We all know that looking after our children’s teeth from a young age is important but it often feels like a struggle. Especially if you have a wriggly, resistant two year old who sounds like they are being murdered any time you try to get a toothbrush near them (trust me! I know what this is like).
As a dentist (as well as a mum) I want to share a few tips and products that I have found useful and that may be helpful for you.
Why is It Important to look after baby teeth?
Baby teeth fall out, so why is it important that they are looked after? There have been some impactful headlines recently about how tooth extraction is the number one cause for a child’s hospital admission in the UK. Looking behind those headlines are other issues. Going to hospital is a frightening experience for a child and if this is their only dental experience it is setting them up for the possibility of a lifetime phobia of dental treatment.
Losing baby teeth at a young age can lead to problems with the positioning of the adult teeth and a need for wearing braces in the future. Usually this takes place during the teen years at a time when kids are already self conscious about their appearance.
Research also shows that children with high levels of dental decay in baby teeth are much more likely to develop further decay in later life therefore preparing them for a lifetime of dental treatment. Another thing to consider is that damage done to baby teeth at an early stage will lead to problems with the development of permanent teeth including discolouration and weaker enamel.
Looking after a child’s teeth sets them up for a lifetime of looking after their dental health. Habits formed in childhood are more likely to be continued through the teenage years and into adulthood so it really is very important to start that brushing as soon as possible.
Here are my top ten tips:
1. Start Early
As soon as those baby teeth make an appearance through the gum start brushing them. Even when they are not fully through, bacteria can start to grow on those lovely new teeth.
Ideally, looking after babies mouth can start before this and there has been a suggestion, but I can’t find any conclusive evidence to correspond with it, that the presence of certain bacteria in the mouth can increase teething pain.
I actually started using dental wipes on my son when he was around 3 months old. I felt that this would help to prepare him for having his teeth cleaned and that it would also improve the environment for the teeth to come through into. Using a clean damp cloth may also be effective. The aim is to remove any residue from the mouth so that bacteria can’t feed on it.
2. 2 x 2 every day
Brush for 2 minutes twice a day. Ideally the teeth should always be cleaned as the very last thing before bed. Nothing should be consumed after this, not even milk which contains natural sugars.
It is so important to brush before bed in order to get rid of any food debris that has built up during the day and to prevent this from being left in the mouth overnight. Our mouths get drier overnight which means that there is less protective spit present. Spit contains lots of good stuff that helps to prevent decay developing and less spit at night means that the teeth don’t have get as much protection whilst we’re sleeping.
The teeth should be brushed at one other time during the day. My personal preference and advice would be to do it first thing in the morning, before breakfast. This means that there is plenty of protective fluoride present whilst eating the first meal of the day.
There are some lovely brushes available which contain 2 minute timers for even the youngest brushers. You may find the Brushbaby Review I did useful. A small egg timer is another good way to make sure that 2 minutes is being used fully. During that two minutes brush the outside of the teeth, the top and the inside, go from one side to the other and do top and bottom.
3. Spit Don’t Rinse
I say this to people all day every day! Advertisements have got a lot to answer for. It really is quite important not to rinse your mouth or your child’s mouth with anything after brushing. That includes not rinsing the toothbrush and rebrushing the teeth. Just don’t do it.
The reason for this is that you have put all that lovely fluoride exactly where it is needed and then you’ve just got rid of it again. Fluoride is wonderful. It was introduced into toothpaste in the 1970’s and following this the rates of dental decay fell by 50%!
When fluoride is present in the mouth it can be taken up into the chemical structure of the teeth and makes them more resistant to acid attack. It is harder for teeth to be broken down when they are regularly exposed to fluoride. If you rinse it away, it doesn’t have time to do it’s job. So please, just spit out after brushing, no need for water or mouthwash.
4. Use the Right Toothpaste
Public Health England developed a paper called “delivering better oral health” which is evidence based and includes information on recommended levels of fluoride in children’s toothpaste. It is always worth checking this on the toothpaste packet, somewhere it will say xxxppm F. This means that for every 1 million units of toothpaste there are xxx units of fluoride.
The recommendations by age are:
0-3 years – Use toothpaste that does not contain less than 1000ppm F
3-6 years – Use toothpaste that contains more than 1000ppm F
7 years + – Use toothpaste that contains 1350-1500ppm F
5. Use the Right amount of toothpaste
“Smear up to the age of 3 and then the size of a pea”
But what exactly is a smear?? It is open to so much interpretation that we are now being advised to recommend a ‘rice size amount’ up to the age of 3. I think this picture is very helpful as to what that means:
Using too much fluoride can lead to white or brown flecks developing on the teeth. I should know!! I used to love brushing my teeth as a kid and I particularly loved the strawberry flavoured ‘punch and judy’ toothpaste we had and I’d sneak off to eat it (in smallish quantities, not a whole tube!) when my parents were busy. I ended up with white flecks on my teeth, but they weren’t severe and I’ve never had to have a filling……
6. Supervise Brushing
This is not a time to go off and fold the laundry or put away some toys. It is really important to make sure that your little one is brushing their gnashers and not just sucking the toothpaste off and chewing the toothbrush!
