Peter is a three-year-old boy. He had always been a happy, active child with good eating and sleeping habits. However, in
the past three months his behaviour had changed. He'd lost weight, cried a lot and seemed disinterested in his usual activities. He'd stopped eating solid food and would only drink bottles - mostly milk, but sometimes juice or cordial.

His parents had noticed some fracturing of his top front teeth but could not identify any recent trauma to the area. Peter brushed his teeth every night just before his last bottle of the day. As he had started to become unsettled at nights, his parents had been giving him a bottle during the night to soothe him back to sleep.

Peter had developed dental decay. His teeth were fracturing away, causing pain, especially when he tried to eat solid food. Milk and other drinks were allowing him to satisfy his hunger,
but the sugar in the drinks was coating his teeth, causing further decay. The treatment was the extraction of four of his top teeth and his baby first molars. As loss of molars affects space, he'd need a fixed partial denture or space maintainer.

An increase in tooth decay in preschoolers has prompted a campaign aimed at getting young children to a dentist to prevent and diagnose problems before they become a tragedy.
Dr Philippa Sawyer is a specialist paediatric dentist and confirms there is a disturbing trend around children and oral health. The one-year oral health check is vital for both prevention and early intervention. We assess the child to determine their risk of tooth decay and talk to the parents about developing healthy habits.'
The dentist will look at the child's medical history, feeding habits, oral hygiene, fluoride intake, growth and development. A return visit will then be scheduled depending on the result, probably in 12 months if a child is healthy.

As they grow older a visit to the dentist might involve teeth cleaning, fluoride treatments and general hygiene instructions to help maintain and improve the brushing and flossing of teeth.

For healthy teeth:

• Twice daily brushing - children up to the age of eight will need adult assistance
• Floss once a day
• Visit the dentist regularly
• Avoid frequent feeding/snacking

Harmful habits:

• Comfort feeding with breastmilk, formula or juice increases the risk of nursing caries, because they basically bathe the teeth in sugar
• High-acid foods such as oranges can cause erosion of the tooth enamel
• Gastric reflux can also cause the enamel to dissolve away
• Chickenpox - get children immunised as the virus can harm a child's teeth if they contract it in their first three years.

Other causes of decay:

• Poor health in the mother in pregnancy
• Health problems in the child after birth
• Poor nutrition, plus highly processed and sugary foods and drinks
• Breathing through the mouth while sleeping reduces saliva and leads to decay
• Neglecting baby teeth. Clean as soon as a tooth breaks through There's no need to use toothpaste or even a brush at this stage - a facewasher in the bath will do.

Comfort feeding can often seem like the only option to soothe your child. How have you managed to wean your child off bottles at bedtime for the sake of healthy teeth?