A reader asks:
Do you have any advice on getting toddlers to brush their teeth? My son (2yrs) only likes to suck on the toothbrush and fights me brushing his teeth. I got him a toothbrush that sings and he just wants to play!
When it comes to any 2-year-old, sometimes doing the best you can do is good enough!
The AAP recommends* that parents brush their children’s teeth until they turn 2 years old. Between 2 and 6 years, children should be shown how to brush their own teeth. Parents should supervise these young children (whose primary “baby” teeth have soft enamel that’s vulnerable to the development of early childhood caries) and help them finish the job twice a day. Since most communities provide tap water that’s supplemented with fluoride (a naturally-occurring substance), fluoride-containing toothpaste is not necessary or recommended in children who drink tap water under the age of 2, since they will probably swallow it. (Children who don’t drink water containing fluoride should receive a prescription fluoride supplement.)
After 2 years of age, a pea-sized amount of fluoride toothpaste should be used twice a day on a soft toothbrush. Rinsing and spitting the excess toothpaste and bubbles should be taught, though children are not expected to do this efficiently until after 6 years old.
Since it is important to get the front and back surfaces of all the teeth, some parents find that electric toothbrushes are more accepted by children and work better for them.
Flossing is also an important part of oral hygiene, removing food and plaque that accumulates between teeth. The AAP suggests:
- Flossing should begin when 2 teeth touch, typically between 2 and 21⁄2 years of age. Some children may only need a few back teeth flossed and others may need flossing between all their tight teeth, depending on dental spacing.
- Children usually need assistance with flossing until they are 8 to 10 years of age.
- Flossing tools, such as pre-threaded flossers or floss holders, may be helpful for children who are just learning how to floss.
- Some children may find it easier to use a loop of floss, which is created by taking a piece of floss about 10 inches long and tying the ends together into a circle. Parents (and older children) can hold the floss tightly between the thumbs and forefingers to floss.
Many pediatric and family dentists have recently begun recommending the application of a 5% fluoride varnish solution to prevent the development of early childhood caries, especially in these high risk children:
- All children eligible for Medicaid
- Siblings with cavities before 6 years of age
- Premature children
- Children with special health care needs
- Children who use a bottle after 15 months or have sweet or starchy snacks more than 3 times a day
- Children without a dental home
Pediatricians typically refer all children to a pediatric dentist (or a family dentist who is familiar and comfortable with treating small children) by the age of three. Children at high risk for the development of tooth decay, kids who we detect have dental problems at their scheduled checkups, those who suffer dental trauma, or those who have parents with concerns are referred earlier.
Read A Pediatric Guide to Children’s Oral Health, part of the AAP’s Oral Health Initiative*, reference guide here and flip chart here. Both are great references with excellent photographs and descriptions of dental issues.
* American Academy of Pediatrics. A Pediatric Guide to Children’s Oral Health. Elk Grove Village, IL: American Academy of Pediatrics; 2009