It is important to develop good dental habits early in life to prevent tooth decay. Decay leads to pain, infection and early tooth loss, and can affect a child’s nutrition, growth and development.
Unfortunately, children with dental decay often also have poor dental health in their adult years.
Dental decay occurs when mouth bacteria break down food and drinks, particularly those containing sugars and processed carbohydrates, to produce acid. The acid then dissolves the tooth surface forming holes.
Cleaning children’s teeth twice a day, ideally after breakfast and before bed, reduces the amounts of bacteria and food supply present in the mouth.
Even before teeth erupt a clean cloth or baby toothbrush can be used to massage gums to acclimatise infants to the sensations of cleaning and ease teething. When the first tooth erupts it is time to establish a brushing routine.
Of course, babies and young toddlers need an adult to brush their teeth. However, from about two years old children often want to hold the toothbrush to “help” or even brush on their own.
Remember, adult supervision is needed until about 8 years old to ensure effective brushing.
It is important to use the right toothbrush. A small manual brush with soft bristles is ideal. Brushes designed for children often have cushioned handles and fun designs which may increase a toddler’s interest.
Electric toothbrushes can clean well but are often too large to effectively manoeuvre around small mouths. Their novelty may appeal to older children though, at which point it is OK to go with your child’s preference.
Until 18-24months old just use tap water on the toothbrush. After this age, the best way to protect teeth is to add a low fluoride toothpaste to the brushing routine.
There is extensive research supporting the benefits and safety of fluoride in preventing tooth decay. Age and risk of developing dental decay may affect which toothpaste is appropriate, so it is important to discuss this with a dentist.
As young children are often unable to spit out effectively a small smear of paste is all that’s needed. Push the paste into the bristles with a clean finger so it doesn’t fall off, bypassing the teeth. Encourage children not to swallow the paste but after brushing there is no need to wipe or rinse away the toothpaste foam as any residual fluoride helps to protect and strengthen the teeth.
Finally rinse the brush and allow it to air dry in an upright position. Replace the brush after 3-4 months or if the bristles become splayed and worn.
To get good access and control when cleaning your baby’s teeth lie them down with their head on your knee, holding their chin.
As they get older, or if they prefer standing, try sitting or standing behind them, again holding their chin, as they rest their head against you. Facing a mirror will let both of you watch the process.
Brush in small circles over all surfaces of the teeth including along the gum line, and gently on the tongue, lift the upper lip to visualise the front teeth as this is an area that is often missed.
Toddlers often don’t like brushing their teeth - but don’t skip it! Keep trying, even a quick brush is better than nothing. Children are more likely to accept cleaning if it is fun and part of their usual routine. So set a good example, involve them in talk about teeth and demonstrate that you value and brush your own teeth.
To keep your child’s interest try singing a favourite song or allowing them to play with a toy, or even another toothbrush, whilst brushing. As kids get older allow them to chose their own toothbrush and consider using books and phone apps about brushing to increase their engagement.
Toddlers may like to attempt to brush their own teeth before an adult does a final check. Brushing at the same time as older siblings or parents may also be helpful as children often model their behaviour on those around them.
Believe it or not flossing can be beneficial for toddlers – if you can persuade them to stay still for long enough! One of the most common places for holes in baby teeth is between back teeth.
Once the back teeth are erupted and in contact, usually between 3 and 6 years of age, flossing is the best way to clean these areas. Use the floss gently, slide it up and down the side of each tooth. Floss holders may make it easier.
In babies and toddlers there is evidence to show that decay can occur if their teeth are not cleaned after feeding before sleep. This usually applies to feeding to sleep with formula or breast milk and/or on demand overnight breast feeding, although it also applies to other sweetened drinks and, in older children, to food.
The milk pools in the mouth and the sugar (lactose) in the milk can then be used by the mouth bacteria to produce acid. This effect is compounded as saliva flow is low when sleeping so the teeth are less protected. This can be particularly challenging for babies who haven’t got the memo about sleeping through the night.
Ideally babies shouldn’t be fed to sleep or put to bed with a bottle and bottles should only contain breast milk, formula or water.
Fruit juices, soft drinks and cordials are a decay risk in older toddlers and children. Tap water is the best drink for most children. It widely known that frequent consumption of cakes, biscuits, lollies and chocolate can cause decay due maybe surprisingly some of the perceived healthy snacks can still cause problems but to their sticky consistency and high sugar content.
Muesli bars, honey and processed fruits such as dried fruit, fruit straps, fruit pouches, often fly below the radar for decay risk. Its best to save these things for toddler emergencies or special occasions.
Teething symptoms are common in children from the time the first tooth comes up at about age 6 months to when the last baby tooth appears at approximately 30 months. However, there is lots of variation when it comes to the timing of baby teeth. All children are different. The order teeth appear in is more important than the time they appear.
Symptoms of common childhood illnesses such as changes in sleep and eating patterns, fussiness, rash, drooling, runny nose, temperature and diarrhoea are often mistakenly linked to teething. It’s always worth checking kids are not suffering from other possible problems such as bacterial, viral or middle ear infections.
If needed, sore gums can be soothed with gentle massage using clean fingers or a wet cloth. Pressure from chilled, not frozen, teething rings work well to reduce inflammation.
Unsweetened teething rusks or sugar free teething biscuits are useful to relieve mild discomfort in infants who are eating solids. Amber teething necklaces are gaining popularity, however there are concerns regarding possible choking and strangulation hazards, so it is advisable to consider other methods to soothe soreness.
Given the duration of teething, symptoms are best managed without medications if possible, however, paracetamol is an effective pain reliever in children if needed.
Thumb or dummy sucking can be a life saver for soothing and self-settling some new babies. However, the longer these activities persist the greater potential there is for displacing the position of growing teeth, changing mouth shape and altering the way teeth bite together.
Ideally dummies should only be used in the first 6 – 12 months and totally retired by 3-4 years, thumb sucking habits should also be discouraged after 4 years old. Breaking these habits can be stressful for all involved, including the neighbours. Be patient and hang in there.
Children should visit their dentist by 12 months of age and then every 6 months. Even if children don’t appear to have any problems this allows them to get to know their dentist, establish a “dental home” and have a positive experience.
It’s the ideal time to start preventing decay, monitor development and treat issues early.
Dr Caroline Howarth
BDS (Hons), MMedSci (Oral Surg), FDSRCS (Eng), DCD (Paeds)
Caroline completed her Bachelor of Dental Surgery in 1995 at Sheffield University, then went on to gain a Master of Medical Science in Oral Surgery in 1998. She has since been awarded the Fellowship of Dental Surgery and initiated into the Royal College of Surgeons of England. Caroline has also completed a Graduate Diploma of Clinical Dentistry and Doctorate in Paediatric Dentistry from the University of Melbourne. Caroline arrived in Australia from the UK in the late 1990’s, originally only planning to stay for two years. However, she now has 5 children who are embracing the Aussie sporting way of life and is here to stay!
- www.babyteeth.com.au “Teething” Dr N. Chawla – Feb. 2013
- Mekertichian, K. (2021) Watch Your Mouth: Brushing and flossing for infants and young children. [Podcast] 29 March 2021. Available at https://www.teeth.org.au/teeth/Podcasts/Brushing-flossing-for-infants-and-young-children