Brushing and Toothpaste

Brushing is the most effective method for removing bacterial-latent plaque from your child’s teeth and gums. Getting food and plaque debris off their teeth and gums in a timely manner prevents the development of harmful acidic waste products, thus minimizes the possibility of decay. Research has proven that brushing within 20-minutes following the consumption of a sugary food or drink will dramatically decrease the possibility of dental decay. Therefore, we highly recommend brushing after every meal and/or any between-meal snacks where a fermentable carbohydrate was consumed.

Infants: Soon after birth, begin cleaning your baby’s teeth after nursing or bottle feeding, using a washcloth, gauze or soft infant toothbrush and water. Avoid using all toothpastes on your child until he/she begins to erupt their first primary teeth. At this point, you can begin utilizing a non-fluoridated toothpaste. This helps to familiarize the infant with the bubbling action of the paste, while adding some attractive flavoring. Working on spitting these bubbles out into the sink can begin around 18 months or when your child begins to mimic your actions. We recommend using a toothpaste containing fluoride once your child reaches age two. At this point you can brush with a non-fluoridated toothpaste in the morning, while beginning to use the fluoridated paste prior to bedtime. Continue to work with your child on spitting into the sink. Once they have mastered this process, they can begin brushing with fluoridated toothpaste only.

Children: Children truly don’t develop the dexterity associated with properly brushing all sides of the back teeth until about 9-10. However, we recommend that from day one you allow your child to take an active role in their brushing. At ages 2-4, this may mean having a parent first brush their teeth while the child watches in a mirror and allowing their child to mimic them afterwards. Parents can expect to be responsible for 100% of their child’s effective brushing until he/she reach age 4 or 5. Once they begin kindergarten, the child can then take a more active role in this procedure. By age 7, parents can expect their child to complete only about 50% of effective brushing. Each child’s ability should be regularly assessed by their parent or guardian and aid provided accordingly.

Brushing Techniques

Since everyone’s teeth are different, we recommend visiting our office before choosing a specific brushing technique. Here are some popular techniques that have been proven to be effective:

• Use a circular motion to brush 2-3 teeth at a time, gradually covering the entire mouth.
• Place the toothbrush next to the teeth at a 45° angle and gently brush in a circular motion – not up and down (this kind of motion wears down the tooth structure and can lead to receding gums, or expose the root of the tooth). Brush all surfaces of the teeth – front, back, top and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
• Don’t forget the other surfaces of the mouth that are covered in bacteria – gums, roof and floor of the mouth, and most importantly, the tongue. Brushing the tongue removes trapped bacteria and other disease-causing germs and may also freshen your breath.
• Remember to replace the brush when the bristles begin to spread because a worn toothbrush will not properly clean the teeth.
• Effective brushing usually takes about 2-3 minutes.

Parents sometimes inquire about brushing too much. It is simple; you can never brush too much. We do, however, stress the use of proper brushing techniques, as this can lead to gingival recession. Make sure your child uses a soft toothbrush with light pressure while brushing in a circular motion along the margin between the teeth and the gum line. This light brushing technique may cause some minor blanching of the gingival tissues. This is fine, as long as light pressures are being utilized.

MYTH: You should avoid brushing your gums and teeth if they are bleeding.

False! Gingival bleeding is a symptom associated with the development of sick or unhealthy gums. This is actually a sign that you’re not brushing a certain area enough. When you repeatedly miss an area, typically at the border between a tooth and the gum line, plaque builds up. This plaque contains caustic bacteria which subsequently irritates and attacks the gum tissues, causing gingival inflammation and bleeding upon brushing and flossing. The remedy to eliminating these symptoms is to focus on brushing and flossing this area with an understanding that these tissues will heal themselves once the irritant or plaque is removed. After only a few days, you should find notable change in both the bleeding and the discomfort associated with cleaning this area. Should symptoms not subside after 3-4 days of attentive brushing and flossing, you should make an appointment with your pediatric dentist to evaluate the area.

Flossing

Flossing is a method for removing bacteria and food debris from between the teeth where a toothbrush is unable to reach. Flossing increases blood circulation into the gingival tissues. Many dentists believe that flossing is the single most important weapon against the development of plaque and calculus. Pediatric dentists agree that once primary teeth erupt in contact with adjacent teeth, it’s time to begin flossing. This may be as early as a year if the front teeth have no spacing between them. However, this usually should begin around age 2 1/2 to 3 years old when the primary molars are fully erupted and the back teeth erupt side-by-side. Daily flossing is an excellent and proven method for complementing your child’s brushing routine and helping to prevent cavities, periodontal disease, and other dental problems which can occur later in life. Developing a regular flossing routine at an early age is the key for developing ideal lifetime oral hygiene habits.

Oral Rinses

Some mouth rinses can have therapeutic benefits; others are only cosmetic in nature and some have both attributes.
In general, some therapeutic rinses containing fluoride have been shown to actually fight cavities, plaque and gingivitis formation (ex. ACT for Kids). On the other hand, cosmetic rinses temporarily treat breath odor, reduce bacteria and/or remove food particles in the mouth (ex. Scope, Plax).

