awareness of immediate care, especially in the case of dental avulsion, a real urgency in dentistry. 

According to data from the White Paper on Oral Health in Spain 2015, dental problems have decreased in comparison with figures for 2010, with decay (18%) and, to a lesser extent, dental malposition (11%) being the most commonly reported. The same study shows that in dental clinics the most commonly carried out procedure in the paediatric population are fillings, cleanings and orthodontics. 

When is it best to begin check-ups by the paediatric dentist? 

The international guidelines of the European Academy of Paediatric Dentistry (EAPD), the American Association of Pediatric Dentistry (AAPD) and the Spanish Society of Paediatric Dentistry (SEOP) point out that adequate prevention of diseases arising in the oral cavity begins during pregnancy, with advice prior to childbirth. Consequently, it is best the child visits the children’s dentist before the age of one. According to the data in the White Paper on Oral Health in Spain 2015, only 4 out of 10 children between the ages of two and six have been seen by a dentist. After the age of 10, visits to the dentist are commonplace. 

Who is responsible for children brushing their teeth? 

Curiously, parents are very often unaware of the guidelines on the need for oral hygiene of their children. From the very first feedings, a mother should take care to remove remains of milk left on the gums in the early stages of growth. The procedure is very easy: simply wipe the remains away with a piece of gauze. Later, when the first teeth begin to erupt, use a brush and a thimble-shaped device available on the market that facilitate massage. This is much appreciated by the infant and should be done after each meal. 

There are many manufacturers who have developed specific products adapted to each stage of growth and development of the teeth. What is fundamental is that we take into account that supervision and responsibility for the proper brushing of teeth lies with the parents until the child acquires sufficient manual dexterity, somewhere between the ages of 8 and 10. 

Parents also ask about the best type of brush for each age. According to the data from the White Paper on Oral Health in Spain 2015, the proportion of the types of brush used by age are: from 2 to 6 years, manual (69%), electric (25%) and both (6%); from 7 to 10 years, manual (61%), electric (26%) and both (13%); and from 11 to 13 years, manual (75%), electric (20%) and both (5%). 

It may be deduced from the data that there is no clear preference for the type of brush used, with parents’ and children’s choice depending on individual preference. We support patients using whichever method that produces the best result in reducing plaque and subsequently motivates children to perform hygiene daily. According to the same study, 7 out of 10 children brush their teeth at least twice a day. 

Paediatric dentists are becoming increasingly important in dentistry. Do you think it should be a speciality in the future? 

A paediatrician is to medicine as a paediatric dentist is to dentistry. For national and international associations that include children within their scope, the need for the inception of this dental speciality is obvious. For the agencies in charge of dental specialities in our country, the call for this speciality is one of the most important and necessary. 

Paediatric dentistry exists as a speciality in Europe, the United States and, in general, in major countries with the highest dentistry level. The International Association of Paediatric Dentistry (IAPD) has been established for over half a century. In our country, the Spanish Society of Paediatric Dentistry (SEOP) was established 43 years ago. 

Do you consider there is sufficient communication between paediatricians and paediatric dentists? 

In general, we see this is as an issue that needs to be reinforced internationally. With paediatricians and paediatric dentists seen as the professionals responsible for children’s general and oral health, we should ideally establish joint strategies for training and development of programmes in order to ensure children’s overall health. 

As of the year 2000, when I had the honour of chairing the SEOP, we started holding joint meetings for paediatricians and paediatric dentists. Those meetings are held annually and our next gathering, the 18th Paediatric & Odontopediatric Meeting, will take place on December 16, 2017. Our experience during these years of working together with the paediatricians has been extraordinarily beneficial. 

There is currently an arrangement in the SEOP by which online training in dentistry is being carried out for paediatricians. We think the need to unite health strategies should be institutionalised and extended to our neighbouring countries. 

Do children now have more malocclusions, or did they previously go undiagnosed? 

The search for the ideal aesthetic and functional standards, and the individual’s greatest degree of quality of life, leads us to seek a standard of perfection as human beings. All this has led to the growing demand for treatment of dental malocclusion. What is more, it should be noted that heredity, modern diet and the existence of certain very common oral habits in childhood, all lead to malocclusion. 

We know that you are doing a fantastic job of managing oral complications during cancer treatment in children with leukaemia. Can you tell us about any major findings? 

Through a subsidised research project, we have managed to include children with cancer in a study whose main objective is to provide them with better quality of life while undergoing therapy. It has been a great challenge for us, firstly to gain access to the hospital centres and, once there, to the oncology units, and to get paediatricians, oncologists, parents and nurses to collaborate in this project. 

We have evaluated the oral needs of these patients during the various stages of cancer therapy and have begun to implement protocols for hygiene and monitoring of oral health in these children. Dr. Martinez, the main proponent of this idea, and Dr. Gómez, who defended his doctoral thesis on this subject brilliantly, are on the dental team carrying out the study. 

We are deeply grateful to all the groups that have made our work possible and we hope that it will be the beginning of the establishment of protocols in oral health and in the improvement of the quality of life of these children.