Our children's dental health
We all want the best in life for our children, and taking good care of their dental health in their early years makes a lifetime of healthy teeth and gums a reality for them. It’s a wonderful gift to give them, and you can do it for your child by following the simple steps laid out below.
The two main dental diseases that people encounter in life are tooth decay and gum disease. Both of these are preventable. As a parent, the earlier you start to lay the foundation for lifelong dental health for your child, the easier it will be to achieve. We have two young children ourselves, so we are aware of some of the many challenges that parents may face. We can help to support you in safeguarding your child’s precious dental health by providing the information and services that you need to do this, now and in the future.
‘It takes a village to raise a child.’ (African Proverb) Every person who is involved in your child’s day to day care has their part to play in maintaining and protecting their dental health. That includes crèches, childminders, family members, playschools and schools. Please tell them about this resource so that they can be involved and support your efforts. Tell your friends, as it will be easier for you to make healthy choices for your children, if your friends and their children do too. Here are the three core guidelines to follow for safeguarding your child’s dental health:
(Click on each section/question to read it or shrink it back afterwards)
1. Clean your child’s teeth at least twice a day. Read on...
- Do let them have a go at brushing themselves too, so they can learn how to do it right by copying what you do!
- Once your child is able to brush their teeth well themselves, (this could be as old as 9 or 10 years of age) we recommend that you still supervise their brushing for them. It is very easy for them to miss certain areas repeatedly and this can lead to decay developing in certain teeth despite their best efforts. We recommend that you continue to supervise them directly until they are at least twelve, and then check regularly that they are actually doing it thereafter.
- For advice and ideas on brushing and motivating your child, please take a look in the F.A.Q.section below.
- Teeth should be cleaned after eating breakfast in the morning, and just before bedtime.
- No more food or drinks, other than water should be taken after the night-time brushing.
- Thorough tooth brushing takes a minimum of 2-3 minutes each time.
- Brushing every surface of every tooth correctly is more important than how long you brush for. Quality not quantity.
- Use a piece of damp gauze to clean a very young baby’s gums (and teeth).
This is very gentle and it helps them get used to having their mouth cleaned.
- For children 0-2 years please use a soft brush with tap water only.
The HSE strongly recommends that you DO NOT USE TOOTH PASTE at this stage, (not even children’s tooth pastes);
Because such young children will easily swallow the paste and this can lead to fluorosis of the adult teeth that are developing in their gums. Fluorosis, caused by ingesting excessive amounts of fluoride, can cause rough white/brown spots and lines on the enamel surface of the tooth and it can also cause the enamel to be brittle.
- For children 2 years and older, use a soft tooth brush with a very thin smear of paste on the tip of the brush.
See image below.
The official HSE guidelines say to use a pea-sized amount of paste, but even this may be too much, depending on what kind of peas you go by! Ask the dentist to show you how much is enough.
- Use ordinary FLUORIDATED toothpaste. The fluoride, found in most family toothpastes available in the supermarket, is able harden up damaged areas of enamel, and is a very important tool in the fight against tooth decay.
- Spit out the tooth paste but don’t rinse it off, it needs to stay in contact with the teeth to work, the longer it is in contact with the teeth, the more effective it will be at preventing tooth decay, especially when left over-night. Also don’t preload your brush with water before applying the tooth paste, it just dilutes it and makes it less effective.
- The concentration of fluoride needs to be at least 1000p.p.m. or more for the fluoride to be effective. Using a thin smear of an ordinary fluoridated tooth paste will be more effective than using paediatric/children’s toothpaste, because the concentration of fluoride in most paediatric toothpastes is less than 100p.p.m. Also, children are much more likely to swallow the fruity paediatric pastes, and this can become a habit. Read the small print of the toothpaste before you buy it. Sometimes it will be shown as Active Ingredients: Sodium Fluoride 0.32% w/w (1450 p.p.m. F-), it’s the last measurement in p.p.m. that you need to know. 1450ppm will be very effective. See images below for details.
Please store all toothpastes and mouth washes out of reach and sight of children.
Treat them as medicines; they are dangerous if consumed by children.
Did you know that ingestion of toothpaste can even be fatal-a 2 year old child can get acute toxicity from ingesting less than 4g of a ‘kids’ toothpaste! While less serious, We have come across a teenager whose front teeth were quite disfigured by fluorosis, and she admitted to us that when she was very young she used to secretly eat the toothpaste, which was kept on the sink in their family bathroom. Her mother had no idea that she had been doing this. Luckily we were able to help improve the appearance of these teeth, but it could have been prevented.
- Choose a small tooth brush, they are often sold by age e.g. 0-2 yrs etc, and that is usually a good guide.
