A couple weeks ago, we shared a couple posts about our first visit to the dentist and sensory toothbrushing. For this special guest post, we’ve hooked up with The Mama Dentist, Dr. Taylor McFarland, DDS, MS and asked her a few questions on what she thinks parents should know about toothbrushing. Dr. McFarland is a Board Certified Pediatric Dentist and Diplomate of the American Board of Pediatric Dentistry.

When to Introduce Toothbrushing

I’m happy to answer some of the questions I often get asked as a pediatric dentist. One that I encounter almost daily is when to introduce toothbrushing. From a familiarity standpoint, beginning the desensitization process to oral healthcare can begin as early as baby’s first bath. You don’t need to use toothpaste or a toothbrush before teeth have erupted, a simple washcloth or a silicone finger brush will do. What I’ve done for my three littles is wipe off their gums, tongue, and cheeks at bathtimes with a washcloth beginning in their first month of life.

Once the teeth begin to break through the gums, you can switch to a bristled toothbrush (no need for the silicone finger training toothbrushes anymore, they don’t clean the teeth well). The AAPD recommends using a grain of rice sized amount of fluoride toothpaste twice daily for children of any age once their first tooth erupts. I am slightly more conservative, recommending fluoride toothpaste only once baby begins eating solids (typically between 4 and 6 months) or at six months of age. On average that timeframe coincides with the eruption of the first tooth, but just in case there are early bloomers out there (some babies are born with teeth!) and to minimize the risk of fluorosis of the permanent tooth enamel, I recommend waiting until solids are introduced or six months of age, whichever is earliest.

A Word On Pacifiers

I have a two-part blog series dedicated to non-nutritive sucking habits if you’re looking for lengthy in-depth information, but the American Academy of Pediatric Dentistry (AAPD) recommends cessation of pacifier use (or digit sucking) by age three years. This allows any changes to jaw and/or teeth position to correct with growth before the eruption of the permanent teeth begins around age six years.

Pacifier use is protective against SIDS in the first year of life when used at sleep times, particularly the first six months of life, so I encourage pacifier use for that reason. If parents restrict use to sleep-time only it will be far easier to wean the child later. If the pacifier falls out after the child falls asleep there is no need to go in and replace it, as the protective effect still remains. Resisting replacement will also minimize jaw and tooth position changes because the actual duration, intensity, and frequency of use are small.

Other Habits

Another common habit that worries many caregivers is bruxism (tooth grinding). In children, it is relatively common and is considered normal when there are no other factors associated with the grinding. Most children outgrow this habit by age seven, which happens to be the age at which their tonsil size begins to decrease and their airways are more open. If you notice that your child grinds but they also snore, exhibit ADHD-like symptoms, have a narrow palate, or have any additional signs of airway obstruction or difficultly breathing, it may be worth further exploration with your pediatric dentist, pediatrician, and/or an ENT.

Caregivers often ask about bottle weaning and sippy cup use as well. Pediatric dentists along with speech pathologists recommend graduating from the bottle at 12 months to cups that will aid in the development of a mature swallow pattern. In a mature swallow pattern, the tongue moves to the back of the mouth rather than pushing forward (tongue thrust pattern). Use of the bottle beyond one year and also using a hard-spouted sippy cup makes it more likely that the child will maintain an immature (tongue-thrust) swallow pattern.

The cups I prefer and used with my three children are open-rimmed, either fully open (ezpz cup), reduced flow (Reflo), or circular valve (Munchkin Miracle 360). Straw cups can work as well, but they need to be cut down so the straw rests just at the edge of the lip when you’re teaching the mature swallow pattern. I waited until my children had mastered the mature swallow with the other three cups and then we introduced a straw cup without having to cut the straw down.

I always encourage parents to offer their children plain water in their sippy cup if they have unfettered access to it throughout the day. Many people reach for watered-down juice or flavored waters to encourage their child to drink more, but they are both acidic and artificially sweetened (exception being Smartwater infused waters) and can lead to increased cavity risk and altered flavor preferences. Unless directed otherwise by your pediatrician, keep it to plain water or if you want a little pizazz, try Smartwater or 1-2 pieces of fruit via a water pitcher infuser. Plain white milk can be served at mealtimes. Anything else sweet – sports drinks, soda, juice, flavored milk, etc – should be considered a treat or dessert and offered in small amounts, sparingly, and with a meal, not to be sipped on throughout the day.