It can be helpful to give a little direction. “you’ve brushed your bottom teeth really well, now how about those top ones too!”
I would always recommend an adult doing the final ‘going over’ as well, just to make sure that no surfaces have been missed. Kids don’t really have the control to be able to brush their teeth effectively until they are able to consistently tie their own shoelaces without help.
7. Keep Sugary treats to Mealtimes
Whenever we eat, our mouths become more acidic which means that our teeth become ‘softer’ on a microscopic level and therefore more prone to attack from bacteria. It takes around 30 minutes after we finish eating for our mouths to return to their normal, neutral state.
This means that regular grazing throughout the day causes our mouth to mainly be in an acidic state which favours the bacteria in the mouth and increases the risk of decay developing. It has been shown that brushing twice a day protects against a maximum 5 ‘meal moments’ or ‘acid attacks’ on the mouth. This includes sugary or fizzy drinks, and even fruit juice and ‘no added sugar’ squash.
It is best to stick to water as a drink in between meals. If a child is thirsty, they will drink water but if they are hooked on squash try gradually reducing the amount of squash used until you don’t need to add any at all.
And please, please, please don’t put anything other than water or milk in a bottle and don’t let babies fall asleep with a bottle in their mouth, even if it is does have milk in. Your little ones teeth could end up looking like this by the age of 3 if you do:
Try to consciously limit your children from snacking and aim for less than 5 episodes of eating during the day. Three main meals and a maximum of two largish predominantly healthy snacks should be enough to keep even the hungriest toddler or child happy.
My parents only allowed sweets on Saturdays when I was a kid and this is something that I have chosen to follow with my little boy. That way they are a consistent treat and not dependent on behaviour.
8. Use Sugar free medicines
Can you believe that a lot of medicine for children contains sucrose, a cavity causing sugar and some contain glucose. Go on! Go and have a look at the bottle.
There ARE sugar free versions available and ideally, it is best to stick to these if you can do. Also, if your child regularly has to take medicine prescribed by a doctor or needs a course of antibiotics then do ask for a sugar free preparation.
Most medicines are designed to be taken 3 or 4 times a day and if you are sticking to the five meal moments a day mentioned above, then you will be left with very little wiggle room for actual food! Even when kids are poorly it is still important to try and follow a healthy diet
9. Encourage Good Brushing
Note I use the phrase ‘encourage’ and not ‘praise’ or ‘reward’. Excessive praise and reward can lead to children who will only perform a certain behaviour if they receive something in return. Bribery is also something avoid (“if you brush your teeth you will get a sticker/treat/extra story at bedtime”) for a similar reason.
The aim with brushing is for children to become self-motivated and eventually manage their toothcare themselves (over time of course). This requires an internal desire to carry out the behaviour themselves. Encouragement is a specific type of praise, it is reinforcing a desire to carry out a certain behaviour or action.
Examples of encouragement would include:
“you brushed your teeth really well tonight. Mummy/Daddy only needed to do a tiny bit of finishing off because you did it so well yourself”
“You are sitting so nicely to let mummy/daddy get your teeth nice and clean’
“It is really helpful when you open your mouth wide like that. Mummy/Daddy can see all your teeth to get them really clean”
10. Managing Battles
I could probably write a whole article on how to manage toothbrushing battles and even then parents may find that nothing works with their child. I currently have a very strong-willed, independent, tenacious, testing two year old who will happily brush his own teeth but puts up a battle when it comes to having them cleaned afterwards. I usually go through the whole repertoire of techniques and end up resorting to the very last one!
- Try to make it fun – If you walked in my house at around 7pm you would more than likely find me chasing my son round the house, toothbrush in hand saying something along the lines of “here comes the mummy monster, time to tickle those teeth!!!”Or “I think I saw a dinosaur in there! Did you eat a dinosaur today? I’m going to catch it with your toothbrush!”
- Let them watch in a mirror. It feels less invasive if they can see what you’re doing. You can also ask them to tell you if they think you have missed a bit
- Brush your teeth at the same time. I have on occasion let little Z try to brush my teeth but it has usually ended up with him trying to brush my tonsils, so if I do let him do it, I say “mummy’s front teeth need brushing” and then go “eeeeee” with my teeth together. Kids like to be like mum and dad so just brushing your teeth together may be enough to encourage them to do it too.
- Books – there are some really lovely books about brushing teeth out there. We have How to brush your teeth with Snappy Croc, Brush, Brush, Brush, Dinosaur Douglas and the beastly bugs and brush your teeth please
- Videos on youtube – there are some great kids songs with cartoons and animation which last for 2 minutes and may encourage your little person to look after their teeth
- Smartphone apps – aquafresh brushtime, disney magic timer by oral B, denny timer, chomper chums, Brush up. In fact search for “brushing teeth for kids app” and you get a whole load for various age rangers to choose your favourite from.
- If all else fails… pin ’em down (gently of course). I usually resort to this one! I stand behind Z to brush his teeth and look in the mirror in front of us but when he is tired and less co-operative then usual, I sit him on my lap and use one arm as a barrier so he can’t interfere whilst I gently brush his teeth. He still protests but once we are done he is happy to toddle off to bed