The American Academy of Pediatric Dentistry is now recommending that infants see a dentist before their first birthday, or shortly after the first teeth erupt. This may seem early, but it is for good reason. Poor oral health and dental decay are all too prevalent in young children and can be cause of significant pain and suffering. Baby teeth serve important functions in chewing, language development, and as place-holders for adult teeth. An early visit to the dentist can help catch any cavities and offers an opportunity to discuss dental care and fluoride needs. Practically speaking, I encourage parents to at least get to the dentist between the first and second birthday.
I took my son to his first dentist appointment around sixteen months of age. I wasn’t quite sure what they’d be able to accomplish at this age, but the appointment itself went better than expected. I was settled into a comfortable reclining chair with the little guy in my arms. A video about trains played on the ceiling television. A dental hygienist reviewed his teeth for plaque build-up with a pink disclosing solution. She brushed his teeth. She took our picture. And, at the end of the visit, we received a little bag with a toothbrush, toothpaste, and an egg timer.
At the time, I didn’t give it much thought. We had started brushing his teeth and gums 2-3 times per day around five months of age and it had never been a big deal. I was sort of proud that he actually seemed to like it. Then, toddlerhood hit. Suddenly, opinionated and independent, little guy’s favorite word is “self”. . . meaning, I will do it myself. He’s quite serious about it. This includes brushing his teeth. Of course we let him “try”. He sucks on the non-fluoridated toothpaste a little, and moves the toothbrush around a little, smiles, and then he’s done. And, I have talked with a lot of parents of toddlers who tell me the same. I advise them to try a washcloth with water, the “finger glove” toothbrush,or an age appropriate soft-bristle toothbrush and see which works best. Have a parent or sibling brush their teeth at the same time to encourage them. Distract them. Stand in front of a mirror. Sing. Say ahh. Let me tell you, we’ve tried them all. The finger toothbrush worked for a while, until he started resisting by chomping down and not letting go.
The other day I was going through some things and ran across the egg timer from the dentist. I figured out it is a two-minute egg timer. I couldn’t help but laugh out loud. A two-minute timer. Have these people ever tried to brush the teeth of a toddler? At this point I’m lucky if I get one good swipe at each area in his mouth. And, I worry about it. I really do want him to have good dentition. So, after a bit of reading and thinking, here are a few tips for avoiding cavities and tooth loss in toddlers who resist brushing their teeth.
- Get rid of the bottle. Both the AAPD and the AAP recommend weaning from the bottle by one year of age. Carrying a bottle of milk (or worse, juice) around and sipping from it periodically exposes teeth to a constant sugar source. Kids should drink milk or water from a cup at mealtimes. In between meals, water is your best bet. No bottle propping or milk in bed.
- Get rid of the juice. There is really no need to give your toddler juice. And, definitely don’t give juice or soda in a bottle. Stick to whole fruits at snack/mealtimes and water in between.
- Minimize grazing and avoid sticky, starchy snacks. Try to stick to a feeding schedule and minimize between time snacking. Intermittent snacking increases the amount of time teeth are exposed to carbohydrate/sugar, which leads to increased risk of cavities.
- Give a fluoride supplement, if appropriate. Check with your dentist or pediatrician to determine if your water source has adequate fluoride to protect against caries. If not, your child may need a daily fluoride supplement.
- Brush with soft bristle brush and toothpaste 2-3 times daily. Non-fluoridated toothpaste is best until your child is able to spit, not swallow, the paste. I go for three times daily, figuring that we up our odds of getting at least one good brushing.
- Creative tips for brushing
- Allow them to brush first and then take turns.
- Create games (the toothbrush is searching for something, the toothbrush is tickling their teeth, etc).
- Brush while reading a book or singing a song. Pick a specific “tooth-brushing song”. When the song is over, they are done.
- Brush while counting. When you get to a certain number, they are done.
- Go to the store and allow them to pick out a “special” toothbrush with a color or character that they like.
- Have sibling or parent brush teeth at the same time.
- Stay positive and upbeat about it. Like all things toddler, the more they “have to do it”, the more they may resist.
Okay, readers, I’m all ears. Please send some more tips my way. How did you get a reluctant toddler to allow you to brush their teeth? When did you first take your kid to the dentist? Other thoughts on saving those pearly whites?