We find the Colgate Smiles good because they are small and soft, but still firm enough to remove plaque well. At your next dental health check, ask your dentist to show you how to pick the correct size brush for your child’s teeth.
- Change the brush when the bristles become ragged and bent out. See image below. You could say every three months
but that is only a rough guide. Toddlers particularly love chewing and clamping down on brushes, so keep a ragged (clean!) one for them to use themselves, and reserve the new one for you to use on them. You’ll get a lot longer out of each brush and save money too.
- It’s very important to brush right up to the gum level because this is how you can prevent bleeding gums (gingivitis), and using the Modified Bass Technique helps your child to get used to this from the beginning.
- Plaque disclosing tablets stain dental plaque so that you can see it better, and remove it more easily. They are available from your dental practice and from many pharmacies. You can use the tablets and time how long it takes to clean it all off and this is a good guide for how long you should spend brushing. It can be used after brushing to check how well they are brushing by themselves. See the section below, on motivating your child about cleaning their teeth, for more suggestions.
- For very small children and babies it is often easier to brush their teeth when they are lying flat on a bed or changing table, under a good source of light. This means you will have the use of both hands, a help in keeping their heads in one position.
- For older children, and especially once you start using tooth paste, you can try sitting on the edge of the bed or bath, your child standing between your legs, with their back to you. Hold your child snugly against your body, and ask them to tip their head back into the crook of one arm so you can support it, while you brush their teeth using the other hand.
- Yes, because it cleans between the teeth where nothing else can.
This becomes more important as your child gets older to protect their permanent teeth and prevent gingivitis,
but please ask your dentist or hygienist to show you exactly how to do this.
It is important to remove food that has packed between teeth, because it can cause decay quickly. It can be very difficult to floss a young child’s teeth, but if it is necessary, it’s best to ask your dentist to show you how to do it correctly. Oral B Satin Floss is one of the best.
- Use floss before brushing, this clears out the spaces between the teeth so that the tooth paste foam can more easily get in there, and harden up the enamel where the teeth touch.
- They are never a substitute for brushing and flossing, because they do not remove the sticky layer of plaque.
- Do not use immediately after tooth brushing as they will dilute the effect of the fluoride in the tooth paste. If you must use them, then use them at some other time during the day.
- We do not recommend them unless we believe it is necessary. Many contain significant concentrations of alcohol, and are certainly not advisable for children. The dentist or the hygienist may recommend special mouthwashes for those who have a high decay rate, who have braces, gum disease, dry mouth (xerostomia), and certain medical conditions.
2. Avoid giving your child sugary foods or drinks, especially between meals. Read on...
- It’s not how much sugar you eat, but how often you eat it that will do the damage, i.e.
the frequency and duration rather than the quantity.
Cut down on the amount of times your child eats and drinks sugars per day, and avoid treats that last a long time e.g. lollipops and jellies.
- The bacteria in plaque make acid out of the sugars we eat, and the acid gradually burns a hole into the tooth structure. The more often and the longer the teeth are exposed to the sugar-acid cycle, the faster decay will develop and the more severe it will be.
- Offer healthy snacks between meals, e.g. cheese and crackers, cheese strings etc, hummus and veg sticks breadsticks, peanut butter sandwiches, steamed carrot sticks, apple. For older children peanuts, nuts (except allergy sufferers) and seeds, plain or salted popcorn, olives, are great, but beware of the toffee-like raisins and other dried fruit!
- Check the ingredients labels of the foods and drinks you buy for the sugar content.
Sometimes supposedly healthy foods are not very good for your teeth, or say ‘no added sugar’ but contain natural sugars, e.g. children’s yogurt, fruit squashes. Did you know that there are approximately 3 teaspoons of sugar in a 180ml pouch of smoothie, and one teaspoon of sugar in a little pot of fromage-frais? Look out for sugars by different names: sucrose, glucose, dextrose, maltose, fructose, syrup, invert syrup, invert malt syrup. The nearer the start of the ingredient list the sugar is, the more sugar the product is made of. You can also look at the ‘Carbohydrates: of which sugars’ list to see how much sugar is in 100g of the product.
- The only tooth safe drinks are water and milk.
Don’t give sugary drinks like minerals and fruit squashes between meals, and keep fruit juices for meal times too. The liquid sugar solution in them is very good at causing tooth decay when consumed regularly between meals. Give your child a straw when they are drinking sugary drinks as it will bring the liquid further back into their mouths where it is in less contact with the teeth. Try to finish meals with water, cheese or milk.
- It’s best not to eat or drink anything except water within half an hour of going to sleep.
