A few things about brushing teeth…

Parents seem to have multiple questions about brushing teeth. Some of the common ones are:

  • When should I start to brush?
  • How do I brush when they won’t let me?
  • When can I let them brush on their own?
  • What about fluoride toothpaste?
  • What is the preferred method for optimum plaque removal?

These are great questions! … And I’m sure that they can, and do, receive multiple and varying answers, that quite possibly conflict. Some people answer on a scientific basis, some answer on a historical perspective, and others just simply make stuff up.

I’ll give you my view. I like a science-based view, with some common sense involved

When should I start to brush?

You should start to brush as soon as you can. This means, even before your child’s teeth erupt. When the teeth appear, you and your child should already be in the habit of brushing.

Some professionals will advocate for a toothbrush, some will say you should wipe the teeth with a towel, and some will ask you to use something entirely different. It really doesn’t matter what medium you choose, as long as you are attempting to mechanically move the plaque off of the teeth and massage the gums.

Brushing the teeth is much more important than what you use to do it. Get started as soon as you can! Just remember that a soft toothbrush/towel/etc. is mandatory. You can leave the steel wool for the golf clubs. :)

How do I brush when they won’t let me?

Almost all parents come in and say, “my child won’t let me brush the teeth,” or “it’s a fight every time we brush.” This is NORMAL, well at least at my office.

Kids are not small adults. Kids don’t always understand why we do what we do. If a child goes to dart into traffic and you grab their shirt, they most likely won’t like the fact that you grabbed them. They will get mad. They will cry. They will fail to understand what your actions are accomplishing.

Yes, it would be nice for children to go along and brush their teeth properly without a care in the world. However, much like eating your vegetables, good for you doesn’t always translate into doing with a smile…

Sometimes kids require a tag team approach. A knee-to-knee set up allows for control of the child in a safe manner, as well as for direct views of both arches (the upper and lower jaws) by one brusher or the other.

If you’ve been into the office, then you know that sometimes this is the only way to accomplish a dental exam. Some kids are just difficult when they are younger. Most will realize that you are helping them and they will stop fighting, but some won’t. It depends on how committed you are to keeping their teeth spotless.

When can I let them brush on their own?

“He wants to brush by himself, so I let him”…

We get this a lot at the office. Kids, especially around 4-5 years of age, wish to be independent. It doesn’t mean that they can be. Most children at that age lack the manual dexterity to be able to clean their teeth properly.

I used to say, “when you child can sign their name in cursive, then they’re able to have the dexterity to brush”… then the Ministry of Education went and cut cursive writing. So…

The new line used is, “you can turn over brushing to you child when YOU are comfortable having them brush YOUR teeth.”  This is usually quickly followed by a laugh, while the parent comments something to the effect of they would “never trust their little one to clean the parent’s teeth.”

If they can’t take care of YOUR teeth, how can they possibly look after their own?

Yes, it is important to promote independence. However, if your child cannot handle the responsibility of cleaning their teeth properly, it isn’t fair to become upset with them when they fall short and cavities develop.

My preference is to have parents floss first and brush second. If the child then wants to make sure that their parent did a great job and then mimic with the toothbrush, that’s awesome!

What about fluoride toothpaste?

This is a great question, and the answer has changed in the last little while. You’ll hear people talk about the ability to spit as the guideline for when to introduce fluoride toothpaste. Well, I have 9 year old patients that can’t spit (and some grandparents that can’t either!). While these individuals may never have a career as a professional baseball player, that doesn’t mean that they can’t take advantage of the benefits of fluoride toothpaste.

The new recommendation (AAPD, CAPD, ADA, CDA) is for fluoride toothpaste to be introduced at 2 years of age.

Now, please understand, fluoride needs to be treated as a drug. I’m sure you wouldn’t turn over the bottle of Tylenol to you child and just let them have at it. Use of fluoride needs to be supervised. And remember… you don’t need a lot of toothpaste.

I love how pretty the toothpaste looks on the commercials ~ the big swoosh looks amazing… and it’s enough toothpaste for a week! A smear on the brush is enough. You don’t need a lot of toothpaste. Please see below for a picture of what I’m talking about. USE LESS, but do use it. It does help to prevent the teeth from forming cavities.

 good1

A smear

too much1

Impressive… but simply too much

What is the preferred method for optimum plaque removal?

Answer: modified Bass technique. (Now you too can pass a random question on the Canadian Dental Exam board). Translating into useful language, it means to make circles with a SOFT toothbrush and after a few circles, brush away from the gum line. I don’t care if you’re from New Zealand and make your circles in the wrong direction :) … Just be sure to make them.  

That’s it.