Future Nemesis
My Two Hats 
Great topic. This one is always a challenge. We brush and floss on the bedroom floor at bedtime, in between and sometimes during book-reading. We definitely don’t get two minutes, but aim for as long as possible with a lot of cajoling and pleading. One dental topic that continues to confuse me is the topic of partial fluoridation in the Bay Area. Have you found any good resources on amounts of fluoride in different areas?
Great question! I already have this on the list for future posts. It is crazy as a pediatrician to try to figure out who is living in fluoridated areas and who isn’t in order to know whether to prescribe a fluoride supplement. It is unfortunately a political issue- cities save money by not fluoridating. San Jose is the largest city in the US (that I’m aware of) that doesn’t fluoridate. The easiest way to know whether your water is fluoridated is to call the contact number on your water bill. The CDC has information on some areas here. The State of California has some information here, but it is not complete.
We took my son to the dentist when he was a little over 1 years old, though it was easier to remember since Grandpa is a dentist too! We’ve gone every 6 months now and will go back next week. He’s big enough now to sit in the chair by himself, yet he looks so small sitting there!
We also came up with games as my son got to his toddler years. We tried to explain that his teeth were dirty and needed to be cleaned before bed and in the morning, but of course he didn’t understand, so somehow we came up with a game that “slugs and snails” were in his mouth and we had to brush them out! It was a fun game to “look” for a slug here and a snail there, and the next thing you knew, we had brushed his whole mouth!
We also started with an electric toothbrush from an early age–more brushing in less time, though we still aimed for 1-2 minutes. This worked for about a year or so, and we also started counting as we brushed each tooth, brushing each side and counting slowly to 25 (we added an extra 5 to make it as long as possible). From 3-4 years old, we’ve used an electric toothbrush that has a timer on it. It’s not a kid-specific toothbrush, just an Oral-B one, but the head of the toothbrush is smaller than his Disney electric one and much more manageable. It makes a noise at 2 minutes, so we keep brushing until the toothbrush “tells” us to stop. We haven’t let him brush his own teeth yet, and it’s a fun game for him to choose whether it’s Mommy or Daddy who brushes each morning or night (and it tends to be whomever is busier with another task—a great way for him to become the center of Mommy’s or Daddy’s attention!).
It’s interesting that a number of people have had luck with the electric toothbrushes. Maybe the kids like the sound/movement and that it “tells” you when to stop? Will have to try that out soon. Thanks for your thoughts!
We also had a game we started when my daughter was about a year old to see if we could get all of the octopuses out of her mouth. It worked wonders! I’d look for the big and small ones, and find different coloured octopuses hiding between her teeth. This also helped in learning to spit the toothpaste out eventually. (I would loosen up the octopuses and she had to spit them into the sink, so they could go “home” to the ocean – Finding Nemo-style). I also had her make sounds like “pizza-aaaaah” and “cheeeeeeese” to help me get at the different teeth. Also sang the Raffi song – “you brush your teeth” which has counting in it and is pretty fun.
Now that she’s four, she has a couple of toothbrushes she can pick from when its time to brush. She loves her electric toothbrush and was so proud to be able to pick it out at the store. She sometimes takes a turn brushing first and then we do another pass at it afterwards. But I agree, two minutes seems like an eternity when you’re in a struggle with a toddler, or trying to cajole them into something!
Octopuses, so creative! I love it. The Raffi song sounds great too- will look for it. Thanks for the great ideas!
When David was at the dentist himself, he got a tip from the dental hygienist that totally turned things around for us. She said that she always brushed her kids’ teeth while they were lying down. That seemed like it would never work. But it totally did! For the moment anyway, our 17-month old stays much calmer and will let us fish around in there for a lot longer lying on his back on the floor between our legs than he ever did any other way. Who knows, maybe he likes looking up at us from that weird perspective. We sing while we’re brushing, too, and let him brush our teeth at other times.
Thanks for the suggestions! Great idea to let him brush your teeth too. A good way to make it seem “normal” for someone else to brush their teeth.
Many people are waiting too long to begin dental care for their children. Twenty percent of children have their first cavity before age five, and many have more than one cavity-50 to 70 percent of children will have at least one cavity in their grade school years. We, as adults, know the importance of proper dental care, but it is important that we apply this information to our children as well. Proper dental care can begin before an infant gets his/her first tooth.
I could not agree more!! As a pediatrician, I see kids with poor dentition every day. Trying to get the word out as much as I can about the importance of primary prevention of dental decay, even for “baby” teeth. Thanks so much for visiting and for your thoughts.
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