Ever since we caught that first glimpse of a tiny tooth pushing its way up through Bubs’ wee gums, we’ve been brushing his teeth.  It was easy in the early days; given that his diet was mostly breastmilk to start with I didn’t worry that much about his teeth if I’m honest, and he was happy to let us give them a quick once over with a teeny toothbrush and a smear of paste before bed.

These days though, oral hygiene is a different kettle of fish.  Bubs has a mouthful (well, 16 and counting) of pearly whites and an independent streak to rival that of Bear freaking Grylls – which makes toothbrushing something of an ordeal.  He wants to do it himself – and by do it I mean chew or suck on the brush because he likes the taste of the toothpaste.  I, on the other hand, want to clean his teeth properly thus avoiding hideous tooth decay of the kind recently featured on a Panorama Special, not to mention some other terrible affliction caused by swallowing too much toothpaste.  Now I’m well aware that when I was a child, little emphasis was placed on brushing the teeth of babies and toddlers, and to be fair my teeth are fine albeit a bit wonky and with the odd filling.  All these mandates about brushing for two minutes and not allowing the child to swallow too much toothpaste and a whole industry based on novelty toothbrushes and pastes are relatively newfangled.  So what’s the best way to care for a small child’s teeth?  What happens if you don’t do it properly – and how can you persuade a less than co-operative child that clean teeth should be high on his or her list of priorities?

Why brush?

First and foremost, the purpose of toothbrushing is to prevent tooth decay and cavities.  Tooth decay occurs when the bacteria naturally present in your mouth produce acids to break down morsels of food left behind after eating.  These acids combine with the bacteria and the food to form a substance called plaque, which coats the teeth and begins to erode the enamel.  Saliva is the body’s natural defence against tooth decay, neutralising some of the acids and inhibiting the growth of bacteria.  Because the body naturally produces less saliva while we are asleep, teeth are more vulnerable at night, which is why brushing before bed is especially important.  Failure to take proper care of your child’s teeth can result in painful cavities which may need to be filled, or severely decayed teeth which need to be extracted. Poor oral hygiene is also a cause of inflamed, bleeding gums (gingivitis) and bad breath (halitosis).

Correct toothbrushing technique

Toothbrushing should be supervised until your child is around six years old and most under fours will need a helping hand to ensure their teeth are properly clean.  Start with a small, soft toothbrush and a smear of toothpaste, or a pea-sized amount for over twos.  Gently brush the inside surfaces of the teeth, where most plaque accumulates, first, angling the brush towards the gumline.  Then clean all outside surfaces of the teeth, brushing gently back and forth, again with the bristles angled towards the gum line.  Finally, brush the biting surfaces of the teeth before encouraging your child to rinse their mouth with water – most will relish the opportunity to spit it out without getting shouted at!

For younger babies, you can buy ‘finger toothbrushes’ to make life easier but a clean, damp muslin will work just as well.

Things to avoid

1.  ‘Grazing’ between meals.  If your child is continually picking at food then their mouth is continually producing acid to break that food down, which in turn means that their delicate teeth are being bathed in acid all day long.  There’s nothing wrong with having snacks between meals – in fact they are often necessary to keep an active toddler’s energy levels up – but try to have clear ’snack times’, offer healthy alternatives with low sugar and offer a drink of water to rinse the mouth afterwards.

2.  Sugary drinks, especially in a bottle.  Sweet drinks like cola or juice are often full of sugar, but even sugar-free alternatives or milk have the same effect as ‘grazing’ on food during the day – plus the effects of constant sucking can be detrimental to the development of your child’s teeth and jaw.  Try to save drinks like juice and milk for meal or snack times and offer plain water at other times.  Also, encourage your child to drink from a free-flow sippy cup once they are established on solids with a view to saying goodbye to bottles by the time they are one.

3.  Putting your child to bed with a bottle of milk or juice.  There is no denying that babies love to suck and there’s nothing like a milk feed to send them drifting off – and we all know that in the real world you would never wake a sleeping baby just to brush its teeth! If your baby is young enough to still need a final milk feed and usually falls asleep at this feed then the best you can do is clean the teeth gently first and then offer the bottle as normal.  You should never allow an older baby or toddler to take a bottle to bed unsupervised though – if they fall asleep with the bottle in their mouth, liquid ‘pools’ around the teeth creating optimal conditions for bacteria to breed.  If your child insists on taking a bottle to bed as a comforter, fill it with plain water or offer a dummy instead.

A note on breastfeeding

There is lots of information on the internet stating that breastmilk, like formula or juice, contains sugars and that extended breastfeeding or nursing at night is a cause of tooth decay.  Personally I always felt that as a completely natural food, breastmilk was extremely unlikely to harm Bubs’ teeth.  In fact, some studies suggest that compounds in breastmilk actually kill harmful bacteria and can protect the teeth from decay.  In our house we always brushed Bubs’ teeth before his last breastfeed and left it at that until we stopped nursing at 12 months.  You can read more about breastfeeding and tooth decay at Kellymom or in some of the resources below.

When baby says no!

So we all know that toothbrushing is important – but what if your kid isn’t so enthusiastic?  Children love nothing more than saying ‘no’ which is extra frustrating when their health is at stake.  The key is to make toothbrushing fun – if you can come up with a game to make it enjoyable for your child then you’re onto a winner!  In our house we have the ’sugarbugs’ who hide in Bubs’ mouth and make his teeth dirty – and it’s a race against time to catch and scrub them all away!  Another friend told me that she used to get her daughter to recite the alphabet in the most exaggerated, crazy way she could – a great way to get that mouth open nice and wide so you can scrub away!  The old faithful reward chart or stickers could also work well here, as will allowing your child to choose their own toothbrush and paste in the shop.

Did you know?

Extraction of the baby or milk teeth before they are ready to fall out is thought to stimulate the adult teeth to come through earlier, which in young children may then occur before the jaw and facial bones have had a chance to grow to accommodate them.  This can result in crowding of the teeth which may require orthodontic treatment and even extraction of permanent teeth.  Fun.

Resources

http://parenting.ivillage.com/baby/bhealth/0,,3×5h,00.html
http://www.kellymom.com/bf/older-baby/tooth-decay.html
http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthAtAnyAge.cvsp
http://www.nhs.uk/Conditions/Dental-decay/Pages/Causes.aspx

The image for this post was kindly supplied by my very talented friend and photographer, Paula O’Hara – check out her work here.