teeth cleaning

[Pj]

My baby is 11 months and has 4 teeth. Should I be brushing his teeth? If so, how often? I was brushing them in the bath and he seemd to cooperate but my health visitor said brushing too young would hurt his gums so I stopped. Now I worry that tooth decay might start early. Any advice?

[Emmam]

Pj - that wasn't a very helpful thing your health visitor said! What did she think you were cleaning your childs teeth with, a brillopad?! Dental hygiene should start as soon as the first teeth appear - baby toothbrushes are lovely and soft. Brush the teeth that are emerging/have emerged.

I clean my son's teeth in the bath too - and have done ever since his first teeth appeared - we're now on the home straight with only three left to emerge now. I've never seen any evidence that brushing his teeth from a young age has damaged his gums at all.

We've had battles and tears and mouth clamping, followed by complete co-operation, which changes like the weather. Right now we're using a Winnie-the-Pooh toothbrush which he loves and so lets me brush his teeth with great gusto.

Good luck with the teeth brushing - if you are in any doubt about what's best then have a quick word with your own dentist.

[Spring]

My dentist also told me that brushing the teeth should start as soon as the teeth appear. I do my daughter's teeth morning and night and she has 3 bright coloured toothbrushes. I ask her which toothbrush she wants to use so rather than the choice being whether to brush or not, she is busy deciding on which brush she prefers. We have very few refusals, mind you she loves the taste of toothpaste!! If I leave it out she always finds it and hides in a corner eating it until I realise she has been too quiet for a while.

[Robinw]

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[Lisav]

Ok, can anyone help me out here? I am getting conflicting advice about fluoride. Some say that babies should not be given any fluoride at all because of the cancer risks and so on, yet my HV says it is ok to use adult toothpaste for my dd and that she'd have to swallow a whole tube for her to have too much. So how much fluoride really is too much? We don't have fluoride in the water and at the moment I am using baby toothpaste once a day.

Also, my dh says that brushing babies teeth is unnecessary as he never had his teeth brushed until he started getting his secondary teeth and his gums and teeth were fine. So now we have this argument about brushing her teeth! What does anyone else think? And if we don't use toothpaste, is just water good enough?

[Wendym]

LisaV A whole tube of fluoride toothpaste could kill your child but smaller amounts may cause fluorosis. That's why some people think you shouldn't use fluoride toothpaste under age 2.

Some people can get away with anything when it comes to their teeth, others can have a healthy diet, regular tooth cleaning and still get decay. A lot depends on the type of streptococcus bacteria you/your child have in their mouth. Children are more at risk too if they were premature or ill in infancy or the mother was ill during pregnancy.

All my family use childrens toothpaste with fluoride but there are arguments against it. To see what fluorosis looks like and for links to pro and anti flouride sites go to Flouride

[Chanelno5]

Lisav - I can just tell you what I use on my kids teeth rather than the rights and wrongs, but it might help to reassure you. From when they got their first tooth (aged from 4-7 mths) I have used a child's toothpaste, usually My first Colgate toothpaste (yellow tube). This one says that it has a lower level of fluoride. However, when I've run out, I have used a small blob of adult toothpaste on them. They have always had toothpaste with some fluoride in, even as babies. Infact tonight, I caught my youngest 'eating' toothpaste which one of the other two had left hanging around - he seemed to be quite enjoying it too! Personally, I would (and did) use a little bit of toothpaste when cleaning my babies' teeth rather than just water alone, as I think they get a better clean (IMO).

[Lisav]

Thanks for the info and the link WendyM, I am now erring on the side of getting her some non-fluoride toothpaste from Boots until she is 2, just to be on the safe side. I didn't start using toothpaste until she had 3 teeth, at about 13 months and I only use the tiniest of blobs once a day. But if left to dh he probably wouldn't clean her teeth at all as he says that they are only her milk teeth and are going to fall out anyway(!). So I need to come up with a good argument why brushing her teeth at all, helps prevent diseased gums and plague. He won't listen to my arguments as he just cites his childhood where they were never given toothbrushes until they were about 8. I'm surprised he has any teeth!

[Green]

When I actually manage to get the toothbrush in ds's tightly buttoned up mouth - I use a brand called 'Tom's' - they do a childrens flouride toothpaste. A good brand which are very 'natural' ie. no artificial sweetners and other nasties.

