Toothbrushing Tips for Babies, Toddlers, and Wild Ones.
Hi friends, Dr. Monica here. Today I’m talking about toothbrushing time. Before I had kids, I had a vision of peacefully singing to my children while brushing their teeth, combing their hair, and reading a few books while they peacefully drift off to sleep.
Turns out, real-life toothbrushing time is more like when Steve Irwin jumps off a fence (toothbrush in hand), and lands on the back of a crocodile, clamping its hand around its mouth as it thrashes and hisses. Fortunately, I have four years of dental school, and two years of specialty training in pediatrics to aid me and my husband Dr. Matt in our quest to brush our toddler’s teeth. So these are the tips I will share with you, as a mom of a 2.5 year old and 4 month old, and board-certified pediatric dentist.
Fluoride: Yay or Nay?
I’ll hit on this briefly so we can move right along. Fluoride is the 13th most abundant, naturally-occurring mineral on earth, and fluoridated toothpaste is the gold standard, cheapest, and most well-researched way to prevent decay in baby teeth. The American Academy of Pediatric Dentistry reaffirms its recommendation on use of fluoride toothpaste for kids of all ages. But how much is too much? What if they swallow it?
Kids 0-3 years old: Grain of Rice size amount of toothpaste
Kids 3+: Pea-sized amount of toothpaste
This is the amount of fluoridated toothpaste we advise your child to use when you brush 2x/day. Start as soon as you see a tooth! Any brand, any flavor. We will discuss fluoride alternatives in the next blog!
When do I start brushing?
Start brushing your kiddo’s teeth as soon as they erupt. Here’s the first pro-tip: Before your child has any teeth, wipe their gums with a damp, clean cloth after they are done breastfeeding/bottlefeeding. This will get them accustomed to you cleaning their mouth. It’s all about sensitization.
Okay, my kid has some teeth. Now what?
Use an appropriate-sized toothbrush with real, soft toothbrush bristles. Skip the silicone finger brush. It doesn’t do much. Use that grain-of-rice sized amount of fluoridated toothpaste to brush all visible teeth for as long as your baby can tolerate. Once they have all 20 of their baby teeth, the goal is two minutes.
Brush from behind your baby, not in front. This actually gives you more control!
If they’re in a lounger, cradle their head from behind and gently brush all visible teeth.
If they’re biting on the toothbrush, put your finger on their gums where their molars will be; they will stay open enough for you to brush all available teeth — switch sides if needed.
If they have their molars, you can put your finger on the gums behind the last molar. They may “gum-bite” your fingers, but it doesn’t hurt. Promise!
After toothbrushing is done, you can wipe away excess from the tongue or gums with a clean cloth, but rinsing is not necessary.
Leaving that leftover film of toothpaste on the teeth overnight actually allows for the remineralizing qualities of the toothpaste to soak into the enamel, almost like lotion!
My kid is crying during toothbrushing time. They hate it! Aren’t I traumatizing them?
Children will cry when they are learning to tolerate the ups and downs of life. My baby cried when he was born — doesn’t mean I told my OB to put him back! But in seriousness, my baby cried while getting examined by the doctor, cried while I changed his poopy diapers, and cries when it’s bath time.
Continuity is the key. Sensitization will happen. Consistency is key. Sing the same songs. Keep up the routine. They will get used to it!
As for traumatizing them: Parents helping hold their kids and making toothbrushing time happen has never resulted in trauma leading to oral aversion or fear of the dentist. Quite the opposite: Lack of proper oral hygiene and subsequent dental disease (decay, toothaches, abscesses) and being held at the dentist for emergency treatment are more likely to lead to oral aversion and fear of the dentist.
This is a difficult conversation to have, but it’s true. It is better for your child to cry because of the toothbrush, than to cry because of dental treatment.
Okay, I’m trying to brush but my toddler is going crazy. How do I do it by myself?
So it’s best to brush teeth from behind, and it’s okay if your kiddo cries. But what if we’re Steve Irwin with a toothbrush and our kid is a crocodile?
It is best if you brush 2x a day: Once in the morning, and again at bed time. That is the goal post. If you had an insane day (or week) and you only have it in you to brush one time a day, brushing at night is the most protective time. We don’t want food and natural sugars/carbs sitting on our teeth overnight and leading to decay.