In any case, make sure to look on the label of a mouth rinse to see that it is accepted by the American Dental Association. We also recommend reviewing the contents of oral rinses prior to selecting one for your child. Many mouth washes contain alcohols which can upset the stomach and in some severe cases cause more serious problems. Because of this, we typically recommend that children stick to fluoride rinses only, as these items are alcohol-free.
Even rinses that are indicated to treat plaque or cavities are only moderately effective. We only recommend using oral rinses along with routine brushing and flossing regimen, as rinses are not completely effective in removing plaques, calculus or cavity causing bacteria.

Some of our favorite rinses:
ACT Rinse is effective in reducing children’s cavities up to 40% more than brushing alone with a fluoride toothpaste.Not only does ACT strengthen teeth to help prevent tooth decay, it’s also effective in preventing decalcification (white spots on teeth) common in children who wear braces or who develop small carious lesions early in childhood. And only ACT Rinse comes with an Exact Dosage Meter, so you’ll know they’re getting the right amount of fluoride.
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Listerine is an anti-microbial rinse which helps reduce “bad bacteria” levels in the mouth that cause gingivitis, bad breath and cavities. Typically this rinse is recommended for teenagers due to the alcohol content and the mild “burning” feeling while rinsing. They do however make an alcohol-free Listerine and an anti-cavity rinse as well now.

Nutrition

We definitely don’t expect children to completely avoid eating all the foods that make being a kid the best time of our life, however it is our duty as adults to help educate our children how to eat in moderation and how to make better decisions at particular points in time. Since dental decay has been directly linked to the consumption of sugary foods between meals, it is important for parents and children to make better choices when snacking. Research has shown that consuming sugary foods at mealtimes, while avoiding these when snacking, dramatically decreases the possibility of developing cavities. Educating our kids starts with making better choices ourselves. We recommend that parents also eliminate some foods, especially sodas from the house entirely.
We teach parents that children should especially avoid frequent consumption of sugary foods, especially those with a “sticky” quality. Typically the longer a food stays or sticks onto your teeth, the greater the likelihood it will precipitate the development of a cavity.

Some healthy snack options that are low in sugar include:

• plain milk
• cheese sticks
• yogurt
• fresh fruits
• raw vegetables
• dark breads
• whole grains
• enriched cereals
• sugar free candies and gum

Sugary foods, especially juices and sodas, are best consumed at meal time and brushed away immediately afterwards.

MYTH: Cavities are caused primarily by eating candy. We often hear from parents, “I don’t understand why little Sally has so many cavities, as she rarely eats candy,” or after we diagnose cavities we commonly hear, “no more candy for you!” Most people think dental decay is caused by the consumption of candy. It is actually more likely that other surgery foods are the primary cause of decay, ones that are eaten on a regular and frequent basis. We find that these foods typically include: juice, soda, flavored milk, chewy fruit snacks, or surgery cereals.

It is also important for parents to understand that even some sweet foods that we promote as better choices, especially plain milk and fruits, also contain some natural sugars. However, these sugars tend to be less cariogenic, as our oral bacteria produce a less potent acid after their metabolism. Like sucrose-containing foods, it is still important to remember to clean these less cariogenic foods off our teeth following consumption, especially before bedtime. Studies are showing that dental disease is just as related to overeating as hear disease, obesity, diabetes and hypertension.

Just like regular brushing, flossing and semi-annual dental check-ups, proper nutrition plays a critical role in the development of your child’s dentition. A balanced diet is one of the most important things you can provide your children to help ensure they maintain strong teeth, healthy gums and a beautiful smile for a lifetime.

Kids who consume too much soda and not enough nutritional beverages are prone to tooth decay in addition to serious ailments later in life, such as diabetes and osteoporosis. Drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel. Soft drinks contain sticky sugars that bacteria in our mouths use as an energy source. They break down into acids and adhere to tooth surfaces. Using a straw when drinking soda can help keep sugar away from teeth.

Remind your child to rinse his/her mouth with water after meals, especially during school, in order to leave their teeth free of sugar and acid.

Here are the essentials for maintaining a well balanced diet:

DO:

• Eat a balanced diet, including fruits and vegetables; breads and cereals; milk and dairy products; lean meats, fish and eggs. Crunchy, healthy fruits and vegetables such as carrots and apples not only provide great nutrition, but are also a natural way to clean teeth.
• Minimize starchy foods such as breads, crackers, pasta, pretzels and potato chips. Remember, some foods that contain sugar or starch are much safer if they are consumed with a meal, not as a snack.
• Be aware that some presumably healthy foods, such as peanut butter, jelly, catsup, salad dressings, raisins, pudding, dried fruits, chocolate milk, ice cream, fruit strips and fruit snacks, milk shakes and granola bars contain sugars that can break down and promote tooth decay. Ensure that your child brushes after eating these kinds of snacks.

DON’T:

• Eat sweet or sticky foods between meals. Sticky foods, such as dried fruits or toffee, have more cavity-causing potential because they are not easily washed away from the teeth by saliva, water or milk.
• Eat a diet that’s high in carbohydrates like sugar and starches. This puts your child at a much higher risk for tooth decay.
• Allow your child to eat any of these kinds of food without brushing immediately afterward: cake, gummy bears, cookies, sherbet, candy, popsicles and chocolate bars.
• Allow your child to drink excessive amounts of soda or juice.
• Put your child to bed with a bottle containing formula, milk, juice or other sweet liquid. As your child sleep, the liquid begins to pool in his/her mouth, essentially bathing her new teeth in enamel-destroying bacteria and other harmful substances. A bottle with water is a much more sensible alternative.