But while we are on the subject - does anyone have any tips for making teeth brushing a more pleasant experience. Until recently (son is now 21 months) I had been very very slack about tooth brushing as ds has just always hated it. He will suck the toothpaste off himself, but if I try to brush his teeth properly he goes ballistic. After a friend scared me with dentist horror stories, I now battle twice a day and just hold him down and brush his teeth (oh what a nasty old mum I am).

[Jasper]

Lisav for your dh to say he never brushed his teeth till he was 8 and never had problems is similar to saying " my grandfather smoked 40 a day for sixty years and never got cancer." I would question him more closely. Does he really claim he had no problems ( decay, extractions) as a child? If he never brushed his teeth ( or rather his parents did not brush them for him) and he did not have decay he either had a diet very low in sugar and/or was extremely lucky and unusual . Only a generation ago it was considered not that big a deal for kids to have a general anaesthetic to have bad teeth removed. I am 38 and haad a dental GA twice as a young child. My parents are not stupid ( my mother is a midwife!) but toothbrushing was not high priority and getting a GA was not thought to be that big a deal. Many people still think this way, but thankfully dental health awareness is improving and there is certainly a far greater reluctance to administer GA ( and strict legislation to control it which came in on 1/4/01)except in extreme circumstances when the child just won't accept the alternatives.
As for his claim to have had no gum problems, how could he possibly remember? Lots of people have ongoing gum problems without realising it. Chances are your dh had the foulest breath in the playgroup!
Continue brushing your child's teeth with a tiny smear of toothpaste. I assume your dh does not actually try to stop you?!

[Suedonim]

Lisav, my understanding is that it is important to look after the first teeth because if they decay, it can penetrate downwards and the new second teeth can emerge already rotting. Also, if the baby teeth are lost too early it can affect the spacing of the adult teeth.

Green, I noticed today in Tesco's that they sell a wide range of children's electric toothbrushes. Maybe this would entice your little one to open wide? We used to coax reluctant brushers by allowing them to clean their own teeth in the mornings while we did a proper job on them in the evening. HTH

[bloss]

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[Joe1]

When I was young I was prescribed medicine for something or other which rotted my teeth. It was taken off the market for this reason but my second teeth have suffered and are not a lovely white colour which I would really love to have. I have also got two teeth missing next to my front teeth which I dont know if this is related. So I am very careful in looking after ds teeth and its not just toothpaste and sweets we need to watch.

[JanZ]

I had a chat with my dentist about ds (who was 1 at the time - now 15 months). He suggested giving fluoride drops, as our water supply here in Scotland is not fluoridated. I asked about fluorosis and he said he recommends givng the drops every other day - that way you're not at risk of overdosing, but you're giving the second teeth, which are already developing in the gums, the best possible start.

He also said that recent research has shown that a lot of dental decay is due to other factors other than just diet - with genetic as well as social factors playing a part. The problem is, how do you target health messages to those at higher risk?

The good news for me, or rather ds, is that both my husband and I have "good" teeth, with neither of us suffering from much decay (despite neither of us being terribly good at looking after them - we'll have to get better to provide a good example to ds!). So hopefully ds will follow suit! We're not taking this for granted though and we've been brushing his teeth once a day since they first started to come through (he's now got about 16 - I can't count any more as he bites when I put a finger in to feel!) I've just started giving him fluoride drops every second (or even third) day.

[wendym]

there's a page of brushing tips at www.kidsteeth.ic24.net/page5.html (sorry couldn't make it a live link) Can I reinforce the mesages about baby teeth being important. If they have to be removed the remaining teeth move closer together so there is less space for permanent teeth to come through and some of those may need to be removed. In America dentists fit "space maintainers" but it isn't often done here. Losing teeth can affect your child's speech and when they start to lose baby teeth naturally they may have very little left to eat with. Although all baby teeth fall out eventually some are there for a long time, they are the most likely to decay.

It is extremely distressing when children have teeth removed - for the parents as much or more than the children. Please clean those teeth - and I speak as someone who didn't have a toothbrush when very young either. It made me determined my child would have good teeth. Didn't work but that's another story.

