Dental Hygiene for Babies and Toddlers

It is important for children to learn to practice optimal oral hygiene habits from an early age. Training a child regarding the significance of taking care of his or her teeth and gums from the start can help develop a healthy smile that can last a lifetime. Parents should be highly involved with their child’s dental hygiene, however, even before the appearance of the first tooth. Infants are born with their entire set of 20 primary teeth existing below the gum line in the lower and upper jawbones. Consequently, it is possible for babies to develop tooth decay even before the first tooth emerges. Even as the first teeth begin to come through around the age of 6 months, the condition of a baby’s oral health can possibly affect his or her adult smile.

Young Children at Risk For Decay

As soon as a baby’s first primary tooth emerges, the risk for developing cavities increases. Some babies may experience such serious tooth decay that some of their primary teeth must be removed completely due to their inability to be restored to health. This type of situation most often occurs when an infant is consistently put to sleep with a bottle filled with milk, juice, or other sugary drinks. Usually, the upper front teeth are damaged the most under these circumstances, but decay can develop in any other teeth as well.

When a baby tooth is removed or lost too early due to oral decay, accidental trauma, or other reasons, crowding and other spatial problems can occur with the future emergence of permanent teeth. It is advantageous for the baby teeth to be maintained and kept as healthy as possible, because this significantly decreases the risk for decay and incorrect eruption of permanent teeth later on. Therefore, concentrating on optimal oral health in children, essentially from birth, can help establish and maintain a healthy smile for decades.

Preventing Tooth Decay

Through optimal and consistent oral hygiene habits as well as seeing the dentist early and regularly, tooth decay is entirely preventable (in most cases). In its guideline on infant oral health care, the AAPD recommends “an initial oral evaluation visit should occur within 6 months of the eruption of the first primary tooth and no later than 12 months of age.” It is further recommended that, during this infant oral health visit, anticipatory guidance should be provided on the effects of diet on the dentition. This diet counseling recommendation bears merit, since a longitudinal study has shown that 3-year-old children with caries lesions had more frequent consumption of cryogenic foods at 12 months of age. Diet counseling issues remain similar among children of all ages, though certain infant-specific issues do exist. This literature review’s objective was to summarize information pertinent to diet counseling during the infant oral health visit.

Keeping Your Child’s Teeth Clean

With age, oral hygiene practices and routines change and expand. To most appropriately care for your child’s mouth from birth through toddlerhood, consider the following suggestions:

0-6 Months

After every feeding, gently clean an infant’s gums with a clean damp washcloth or gauze pad. Never prop a bottle in an infant’s mouth or let a baby feed “at will.” Also, it is extremely important to never put a baby to sleep for a nap or at bedtime with a bottle. Note that dental decay can be spread from a parent to the child through the exchange of saliva, so parents should not test the temperature of a bottle directly with their mouth. It is additionally advantageous for parents to avoid sharing utensils or washing a bottle nipple or pacifier by putting it in their mouth. This helps in obstructing the spreading of bacteria that causes tooth decay.

6-12 Months

Typically the first tooth emerges when a baby is between 6 and 8 months of age. Continue the earlier advised practice of cleaning a baby’s gums with a clean damp washcloth or gauze pad. After the appearance of the first tooth, switch to lightly brushing the teeth and gums with a soft bristled toothbrush but no toothpaste. Also make sure to continue to very gently massage the gums. Also, as the baby begins to increase his or her consumption of solid foods and drink from a sippy cup, parents should start weaning their child from the bottle gradually. Helpful information regarding weaning and sippy cups can be found below.

It is also crucial to keep track of what the normal appearance of a child’s gums and teeth look like. The parent should frequently look for new brown or white spots on the teeth, which may denote tooth decay. If any strange or new spots of this type appear, immediately contact the dentist for an appointment.

At this stage, the parent should schedule the child’s first dental appointment, and as mentioned the AAPD recommends a child see the dentist no later than their first birthday. Also, it is a good idea to ask the dentist about infant fluoride supplements if the household’s drinking water is not fluoridated.

12-18 Months

A child should receive an oral examination from the dentist by 1 year of age. At this point, the parent should brush the child’s teeth for them with plain water only twice daily. The parent should also continue avoiding any transfer of decay-causing bacteria to the child by abstaining from any habits that transmit saliva, like sharing drinks. Also, as in the previous stage, keep frequently checking the child’s mouth for irregular brown or white spots, which may demonstrate evidence of tooth decay. Immediately make an appointment with the dentist if any such spots appear.

