It is a privilege to welcome Dr. Gator to Angel at Home this week. Dr. Gator is the 1 dentist the other 9 warned you about.
I know that oral health is something I struggled with as a kid. My mother never took it seriously and I suffered for it. As an adult I had a lot of learning and work to do to get my smile where it is today. I now know how important it is to have excellent home care with my teeth, and I work on teaching my kids the same!
Dr. Gator provides us with tips on establishing good habits in the following article. Enjoy!
DISCLAIMER: Let me start by saying that I am not a parent, so there will only be a basic level of understanding I have to the struggles that parents face with their children and oral hygiene.
Oral hygiene is a critically important aspect of your child’s health. Tooth decay in children was the number one cause of hospital admissions in England. It is a completely preventable disease (yes, it’s a disease), and it all starts with you, the parent. While I am not a pediatric dentist, I have worked with many children and parents to devise a routine that works. It may not be infallible, but it should provide a basic introduction to getting your kids to understand the importance of oral hygiene.
Creating a strong foundation that will allow your children to take care of their teeth will save you a lot of headaches, money, and time. Dental treatment is not perfect and it can become costly. The best investment you can make in your child is to create a routine that will promote healthy, mineralized teeth without decay and infections. They will thank you later, trust me. Every adult I know with perfect teeth say they “LOVE THE DENTIST” and can remember oral hygiene being a very important part of their upbringing.
“The Dental Timeline”
Depending on the age of your children, you may be facing different hardships and dilemmas. Before I begin speaking to the common pitfalls many parents face, let’s go through a general guideline of milestones in a child’s development and where oral hygiene fits in:
Newborn (0-6 months)
Shortly after birth, despite the child having no teeth you can begin to habituate them to having their personal space invaded by washing their gums with a clean and damp washcloth after each feeding. While not necessary, this can help establish good oral habits early. If you don't do this, it doesn’t mean that you’re setting your baby up for dental problems in the future, but cleaning some debris is an additional bonus to the behavioral component. It helps establish a good framework for healthy microbiome when done properly, but most importantly it signals to the child “hey listen, we keep the mouth clean and I’m gonna get in there ok?” so that when they have a bit more personality this isn’t a new concept to them.
Infant (6 months - 3 years)
Around the 6 month mark, you will start to see baby teeth poking out of the gums. You can take an extra soft toothbrush with or without toothpaste (if you’re going to use toothpaste, only use an amount equivalent to the size of one grain of rice sized. You can visually inspect the child’s teeth for any strange observations (brown/black spots) and you can bring your child to the dentist if anything concerns you.
Children Ages 3-5
This is where you want to start incorporating a regular and “adult” brushing and flossing routine. A helpful angle may be to include the child in the decision making process (which toothbrush does he/she like, which flavor toothpaste, etc) to give them a sense of ownership of the process. Don’t beat yourself up if you can’t get them to brush for a full two minutes or if flossing is out of the question, but definitely aim for morning and nighttime brushing. Going to the dentist for a well visit at this point is a personal preference, it can establish a good framework for the child to experience a dentist and dental office, but you can make this decision for yourself. If I had a child I’d probably take my child to the dentist once a year at this stage in their life.
Children Ages 5+
When the child reaches the age of five or six is typically when we want them to take on the responsibility of oral hygiene into their own hands. Again, this is a framework not absolute numbers. If you’re child is 7 and you still need to monitor, don’t beat yourself up about it. It’s advised to take your child for bianuual cleanings at the dentist at this stage in the child’s life, despite having a mouth mostly filled with baby teeth that will fall out. The logic behind this is that shielding your child from the dentist will only exacerbate the potential for having severe dental phobia. I recommend you find someone who is great with children, as the skill of the dentist is not so important in this phase.