Only water is suitable for drinking after brushing your child’s teeth at night. When we go to sleep our body reduces the amount of saliva that we produce (because it’s not needed then), and saliva is good at neutralising the acid that plaque bacteria produce. So if we eat just before going to bed, the mouth doesn’t have a chance to naturally cleanse itself with saliva, and the plaque bacteria have a night long party on our teeth. If eating before bed, e.g. a bowl of cereal, is a habit, it can have serious consequences for your child’s teeth. Give it to them earlier, make sure it is a tooth friendly food or cut it out.
- Prevent ‘baby bottle/nursing’ decay:
NEVER allow your child to have fizzy drinks, juices, milk or breastmilk in constant contact with their teeth.
Don’t let them sleep with a bottle or feeder in their mouths. Never dip a soother in anything sweet before giving it to your child. Encourage your child to start drinking from a beaker or cup (you can gradually do this from about 6 months old). Don’t forget to brush their teeth after the last feed of the day.
- Ask for/choose sugar free medicines. Your pharmacist and doctor will be happy to help you with this. This is especially important if your child takes regular medication.
- Don’t give ‘sweet treats’ between meals, keep them for just after main meals, and give ones that can be eaten quickly in one go, and not slowly over time. There are sugar free treats available in some stores like M&S and Boots. They contain artificial sweeteners instead of sugar, but they are still a treat and the same rules should still apply to give your child good habits.
- Sugar free chewing gum is great for making saliva: Saliva is great for teeth.
Please read the label, as not all gums are sugar free. It is only suitable for older children, and you will need to tell them how to use it and dispose of it carefully, but it is great to use after a sweet treat to help neutralise plaque acid and remove debris from the biting surfaces of back teeth.
- The older your child is before they are introduced to sweet treats and drinks the better.
This is easier to do with your first child, but hold firm, you are not being a ‘mean’ parent by not giving them sweet treats at a young age. You are protecting their teeth, and they don’t miss what they don’t know. Their ability to appreciate savoury flavours may lead them to healthier food choices later.
- A ‘Diet Diary’ is a good way to assess the tooth friendliness of your child’s diet. A diet diary can also be a very helpful thing to bring along to your child’s dental visit, your dentist can read through it to look for any "hidden-sugar" foods. If your child is diagnosed with tooth decay then your dentist may ask you to complete the diet diary and bring it in so they can give you further advice on a tooth friendly diet. Download Diet Diary and instructions here.
3. Bring your child to visit the dentist regularly, as often as your dentist recommends. Read on...
- ‘First visit by first birthday’ is a good guide but you can bring your child to the dentist as soon as their first tooth erupts. This is what the Irish Dental Association, and all the international dental associations recommend.
Prevention is ALWAYS better than treatment.By bringing your child to the dentist at this young age, and before problems have a chance to arise, we can:
- show you how to clean your child’s teeth properly;
- give you the best advice on your child’s diet for their age (many foods that seem healthy can be very damaging to teeth);
- check for any potential problems that may be there, e.g. early diagnosis can be made of oral disease, developmental tooth defects or perhaps missing or unusual shaped teeth. The earlier problems are found, the better we can plan to manage them. Early advice on soother use & thumb sucking can save on bills for braces later.
- It gives your child a chance to get know and trust your dentist, and helps ‘visiting the dentist’ to become a normal, enjoyable, routine event in their lives.
- Your dentist will advise what is best depending on your child’s needs, but generally we recommend twice a year. People who attend the dentist regularly go on to need much less treatment than those who don’t.
- For very young children and babies, all we seek to do is check their teeth and mouth in so far as they will let us, help them to get used the dental environment (bright lights, shiny instruments and strange smells) and give you advice and demonstration on how to clean their teeth and manage their diet.
- For older children we aim to do the same, and the more cooperative they are able to be, the easier it will be to check their teeth.
- With the exception of a child attending after a dental trauma (e.g. knocking a tooth out) we will try not to do any treatment at the first appointment even if it is the main reason for coming in. The reason for this is that it is very important that we can gain your child’s trust, before we attempt to treat them. Pushing a child into treatment in a situation where they do not feel comfortable can often result in them not wanting to attend ever again. It is very important that your child’s first visit is pleasant. In the event that your child is in pain from a toothache or open cavity, we may opt to give an antibiotic to treat the infection, or place a simple temporary filling first . We request that you bring them back to have the treatment they need at a subsequent appointment, when they are no longer in pain. We find that they are able to accept treatment much more easily in this way.
As we said above, we really want your child’s first visit to be enjoyable and memorable, so a little bit of positive preparation at home in advance is also a good idea.
It is a great idea to read children’s dental books or watch a DVD prior to the appointment.
