Caring for your child's teeth

This is an edited transcript of our live webchat with Dr Anthony Zybutz on 8 September 2008. He's a dentist with many years of experience who practises in Harley St and has two sons.

What's the best way to get children to brush their teeth correctly?

Q. ladytophamhatt: My nine year old is a nightmare at toothbrushing, he'd rather stick pins in his eyes to be honest. All of his younger brothers are better, including our 20 month old! Is there any snippet you can give me to persuade him that manky teeth is not good. I've even resorted to showing him hideous photos of tooth decay but he still faffs and whinges and moans. 

A. Dr Zybutz: Thanks for being the first to post a question. I think the most important thing I can recommend is to avoid scare tactics. I find children just don't respond to them. It will be much more effective to encourage him with positive reinforcement and find ways to make brushing enjoyable than to threaten him with pictures of rotten teeth. Because he can't really understand what that would be like, it's probably not having any effect other than to make him feel negative about the entire brushing experience.

Because he is getting to an age where his autonomy is important, why not start by allowing him to make some grown-up decisions about his oral health. Let him pick out his own themed electric toothbrush and his own toothpaste (make sure it's for children) – perhaps even introduce a product that makes him feel more grown up, like children's mouthwash. He needs to feel he's cleaning his teeth because he wants to, not because you are coercing him to.

Q. mummyc: My 14 month old doesn't much like cleaning his teeth (we only try at night) and so most nights me or DP 'help' by gently cleaning them, which leads to screaming fits on his part. I'm worried we might be creating an issue making him hate cleaning his teeth/having them cleaned. My DP is more worried about his teeth rotting and thinks it's worth the struggle. Any recommendations? The essence of my question is: how important is the level of cleanliness of teeth versus the habit of him cleaning his teeth happily?

A. Dr Zybutz: You ask an important question about habits. I think the main reason you're having difficulty is because you're only brushing at night and perhaps not enforcing that teeth cleaning is a normal part of your child’s daily routine. As mentioned to RubySlippers, try brushing your teeth together and make sure your 14 month old likes the toothpaste.

Children should become accustomed to cleaning their teeth at least twice a day. The earlier this becomes routine the better, as this will help them form good habits from an early age. There may be screaming matches at first, but don’t let this deter you from keeping to a schedule. All that will subside when, like getting dressed and napping and bathing, children learn that brushing is simply part of their everyday routine.


How can you get toddlers to stop chewing their toothbrush and start brushing?

Q. RubySlippers: DS only really chews his toothbrush (he is 2.2 years old) and he can sometimes be cooperative and let us have a brush, or sometimes his mouth is clamped firmly shut! Is this bad? How can I teach him to brush rather than chew?

Q. solo: Repeat of Rubyslippers question really. DD (20 months) chews her brush and rarely allows me to clean her teeth. It's a real stressful battle. My DS was the same and has only in recent weeks realised that cleaning them properly has its rewards and he's now 10. Is there any way I can persuade DD to let me clean her teeth please?

A. Dr Zybutz: I find that children like to mimic, so I would suggest you teach by example. Brush your teeth with your child so he can see how you do it and copy you. This also helps reluctant brushers as it conveys the message that brushing is something fun that 'we' do together, rather than something the child must succumb to.


Should children rinse after brushing their teeth?

Q. carolt: Is there anything you'd recommend for kids who don't brush their teeth well enough/use enough toothpaste? I think I've heard of some sort of painting their teeth with something? Anything that can be done?

A. Dr Zybutz: Hi Carolt, like many mums it seems you're concerned that even though your children are brushing they may not doing quite a good enough job yet. There are things you can do to help enhance your child's cleaning efforts. The first thing I would recommend is not allowing your children to rinse with water after brushing. This washes away the good fluoride that toothpaste has deposited on their teeth.

If they're going to rinse, best to do so with a children's mouthwash that contains fluoride. Proper rinsing will also help to dislodge any left-behind food particles or plaque that has broken free of the teeth during brushing.


How often do children need to clean their teeth? 

Q. ruthhaasbb: Why is the general advice in the UK to brush teeth twice a day, whereas in Europe you're told to brush teeth after every meal?