“Ok but Gator, this is all fine and dandy but my kid doesn’t listen to me and won’t brush his/her teeth by himself, and won’t let me help him/her”
Yes, this is one of those things. It happens. There are tricks and tips I can give you, but that won’t take away from the fact that this is one of those difficult aspects of parenthood. Here are some things that can help if you’re having difficulties:
Starting early is the number one thing that will help you. Hands down, no contest. I see it over and over again. Following the above guidelines will ensure that your child will be open to brushing and flossing when they are toddlers and have a bit more personality. However, this is an unhelpful tip if you’re already telling me that you’re having a difficult time, leading me to the remaining tips.
Visual distractions. There are the classic hourglass timers, toothbrushes that light up and make noises, and the ever popular Brush Along Youtube videos. Brush with your child, play music, put on the tv. Anything to get them to mindlessly brush their teeth while their attention is on something a bit more stimulating.
Get creative with story telling. I have a patient with young kids that had success with telling a mildly “scary story” about the bugs crawling on their kids teeth and she uses a flashlight to “see” them. Once the flashlight comes out they are very quick to grab the toothbrush get rid of the pesky bugs. Children are extremely imaginative, use this to your advantage to incite intrinsic motivation.
Let them brush your teeth. I know this sounds crazy, but parents have reported this being a hilarious way to engage the child into having fun with oral care. I’d advise you to brush your own teeth afterwards though, haha!
Bring the attention to things outside of their own mouths. Some patients of mine have told me they bring up brushing their kids stuffed animals teeth as a playful exercise to create a general awareness of the need for oral hygiene.
Rewards. I’m torn on this one because I think it gamifies the brushing game too much and creates a faux extrinsic motivation. Once that reward disappears what happens then? You can experiment with different rewards whether it’s a sticker, iPad time, etc. I put this one last on the list because it’s my least favorite, despite it’s effectiveness.
When to help, when to let them take over
Letting children take the reigns on their oral hygiene is a tough balancing act. On the one hand, you want to grow their independence and slowly reduce the endless list of supervised activities, but on the other: kids can deceive. They will tell you they brushed their teeth when they didn’t, they will do a rush job, and they won’t care as much as you do.
The general rule of thumb to let your kid hop in the oral hygiene cockpit is 6 years old. Some children may have the dexterity and motivation to do this sooner, and others may lag behind. Wherever your child is, support them until they can take on this task with pride. The entire goal of this endeavor is to create a sense of ownership in the child so that they WANT to keep their teeth clean.
Dietary Challenges
Now, before we put the cart before the horse there’s something super important here that we haven’t discussed: diet.
No matter how much of a brushing star your child is, he or she cannot brush their way out of a bad diet. The same rings true for adults. Think about it, you are awake for 16 hours of the day, but you are only brushing for a few minutes in the morning and evening. There is no possible oral hygiene routine that can out-compete with a bad diet. A general rule of thumb is that. “Paleo” style diets (AKA avoiding processed foods with a focus on natural sources) tend to promote great oral health. Sugar and acid are the number one killers of teeth. It’s not my intention to turn this into a diet post, but it would be unfair to write this without mentioning it.
Here are some major red flag snack foods to avoid:
Goldfish
Juice
Soda
Cookies
Crackers
Baby bottles
Raisins
Candy
Here are some alternatives that are kinder to the teeth:
Carrots
Cacao nibs
Monk-fruit sweetened products
Yogurt
Celery with peanut butter
Hard boiled eggs
Frozen fruit
So there you have it, a nice and clean looking template for you as a stressed out parent to tick off "oral hygiene” from your endless to-do list. Just kidding, I am acutely aware that writing this post is infinitely easier than putting the content above into action. It’s not for the faint of heart. You will have missteps, you will have arguments, there will not be this straight linear path to oral hygiene autonomy with your child. That is OKAY. Focus on each day at a time, make sure there is a general improvement month to month and year to year without sweating the obstacles along the way.
I hope this was helpful, and as always you can reach out with any questions you may have.
With love,
Gator
Thank you Dr. Gator for your insight! Dr. Gator can be found on Twitter @BowTiedGatorDDS and on his Substack, Tooth Wisdom.