Flossing

As with toothbrushing, flossing can be introduced before it’s truly “necessary” in order to desensitize the child to the process. Flossing isn’t crucial until the teeth touch side-by-side. For some children, this means it is in fact necessary as soon as their first teeth erupt, but for many, they have spacing between their teeth, and flossing between them is more for practice than out of necessity. I recommend beginning to introduce floss as soon as the child is comfortable with toothbrushing, or earlier for any teeth that are touching side by side.

Parents often wonder when they’ll be free of having to help their child brush and floss. I tell them that most children lack the dexterity to brush well on their own until about age seven. Once they can tie their shoes independently, that’s a good sign they may be ready. You can test this by purchasing disclosing tablets that dye the plaque pink or purple and they’ll demonstrate for both you and the child whether or not they’re brushing all the areas well. Flossing, as you might imagine, is a little later, usually around age nine.

What To Do When Toothbrushing Is A Challenge

The most frequent question I get on social media is what to do when toothbrushing is a battle. The child is crying, the caregiver is frustrated, and most of the time it looks like they’re wrestling an alligator. I feel you. I’ve been there with my three. My best advice is to try as best as possible to keep toothbrushing positive and consistent. Don’t let them get out of it by pitching a fit or you will set yourself up for future fits in order to avoid it again. Keep it a part of a routine, the same sequence of events, same place, same person, same time, focusing on mastering nighttime brushing before bed as the most important brushing time.

What you can do when the child is upset is validate their feelings and try to figure out why they don’t want to brush (“I see you don’t want to brush your teeth, can you tell me more about that?). Sometimes they’ll tell you it hurts (watch out for the line of tissue under their upper lip – brushing across that is often painful) or that the toothpaste burns or is spicy (try an SLS-free toothpaste if that’s the case). Then try to offer choices to give them a sense of control (toothbrush color, toothpaste flavor, location for brushing). Obviously, this is easier and involves more back and forth with older children, but it works for babies, too.

Turn-taking and modeling the behavior will help immensely for the younger ones. I pause for my 14-month-old when she fusses about brushing and I validate her feelings and offer choices (“You’re mad? Don’t want to brush now? Mommy help. Baby hold toothbrush? Pink or blue?). She likes to hold a toothbrush in each hand and sit facing the mirror in the bathroom with me standing behind her so she can see herself. I’ll often sing a song or tell a silly story as we brush.

Toothbrushing only needs to take five seconds per number of teeth in the mouth, so for a baby with just four teeth, that’s 20 seconds. For a child with all 20 teeth, that’s 100 seconds, or a little over a minute and a half. Please don’t feel like you have to brush your little one’s teeth for two minutes! Quality is far more important than quantity. If you’re really struggling to get more than a few seconds, reach for a triple-sided toothbrush (Fridababy and Surround by Specialized Care Co. have great ones) to get more brushing out of a short period of time.

If you’re still struggling, try to reset and desensitize the toothbrushing experience using different locations (bathtub, changing table, sitting/standing supported in front of a mirror, the high chair, the swing outside, laying in mom’s lap). You can also get a fun new toothbrush (electric is fine if the child doesn’t bite down on it) or toothpaste flavors (lots of fun options on my site shop). Apps and games can also be great for distraction (Pokemon Smile, BrushDJ, Disney Magic Timer by OralB). A visit to your local pediatric dentist will also prove helpful and they can offer tips specific to your child and your family’s situation. The AAPD recommends the first visit occur within 6 months of the first tooth coming in or by the child’s first birthday, whichever is earlier!

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To find a pediatric dentist in your area you can search via zipcode at the AAPD or the American Board of Pediatric Dentistry (ABPD) websites, linked below:

www.aapd.org/publications/find-a-pd/

www.abpd.org/general-public/find-board-certified-dentist

Do you have more questions about your child’s oral healthcare that weren’t answered here?
Feel free to find Dr. McFarland on TikTok, Instagram, or Facebook @TheMamaDentist or contact her via her website (which is also where she links via Amazon many of the products she discusses) at themamadentist.com.