A. Dr Zybutz: You don't need to brush your child's teeth three times daily and definitely not within one hour of eating as this could accelerate acid erosion. A good idea is for your children to rinse with water after lunch at school.


Can children use adult toothpaste?

Q. Smamfa: My son gets persistent and nasty mouth ulcers whenever he uses grown-up toothpaste. He's now eight. I've heard there's a direct connection between ulcers and sodium lauryl sulphate so I've tried to find him a toothpaste without this in, but the only ones he likes are kiddie ones. Is there really a connection or is it just coincidence? What brands can you recommend that don't have it in?

A. Dr Zybutz: Snamfa, as your son is only eight, he should not be using a grown-up toothpaste. It isn't confirmed that sodium lauryl sulphate is a cause of mouth ulcers. I advise you to see your dentist when your son has mouth ulcers to help the dentist diagnose the cause and provide appropriate treatment.


What should you do if your child hates toothpaste?

Q. carolt: My daughter hates the taste of her toothpaste so uses it as little as possible or not at all (she hates mint, as do all my kids). I used strawberry flavours etc when she was younger, but can't find anything suitable for her age range. Can you recommend any other non-minty toothpastes?

A. Dr Zybutz: I suggest letting your eight year old use children's strawberry toothpaste. If you're concerned this isn't providing enough fluoride, then I'd recommend supplementing it with a berry-flavoured all-in-one mouthwash.

Q. StarlightMcKenzie: Is toothpaste really necessary? I read somewhere that it isn't at all, it is just some wierd thing that we like to use to make our mouths feel fresh.

A. Dr Zybutz: Toothpaste is absolutely essential. In addition to containing fluoride, which strengthens and protects teeth against decay, it also helps to clean the teeth.


Should parents floss their children's teeth?

Q. MARGOsBeenPlayingWithMyNooNoo: Should parents be flossing their children's teeth?

A. Dr Zybutz: Flossing is very important as it gets to trapped food particles between teeth and at the gumline. Although you may find it difficult to floss your young child's teeth for them, it's a good idea to show them how to floss and let them 'pretend' to floss with you. This way, flossing becomes something they're familiar with. When they get old enough and dextrous enough to do it properly, they'll see it as part of a complete oral care routine. In addition to regular visits to the dentist, flossing is an important part of a daily three-step routine - brush, floss and rinse - that children should get used to from a young age.


When should children start going to the dentist?

Q. happychic: At what point should children visit a dentist for the first time?

A. Dr Zybutz: Children should visit a dentist within a few months of the time their first primary teeth break through. Certainly by the time a child is 12 months old a dentist should have a chance to assess tooth development and advise on proper oral care tailored to your child's needs.


Are fruit and raisins bad for children's teeth?

Q. werewabbit: My 20-month-old DS2 has yellow stains (plaque build-up?) on his teeth. We brush them night and day and sometimes at lunchtime and are pretty thorough, though he has a knack of holding his lips really tight so getting to the front top and bottom is a struggle. He doesn't have juice/milk bottles to suck on but he does like raisins. His doctor and dentist just say keep on brushing, but should we worry or do something more? I don't want him to have stumps for teeth at kindergarden.

Q. Tinkywinks: Hi, I've got a couple of queries concerning my three-year-old son. Just one of his upper teeth seems to be really stained yellow, as if there are food deposits on it. I don't give him any sugar but every day he has fruit and snacks. A lot of these are fruit based or sweetened with fruit and I wondered how much impact this would have on his teeth? A dentist told a friend that eating too much fruit is bad for teeth.

A. Dr Zybutz: Without seeing your child's teeth it's hard to say if the staining is due to plaque build-up, so I would ask your dentist. You do not need to brush your child's teeth three times daily and definitely should not brush their teeth within one hour of eating as this could accelerate acid erosion.

A lot of mums think they're doing well to give their children fruit in place of sugary snacks, but too much fruit can be very bad for teeth. Avoid dried fruits in particular as these have lots of concentrated sugar and when feeding your kids fruit juices, dilute them with water by at least a 50/50 ratio. I can't be sure yellow stains have anything to do with the fruit, but suggest visiting your dentist for a proper assessment.


Is sealing children's teeth a good idea?

Q. Porpoise: I'd really like to know what you think about sealing children's teeth? Is it a good idea? How does it help (if it does)?