[TigerMoth1]

Wendym, how do you view using an electric toothbush to clean toddler's teeth? Is it more harmful than not cleaning at all?

My 2 year old is fairly happy to use an electric toothbrush (a mixture of sucking and brushing) and he does so quite gently - or he'll let me use it. But he absolutely hates the non-electric sort. I am not pushing the latter at the moment, though intend to do so later - he can't go through life expecting to find an electric toothbrush in every bathroom.

Does your website cover this or can you give me an answer here?

[jasper]

Using an electric toothbrush is fine, particularly if your child is really resistant to having his teeth cleaned any other way.
Don't let your young child wander round with a toothbrush of any sort sticking out his/her mouth as it can cause a nasty injury if they fall on it. Sorry if this is stating the obvious, but it can and does happen.

[wendym]

Website doesn't cover it explicity but sort of implies it, maybe I'll improve that bit. Can't find any research on very young children but the evidence from studies of older children is that is does no harm and may be better in removing plaque. Lots of evidence that the sooner a child has their teeth brushed the less decay they are likely to get so if it's a choice between electric and no brushing electric is definitely better.

Make sure the brush has a small soft head and try to do it yourself at night as children don't have the dexterity to clean their teeth properly until they can write their name. And as has been said already never leave them alone with it as it could choke them/ they could fall on it.

We bought dd an expensive electric brush when she reached 7 with a pressure sensor to make sure she didn't brush too hard. She hates it and has my older, slower, model. On that very limited experience maybe the slower ones are better for children. No need to invest in the expensive disney version, although that may encourage them to brush longer, as long as its a small head.

[mollipops]

My two and a half yr old ds loves chewing and brushing with his toothbrush (the old fashioned variety!), more for the taste of the toothpaste (my first colgate). He's not always keen for us to "help", it depends what mood he's in - if he is unwilling we sometimes wait a bit and then he's okay. Better than the all out wrestling/struggling thing! We do animal noises - a lions roar for the open wide mouth and a tiger growl with teeth clenched to do the front teeth! It works most of the time! He's just learned to rinse and spit which is great - before that we just gave him a drink of water and said the words. One day he tried it - he liked to watch us and his big sis do it as well. If you are using low flouride toothpaste (about a pea sized amount) it shouldn't harm them to swallow until they learn to spit it out.

My 5 yr old dd is another matter as she thinks she can do it by herself (she can't yet! - apparently it's usually closer to 6 or 7 before they have the manual dexterity to do it properly). Sometimes it's a battle but we make it part of her bedtime routine, teeth and toilet (she chooses which first), then if successful/cooperative at both she gets a second bedtime story. If she dilly dallys she knows she'll miss out or run out of time!

One thing - make sure when you check/brush their teeth that you have a good overhead light and really look in their mouths. We got a bit lax with dd and the other day when I did have a proper look I found a big hole in her back molar ...now she needs a filling and I think I'm more scared than she is! I know it's no big deal but I feel so awful about it, as I feel I should have prevented it or seen it sooner. (Ah motherhood! Don't we beat ourselves up about these things!?)

Anyway persistence is the key and be as thorough as you can...but try not to let it turn it into all out war as it just makes it harder next time! Good luck!

[TigerMoth1]

Thanks WendyM and Jasper for replying to my electric toothbrush query. At least that's one thing I don't have to feel too guilty about.

[wendym]

Half of all British children have one or more decayed teeth by the time they are 5. So don't beat yourself up about this mollipops, it's a lot more common than you think. If you want to make sure her permanent teeth don't need fillings though keep off the fizzy drinks, eat lots of cheese and consider giving her xylitol. The molars are more susceptible to decay than other teeth and if she chews xylitol gum as they erupt it seems to go on providing protection even after you stop using the gum. In a clinical trial children who chewed xylitol gum had less decay in the teeth that erupted while they were using it even 3 years after they'd stopped using it. Some people call it "the new fluoride".

[Rhiannon]

If you look at the baby teeth you'll notice that there's far less pits and fissures than adults teeth. This is because the teeth are known as 'self cleansing'. Baby teeth are fairly good at looking after themselves but help with a pea sized amount of paste is good. Don't beat yourselves up about toothbrushes, just having it in the mouth is good enough when they're tiny.

