Before tooth eruption: clean gums and tongue with wet washcloth either at bedtime or at bath time

Cleaning the baby’s mouth before tooth eruption either at bedtime or bath time helps the child to get used to the adult/parent manipulating his/her mouth, but most importantly it helps the adult/parent to establish a daily oral hygiene routine in their schedule that will be crucial after the eruption of the child’s teeth

After eruption of lower and upper front teeth: best to brush with toothbrush

After eruption of the lower and upper front teeth, it is best to start brushing the child’s teeth with a toothbrush rather than a wet washcloth. The washcloth will not clean and remove plaque from teeth as well as the toothbrush. Most of children’s toothbrushes have soft bristles that will not hurt the child’s gums and other oral structures

Begin brushing with fluoridated toothpaste after the first tooth is fully erupted

Small amounts of fluoride from the toothpaste on a daily basis is the most effective way to prevent caries, especially for high-caries risk children

smear: (6-24 months)

1/2 pea-sized: (24-36 months)

pea-sized: (>36 months)

Young children can’t spit most the toothpaste used and may swallow some of it. So, the key is the amount. A “smear” amount is the ideal amount for children 6 to 24 months; a 1⁄2 pea-sized amount for children 24 to 36 months of age, and a pea-sized amount for children older than 3 years of age

The more times teeth are brushed during the day, of course, the better it is. However, the most important time is right before bedtime.

Toothbrushing in the morning and before bedtime is ideal

Brushing teeth before bedtime is extremely important since there is a significant reduction of salivary flow during sleeping hours. The chemical and physical properties of saliva help to fight off bacteria that cause cavities.

Brushing twice a day increases the likelihood that plaque will be better removed from teeth rather than only once a day. However, if brushing will occur only once a day, the best time is right before bedtime

An adult should brush the child’s teeth until the child is in 1st or 2nd grade

After the child is in 1st and 2nd grade, adults should supervise the toothbrushing

It is not until children are 6 to 7 years of age that they have the necessary motor skills to brush their teeth effectively

Adults should motivate children < than 6- to 7-year-old to learn how to brush their own teeth. Making a deal during brushing between the child and the adult is a good way to form a great partnership and guarantee that the child will have fun and learn how to brush his/her teeth, but also guarantee that the adult will be the one responsible for cleaning the child’s teeth

One tip: place the fluoridated toothpaste on the toothbrush only when it is the time for the adult to brush the child’s teeth

Brush before bedtime feeding and first thing in the morning after any nighttime feeding

When mothers are willing to breastfeed on-demand and/or the child is being bottle fed to sleep or in the middle of the night, the best is to educate them about the caries risk of nighttime feeding. But also to educate them of the importance of toothbrushing with fluoridated toothpaste right before the bedtime feeding and brushing the child’s teeth first thing in the morning after any nighttime feeding. It will not completely decrease the risk for caries, but it may help in the re- mineralization of teeth with the fluoridated toothpaste and guarantee that feeding will occur most likely in an environment free of plaque

During toothbrushing, distract the child: sing, tell a story, watch a movie, play a game

Establish a partnership between the child and the adult

Be creative and consistent with toothbrushing day after day

The problem of toothbrushing with children is the restrain necessary during brushing and the desire to be independent and do things by themselves. In terms of the sense of independence, establish the partnership between the adult and the child as discussed above. In terms of the restrain, try to make brushing fun by distracting the child with songs, games, movies, cartoons, etc. Advise the adult/parent to be creative during brushing and find out what works best for the child and, very importantly, to be consistent with brushing day after day

Make it comfortable for the child and effective for the adult to brush

Adults need to restrain the child’s body and head movements during toothbrushing. Advise them to be creative and gentle

One tip: Lift the child’s lip during brushing to brush the upper front teeth better and pull the cheeks away to better brush the outside (buccal) surfaces of the back upper and lower teeth