A. Dr Zybutz: Sealing the teeth is an excellent idea as this helps protect the more vulnerable areas of the teeth from decay. This is especially important for newly erupted permanent back teeth.


Are stains on children's teeth caused by fluorosis?

Q. babyboo1and2: My 10-year-old son had beautiful milk teeth but as his adult teeth are appearing they're much more yellow and also appear to be stained with white bits. When I questioned my dentist he said it might be fluorosis and that I must have added fluoride to his diet when he was younger, but I haven't, we are very careful with his diet (no fizzy drinks, chocolate just a couple times a week etc). He brushes twice a day and has no fillings. I'm starting to see these same stains on the back milk teeth of my two-year-old daughter.

Is this a hereditary thing? Is there anything I can do to prevent this happening to my daughter's adult teeth before they appear? My son is becoming very self-conscious about his yellow teeth. Would you recommend whitening?

A. Dr Zybutz: The white bits on adult teeth in this case sound like normally occurring opacities which are not clinically significant. If it's an aesthetic problem, a cosmetic dentist can help. Permanent teeth naturally appear yellower due to the increased amount of dentine.

Fluorosis results from an excessive fluoride intake, which does not seem to have been caused by your diet. This also does not sound like an hereditary cause of discolouration. However, it might be best to check with a paedodontist. I would not consider dentist-supervised whitening for your kids until they're 16 years old.


Is thumb sucking bad for children's teeth?

Q. Slubberdegullion: I have two thumb suckers, age three and four. They only really thumb suck at night, but if you go into their bedrooms, their thumbs are always firmly lodged in situ. They both have a slightly protruding upper front tooth because of this. Am I going to have hideous orthodontic bills in the future? Do I only need to worry if they continue thumb sucking when their adult teeth come through? Do I need to start investing in that revolting dandelion tasting nail polish? Or can I just chill?>

A. Dr Zybutz: Slubber, I'm afraid you are facing a difficult battle. Thumb sucking is not an easy habit to break, especially if your children are over the age of two. A good rule of 'thumb' (no pun intended) is to try to take the dummy/pacifier away as soon as possible to wean them away from a sucking habit. If the thumbsucking (dummy/pacifier) stops before the age of six, the teeth should go back to their right position without orthodontics. Nevertheless, it's best to break the habit as soon as possible.


What's the best way to overcome children's fear of the dentist?

Q. rainbowfish: My DS, age two and a half, will not go in the room with the dentist. He is terrified. Tried twice - no joy. My elder son, aged four, goes first and will sit in the chair etc. Tried bribery. Any tips on how to get him to like the dentist. Also when should little ones go to the dentist?

A. Dr Zybutz: I hope your dentist has a good manner with children, as that will help. Just one question – have you ever tried sitting in the waiting room while your son goes in without you? I find some children feed off of their parents’ presence and only experience anxiety when mum is there to 'rescue' them, but when mum is taken out of the equation I tend to get on very well with most of my little patients.


Can antibiotics damage children's teeth?

Q. wilbur: DS1 (age seven) has several hyperplastic baby molars, so they're an unpleasant dull brown colour and the enamel is not in good condition. What is the chance of his big teeth coming through in the same way? And is there any real evidence that antibiotics caused this (both he and I had antibiotics when he was a baby and in pregnancy), or has he just been unlucky?

Q. PastYourBedtime: My six-year-old son has had brown stains on his teeth since he was 12 months old. One of them has seemingly eroded a little. The only thing I can think of is that he had a lot of antibiotics at ten months. Could this be related? He was breastfed until 14 months and brushes his teeth, doesn't have fizzy pop, sweets etc, yet he has just needed four fillings.

A. Dr Zybutz: It's true certain antibiotics have been shown to cause problems in developing teeth – specifically tetracycline. Most doctors now know this and avoid prescribing tetracycline for young children, but if your child has darkened lines across his teeth, this could be the reason.

If your children are showing signs of decay at a young age, then it would suggest you need to take extra care when cleaning their teeth. Again, all children have different needs - some don't have to brush very diligently to have healthy teeth, others need to try harder. Do consult your dentist, but I imagine he or she would suggest you take extra measures to ensure your children are cleaning thoroughly.