Brush those teeth two or, dare I say it, THREE times a day.

  • With a smear of fluoride toothpaste on a soft toothbrush
  • Knee to knee if you need to
  • Using the modified Bass technique

Your children will thank you (maybe not right away, but at some point).

Your dental assistant will thank you.

Your dental hygienist will thank you.

Your dentist will thank you.

Prevention is better than treatment. Fight those sugar bugs… and floss on days that end in “y” :)

 

References

Policy on Use of Fluoride. American Academy of Pediatric Dentistry (2014).
Retrieved from http://www.aapd.org/media/Policies_Guidelines/P_FluorideUse.pdf

 

Fixing Baby Teeth

Well, I think we skipped Spring and Summer has decided to appear!

Some parents hold off on taking their children to see a dentist until the age of four or five.  They go in for the exam and cleaning and are told: “Timmy has a cavity.”  The next question asked is:

Why are you going to fix a tooth that is going to fall out?

Primary teeth (baby teeth) are an important part of your child’s smile.  They assist with the growth and development of the jaws,  they help with chewing and speech.  They do have a tendency to fall out, but not always ;).

Primary teeth normally start to fall out at age 6 or 7.

 

BUT THIS ISN’T TRUE FOR ALL PRIMARY TEETH!

 

Posterior teeth (the molars, the ones in the back that get food stuck in the grooves) are present until 10-13 years of age.   If the cavity has been diagnosed at 4 years of age, it’s fair game to say the tooth won’t last until it’s supposed to fall out.  We are left with a few problems:

1. There is an active bacterial infection causing destruction of tooth surface.
2. There is loss of tooth structure, which leads to movement of other teeth.  This movement is often in ways that interfere with the eruption of other teeth.
3. There is alteration of bone growth due to early loss of tooth structure or the entire tooth.

And therein lies the problem.  The job of the primary teeth (besides smiling, chewing, helping with speech and being difficult to clean) is to maintain space for the permanent teeth.  The cavity holes allow other teeth to move into that space (think: general admission seating at a rock concert).

By not staying in “their allotted space,” this loss can lead to other issues, such as crowding, inability of teeth to erupt….. ORTHODONTIC BILLS :)

 

Primary teeth should be fixed to:

  1. Eliminate pain or the potential for discomfort
  2. Maintain space for the adult teeth to erupt
  3. Remove bacteria from the mouth

Hopefully, this helps answer the question.  I’m sorry if any Timmys were harmed in the making of this blog post (it wasn’t my intention).  However, the better question is:  “how do I avoid cavities?”  Speaking to your dentist is the best way to gather info.  Early is better.  Remember…. Year 1 visit!

Year One Visit

So, I have a question for you….

It is all too common:  regardless of when or where, people routinely have questions that they would like to ask professionals.  However, sometimes the professional setting is too intimidating.

With this in mind, I hope to answer some of the questions that come up over and over again.

Question #1:  At what age should I bring my child to the dentist?

And the answer is…..

 

One

Uno

 

It doesn’t matter how you say it, spell it or count it –  your child should be in to see a dentist by the age of one.

“WHY? My kid doesn’t even have all of their teeth, so why do they need to see a Dentist?”

Short answer – they don’t have cavities!

The main objective of the YEAR ONE VISIT is to AVOID cavities. 

 

Can’t a dentist fix cavities?  

Of course!  However, the goal is to avoid them and to keep all teeth cavity free.

If a dental practitioner says you don’t need to bring your child in that early for dental care, it may simply be that they do not see kids that early.  Keep trying!  It’s worth your effort! 

Remember, the objective is CAVITY FREE, not “out of pain”

 

Now for the disclaimer: 

Sometimes, age one is not soon enough.   A rule of thumb:  your child should have their first dental visit within six months of their first tooth eruption.  For example, if your child’s first tooth is in at three months, it is best to aim for nine months. 

Here are some of the goals of the year one visit:

      • Have a dentist look in the mouth to check development, eruption and sequencing of teeth
      • Discuss diet concerns, fluoride, tooth brushing, and family history of dental work.
          • It is important to acknowledge that each child is unique and therefore may have different dental issues from other members of their family

 

Don’t worry if your child doesn’t go for a chair ride, there will be lots of time for that throughout their lifetime .

The year one visit is less about your child and more about YOU.  As your child doesn’t buy toothpaste or cook their own food and, generally speaking, has a very limited knowledge of how to brush their teeth (there are advanced kids out there :) ), it’s more important that YOU, the parent, has the individual knowledge to deal with the day to day oral care of your child.  Cavity free is the goal and the year one visit is the first step in achieving it! 

Remember, only brush the teeth you want to keep on days that end in “y”…