1. Off We Go: To The Dentist by Avril Webster, Easons Tuam.
2. Peppa pig: Dentist Trip, published by Ladybird, available on amazon.com
3. Going to the Dentist (Usborne First Experiences) by Anne Civardi and Stephen Cartwright
4. Show Me Your Smile: A Visit to the Dentist (Dora the Explorer) by Christine Ricci.
5. Visiting the Dentist:First Visit, Brimax ISBN 978-1-74211-634-1
Just bear in mind when discussing the stories with your child, that not every dentist will follow the same routines or give the same little gifts as in the books. We will give your child a ‘First Visit to the Dentist’ Certificate, stickers and a small toy (when available).
- Our children model much of their behaviour on what they see us do, so If you or an older sibling is attending your dentist for a routine check-up it can be helpful to bring children to watch by way of introduction.
- It is essential that you speak positively about visiting the dentist and don’t expose your child to negativity relating to your own experiences or those of any relatives or friends.
Click here to download Cleaning Chart
Click here to download Diet Diary.
Frequently asked questions:
- ‘Insist and Persist’ technique: If they are very young (from arrival of first tooth into toddlerhood) .
This is the time to gently but firmly institute a good tooth cleaning routine. Brushing at this age should take no more than five minutes, taking into account any manoeuvring you might need to do, because little people get bored easily. Remember to explain, calmly, exactly what you are doing, they understand so much even from a very young age. We suggest that you encourage your child to lay down on a bed or changing table, or lay them down yourself if they are very small (with the help of your partner if necessary to hold the child). Do your best to get as many of the teeth brushed as well as you can.
Be very gentle, talk calmly or sing a song, and praise them for every little bit they let you do. Like many other body-related jobs small children often do not like having their teeth brushed, and there will likely be resistance, with some shouting and even a few tears at first. While this is normal, it’s never pleasant to see your child apparently distressed, (though in reality it’s more likely temper than distress!) But as soon as you have finished they hop up, escape and don’t give it a second thought.
Show them their cleaned teeth in the mirror afterward and tell them how lovely and sparkly they look. In our experience, if you insist and persist with it every day they quickly learn to accept it as part of their daily routine. Soon you have the routine set in stone for the future. Never underestimate the power of example; every little one mimics their carer so let them watch you brushing your teeth regularly. For those of you not convinced, consider which is harder for your child: a few minutes twice a day resisting you cleaning their teeth well, or the pain of an abscessed tooth, visit to the dentist, antibiotic, local anaesthetic, tooth extraction and possibly a referral for general anaesthetic treatment? No contest!Click here to read about our personal experience with this approach.
We used this method with both of our children, and we found that when they were under one they didn’t make too much of a fuss, but when they turned one they began to resist a bit more for a while. We got around the little hands trying to grab the tooth brush off us by giving them a little brush to hold too, letting them brush our teeth while we did theirs. This worked very well with our daughter, but not so well with our son, who preferred hitting us with it! We wrapped him up in a big towel for a while with only his head free, and that worked well. Thankfully, at twenty months, he is now accepting of it. Although he still runs off when he sees the brush coming out, he does let us brush his teeth thoroughly. Once our daughter turned twenty one months, she began to climb up on the changing table and lay back with her mouth open when we got the brush out. It has been well worth the few months of insisting.
- Motivate: (This as a technique you can also apply to any household chores you would like them to do for you!) Use the downloadable reward chart found here and encourage your child to be the active participant in protecting their own dental health. The chart could be customised with stickers or coloured pens. Explain to your child how important it is for them to keep their teeth clean and their diet healthy, they will often surprise you by their enthusiasm to get it right. Set a goal for the week, and agree a reward that is suitable to you both, see reward section for ideas.
- Monitor: Follow the age appropriate advice in the ‘Clean your child’s teeth section. Then once a week use a disclosing tablet or bud to stain the plaque on your child’s teeth, this will show them the areas they can improve on. (Always put Vaseline on their lips first, and note that the disclosing agent will stain clothes and furnishings.) Children find this great fun and will usually work hard to remove the coloured plaque now that they can see it!
- Offer a small reward (not a food or drink), something small but special, (like a trip to the park, more stickers, their favourite T.V. programme), for completion of a full week of good brushing without a fuss. It has to be sustainable, so don’t promise the earth, and then not be able to follow through on it. This usually has great results with children up to their teenage years.
For older children: Motivate, Monitor and Reward.
Contributors: Dr Catherine Vaughan, Dr John Burke, Dr Martina Kelleher, Dr Amita Bhagwat, Ms Hilda Reid. Many thanks to all those who gave time and expertise so willingly.
We really appreciate your feedback, it helps us better meet your needs, improve our services, and be the best we can be! If there is something here that you would like further information on, or like covered in the future, please email us at firstname.lastname@example.org, or telephone 093-60333.