Learning proper brushing technique, using an egg timer to ensure children are brushing for two minutes each time and adding a fluoridated mouthwash to the equation will all help.


How serious is it if your child snaps their front teeth in an accident?

Q. Peachy: My eight year old fell and snapped his teeth at school, diagonal snaps (about a third of tooth height) on both adult front teeth. Is there likely to be any long-term damage? Or is it just cosmetic?

A. Dr Zybutz: Peachy, you should go and visit a dentist as there could be long-term damage.

Q. DanJARMouse: My DD2 is nearly three. She fell at about 18 months old and chipped her front top tooth. It has turned yellow and the one next to it is starting to go the same way, despite brushing regularly. Our own dentist said it was due to weak enamel, and there are signs of the same on her back teeth, but there is nothing that he would or could do for her. I'm terrified of her going to school and having the mickey taken for discoloured teeth when we seem to be doing all we can. Is there any sort of solution?

A. Dr Zybutz: I think you should definitely see a specialist child dentist (paedodontist). As it is difficult to tell from your question if there is a serious issue that needs addressing.


Does tooth grinding damage children's teeth?

Q. ruthhaasbb: My daughter had a cavity in her molar at the age of four. I was devastated as I take oral hygiene very serious. She grinds her teeth during the night, could this have an effect?

Q. My2: My 3.8 year old is grinding her teeth at night. Will this cause problems? Also, maybe a really silly question, but her eye teeth have lost their pointiness - does this mean her teeth are soft and when her big teeth come through they will be soft too?

A. Dr Zybutz: At a very young age tooth grinding, although it sounds horrible, is not significant. The loss of tooth structure is possibly due to an acidic diet (lots of fruit juice?), grinding and excessive brushing. Make sure your kids are using a children's fluoride-containing toothpaste and a kid-friendly mouthwash.


What treatment do cavities in children's milk teeth need?

Q. WilfSell:  Do milk teeth molars with decay need pulling, filling or leaving? (DS1, age 9, has a really bad cavity in a molar, very hard to get him to brush his teeth properly, we've had some success with disclosing tablets recently)

A. Dr Zybutz: The first thing is to see a dentist as soon as possible even if that means paying privately. The large cavity can lead to abscess in the jaw causing pain and problems with the future teeth. How to treat milk teeth will always depend on the severity of the decay, but it is essential to try to keep the teeth in place bearing in mind this is not always possible. Remember prevention is better than cure.

The milk teeth are extremely important as they guide the permanent teeth into place. It's essential you institute an oral hygiene routine, which should consist of brushing twice daily, flossing and rinsing with a child-friendly mouthwash. Bacteria left in the mouth can lead to cavities, tartar build-up and even gum disease, so it's important teeth are cleaned effectively.


Is it safe to whiten your teeth at home?

Q. Nbg: I have staining on my teeth, are there any home products that you would recommend to whiten them? My NHS dentist is talking £300 to whiten them for me.

A. Dr Zybutz: The only way to safely and predictably whiten your teeth is to see your dentist. Over-the-counter products rarely work and can be damaging to teeth, gums and your jaw.

Is it ever too late to start practising good oral hygiene?

Q. FlightAttendent: I have needed a lot of work on my teeth - not cosmetically at all but acute/chronic problems. Is it too late for me to make a difference with my oral hygiene as the damage was done years ago?

A. Dr Zybutz: Definitely use an electric toothbrush and see your dentist/hygienist on a regular basis.


How to protect your children's teeth

Dr Zybutz: Thanks to everyone who came to chat today. I really appreciate the excellent questions and I hope I managed to answer most of them. As a reminder, my best advice is to go for prevention.

Before I sign-off, remember the routine:

  • Brush twice daily with an age-appropriate toothpaste
  • Start flossing as soon as you can
  • Rinse with a child-appropriate antibacterial fluoride-containing mouthwash (remember this is only advised for children older than six to prevent swallowing)
  • Visit your dentist and a dental hygienist on a regular basis

This chat with Dr Anthony Zybutz, BDS, was sponsored by Listerine Smart Rinse. Please note the views and opinions expressed by Dr Zybutz are independent and are not endorsed by Listerine.

Last updated: 15-Apr-2013 at 4:56 PM