So, the goalpost is 2x/day. When life gets busy, sometimes we brush at night only. Okay, this week has been insane. We haven’t brushed at all. I really need to get in there, and my kid is going nuts.
Toddler Toothbrushing Alone
If you have no other adults or older siblings to help you, here’s a method you can use. Sit on the floor, feet stretched out. Your child is laying back in your lap, their feet toward your feet. Their arms are pinned under your legs. And you brush!
Toddler Toothbrushing with Help
If you have a second adult available, or even a school-aged sibling, this person’s (vital) job is holding hands! Hands are strong, and brushing with those fighting hands is hard even for a pediatric dentist.
Should I use an electric toothbrush or a manual one?
For baby teeth, both are equally effective. So I leave this up to the parents. Your kids will get a free toothbrush from us when they come for their checkups, so if their free toothbrush with Bluey/Lightning McQueen/Minecraft/Disney on it gets them more excited for toothbrushing than a $20 electric from the store, then the free toothbrush is better! We don’t have to get fancy with the spices if we don’t need to!
When do I start flossing? Is flossing important?
Cavities can occur between any two teeth that are touching. Some kiddos have good visible spaces between all of their teeth; some kiddos have teeth that are tight/touching together! Use floss to clean between any baby teeth that are touching.
The most common area kids get cavities on their baby teeth is between the back ones. When these back baby molars first come in, there’s usually some space between them. This space usually closes around age 4, so you can use floss to practice/sensitize your child to it, so that when it does become extra important, they’re already used to it!
We recommend flossing these touching-teeth every night, but you can start by slowly incorporating it into the routine once or twice a week. You can use string floss, or floss picks. I would skip the toothpicks and water flossers, though.
Okay, so I’m brushing and flossing their teeth. When can the kids take over?
The manual act of toothbrushing is actually more of a fine motor movement than we would think. Young kids who only brush their own teeth without parent help I have frequently seen having no issues on one side of their mouth, but a few cavities on the other.
Whether they use an electric toothbrush or not, we recommend you aid in toothbrushing your child until they have the manual dexterity to tie their own shoe laces. Or as Dr. Matt puts it, until they wash your dishes before dinner and you would actually eat off the plate. ;)
I have an older child with special needs. Toothbrushing is so difficult. Any tips for me?
For children with special healthcare needs, prevention of cavities, decay, or other oral disease is essential. These children are at higher risk for cavities on their permanent and baby teeth due to restrictive dietary preferences (crackers, chips in lieu of fresh fruits or veggies), use of calorie-dense/sugary supplemental beverages such as PediaSure (which should always be used when your pediatrician recommends it), and oral aversions which make toothbrushing and hygiene difficult.
Minimally invasive options for dental treatment do exist for treating decay on children with special needs, but if definitive treatment is required, often times sedation is advised for your child’s safety and comfort.
So toothbrushing is important, but that doesn’t solve the problem of it being extremely difficult, especially if your child has a particular oral aversion, which is not uncommon.
At M&M Pediatric Dentistry, we utilize these foam bite sticks that are available on Amazon. Your child can bite on these, but it keeps their mouth propped open enough to brush the opposite side.
Having a second adult (or older sibling) help with toothbrushing time is helpful. They can help hold hands, and you can cradle your child from behind and brush using the foam prop and good fluoride toothpaste.
Establish the routine, sing the same songs, allow them to watch the same video every day during toothbrushing time to continue to sensitize your child. The consistency is the key!
If you have no one to help you, you can brush their teeth on the floor of their bedroom, with their head in your lap, their feet toward your feet, and their arms under your legs.
Alternatively, you can allow them to play a special videogame or watch a special video on your phone or tablet during toothbrushing time ONLY. You can even buy a little tripod or stand on Amazon and mount your phone to the bathroom mirror. They can play games like Fruit Ninja to occupy their attention while you brush their teeth. It is vital that they have one special game or video for toothbrushing, and they can never have access to this special game/video outside of toothbrushing time!
Occupational Therapists are also available to help with oral aversions, so keep doing everything you can! You’re doing amazing.