18 Months-5 Years

Around the age of 24 months, parents should begin brushing the child’s teeth twice daily with a pea sized amount of fluoridated toothpaste. The child should be taught not to swallow the toothpaste and to spit all of it out after brushing. Toddlers usually need help brushing their teeth until their hand coordination becomes more developed, but the parent should begin teaching them at this stage how to brush their own teeth. Most children should be able to brush their own teeth without supervision by 6 or 7 years old. Keep in mind that too much fluoride can cause tooth staining. When your child has two teeth that touch, you should begin flossing their teeth daily. Most children have their full set of 20 baby teeth by 30 months, and by 3 years old they should no longer be using pacifiers or sucking their thumbs/fingers. Parents should consult the dentist if the child is having a hard time giving up these habits by 3. Always remember to continue to regularly check for suspicious brown or white spots on the teeth that may denote cavities, and anytime irregular spots appear in the child’s mouth, an appointment should be made with the dentist immediately. At this stage in a child’s life, he or she should also be regularly visiting the dentist for cleanings and check-ups, on the schedule recommended by the dentist.

Other Infant Oral Health Information and Recommendations

Breast Feeding

The AAPD has endorsed the AAP’s policy on breast-feeding. The AAP recommends breast-feeding as the ideal method of infant feeding, with exclusive breast-feeding for the first 6 months, followed by the addition of iron-enriched solid foods between 6 to 12 months of age. It has been observed “infants who were fed breast milk more than infant formula, or who were breast-fed for longer periods, had a lower risk of being overweight during older childhood and adolescence.” The AAPD suggests “ad libitum nocturnal breast-feeding should be avoided after the first primary tooth begins to erupt.”

Bottle Feeding

Contrary to the AAP’s breast-feeding recommendation, many infants in the United States are not being breast-fed. Only 1 in 4 U.S. infants is breast-fed at 6 months of age. Bottle-feeding, therefore, appears to be the predominant method of infant feeding, with about 95% of 6-month to 5-year-old children having used a baby bottle. Infant formulas are acidogenic and possess cariogenic potential. Therefore, parents need to be made aware of the deleterious effects of inappropriate bottle usage and the need for good oral hygiene practices upon the first primary tooth’s eruption. Parents should be counseled against putting their children to sleep with the bottle.

Weaning

The AAP suggests that infants be breast-fed for at least 12 months and “thereafter for as long as mutually desired.” It has, however, been observed “breast-feeding for over 1 year and at night beyond eruption of teeth may be associated with Early Childhood Caries.” A similar relationship between dental carries and prolonged baby bottle use beyond 12 months of age has been suggested. It has been further reported that approximately 8% of 2-to 5-year-old US children continue to use the bottle. Pediatric dentists should counsel parents to follow the AAPD’s suggestion that infants should drink from a cup as they approach their first birthday and be weaned from the bottle at 12 to 14 months of age.

Sippy Cup Tips

To reduce the risk of cavities, please read the following:

The sippy cup is designed to be a training tool to help children transition from a bottle to a cup. It should not be used for a long period of time. The sippy cup is not a bottle and it is not a pacifier.
Unless being used at mealtime, the sippy cup should be filled ONLY with WATER. Remember, frequent drinking of any liquid from a bottle or no-spill training cup should be avoided, even if diluted.
Schedule regular visits with your pediatric dentists to help keep your child cavity-free.

Fruit Juice Consumption

The AAP suggests that infants should consume only 4 to 6 oz of fruit juice per day, representing 1 food serving of fruit. Infants should be encouraged to consume mashed or pureed whole fruits. The possibility of sugars being added in commercial preparations should be considered. The AAP cautions “fruit juice offers no nutritional benefit for infants younger than 6 months. Malnutrition may be associated with excessive fruit juice consumption. Also, juice drinks that are reconstituted from concentrate may have added sweeteners.

It has been observed that “juice and juice drinks appear to replace formula and milk intakes during the transition stage of infant nutrition” from 6 to 24 months of age. Nine out of 10 children have consumed fruit juices by 1 year of age.

Other Recommendations

Infants older than 6 months and with exposure to less than 0.3 ppm fluoride in their drinking water need dietary fluoride supplements of 0.25 mg fluoride per day.
Parents should be advised to reduce their child’s sugar consumption frequency.
Infants should not be given powdered beverages or soda pop, as these drinks pose increased risk for dental carries.
Only iron-fortified infant cereals along with breast milk or infant formula should be given to infants who are older than 6 months of age. Cow’s milk should be completely avoided in the first year of life and restricted to less than 24 oz per day in the second year of life.
Parents should be counseled on the potential of various foods that constitute a chocking hazard to infants.