Sweets are fine, should be eaten in one go and finished not kept in a pocket to be eaten one every 30 minutes. This minimises the amount of time the sugar can sit on the teeth. The stickier the sweets, the more the sugar hangs about.

With regards to cups and bottles, the juice whether its squash or real fruit juice should be watered down as much as possible, until it's nearly clear if you can. If you see friends with bottles full of dark juice, warn them of the dangers of sugar and acid.

Tetracycline is an antibiotic known to cause terrible discolouring of teeth whilst being formed. R.

[wendym]

What you don't see with baby teeth is that they are not as tough as adult teeth and decay more easily. All teeth are self cleansing to some extent but the moment you start giving a child sugar (fromage frais, perhaps or breakfast cereal) you upset the balance. That is why half of 5 year olds have decay in one or more teeth.

We were more careful than most with our daughter's teeth and she still got decay. Some of your information was good Rhiannon but its irresponsible to suggest that all baby teeth will somehow clean themselves.

[Rhiannon]

It should be good and is correct as I'm a qualified dental nurse! R.

[jasper]

Please DO take care to brush your tiny child's teeth, even if they do appear to have smooth "self cleansing" surfaces.It really is not sufficient for them just to have the brush in their mouth .Baby teeth are very susceptible to decay, and what's more they have big "pulps" - the soft inner core of the teeth which contains the nerve and blood vessels, and this means it does not take a great depth of decay to reach the sensitive part, i.e. cause pain.
Another thing about baby teeth. While it is correct that they may have less deep pits and fissures than adult teeth there is a lot of variation in tooth morphology and some children do have deep pits and fissures in their deciduous teeth.
Another factor is how close together their teeth are. If their teeth are very close it is easier for decay to develop interproximally ( where two teeth in the same arch meet )and the thing about interproximal decay is it can seem to appear literally overnight. Of course it does not really appear overnight but what happens is the enamel ( The really hard outer shell) in one or both teeth at the contact point develops a tiny "pore" of decay, which spreads very quickly into the underlying and softer dentine. The decay can spread much more quickly in the dentine and not much is visible in the mouth (unless you know what to look for) until the enamel caves in over the softened dentine and a cavity appears seemingly from nowhere.
Although fluoride at the correct concentration is a great strengthener of enamel there is some evidence that fluoride strengthened teeth are at even more risk of decay progressing unnoticed, but only once the decay has started if you get what I mean. In other words this is not an argument against fluoride which definately does protect against decay, but if interproximal decay does get a foothold the dentine can decay to a greater extent before the enamel caves in the problem gets noticed.
Incidentally , interproximal decay shows up earlier in x-rays that by careful oral examination, but few parents are happy to have their child's apparently perfect teeth x-rayed "just in case". Also not too many young kids are very cooperative with the process of obtaining a decent x-ray.
Wendy makes an excellent point about sugars in things like fromage frais and weetabix; think of it this way - the bacteria in plaque which feed on sugars in food and drink to produce acid (which causes decay) are microscopic, tiny bugs. They don't need a huge quantity of sugar to do their damage. Bacteria can metabolise tiny amounts of sugar. And not all mouths are created equal in terms of the type of bacteria they play "host " to! Certain bacteria are far more efficient than others at this process, which is why some very unlucky individuals can take better than average care of their/ their children's teeth and still get decay. while others feed their kids junk and don't brush their teeth carefully yet escape problems. However these are two extremes and not an excuse to think you or your kids are genetically programmed regards the fate of your teeth!
Ahem! Is anyone still awake??!

[wendym]

I am Jasper. You're describing my daughter - deep fissures in molars, teeth crowded, decay between the teeth missed by dentist, rapid deterioration. X-rays aren't recommended for children unless there is reason to suspect decay so its not a case of what parents want - they aren't normally given any option. At dental hospitals even very young children can be x-rayed. Don't work in the south west do you? I'm still looking for a good dentist.

Rhiannon if I had £5 for every statement made by professionals that turned out to be unsupported by the evidence or just exaggerated I'd be rich. I lost my faith in professionals after one claimed my daughters molars couldn't possibly have erupted before age 3! (He was investigating my complaint against the dentist who missed the decay).