Oral hygiene education

Children's Dentistry

When should my child have their first dental appointment?

Children should have their initial dental check up by their first birthday.

This will allow us to monitor your child’s dental health and development from a young age, and provide them with proactive and ongoing management of their dental health needs.

How important are baby (primary) teeth?

It’s a misconception that baby (primary) teeth aren’t as important as adult (permanent) teeth. Even though they eventually fall out, they are still extremely important for your child’s developing oral health and overall wellbeing.

Baby teeth are important because they:

  • Play a vital role in the proper alignment and spacing of adult (permanent) teeth. Baby teeth hold space in the jawbone to guide adult teeth into the correct position, and on a straight angle, when they erupt. When a baby tooth is lost too early, adult teeth can drift into the empty space when they erupt which can cause crowding and/or crooked teeth.
  • Assist in stimulating the normal development of the facial structure (bones and muscles).
  • Assist in the development of correct speech and pronunciation.
  • Ensure your child receives adequate nutrition (by being able to chew a variety of foods effectively).
  • Ensure your child is digesting food properly (by being able to break food down into small enough pieces).

Tooth decay is the main reason that children lose their baby teeth too early.

How to properly care for your child’s teeth

Babies:

Use a damp washcloth to clean your baby’s gums daily by gently rubbing them.

As soon as the first tooth erupts, begin brushing them daily. Use a soft, child-sized toothbrush with only water. This can be easier if your baby is laying on your lap or on a bed. Gently brush each tooth and massage the gum using a soft, circular motion.

Do not use toothpaste.

Visit a dentist before your child’s first birthday.

 

Toddlers:

Brush your toddler’s teeth twice daily with a soft, child-size toothbrush. This can be easier if your baby is laying on your lap or on a bed. Gently brush each tooth and massage the gum using a soft, circular motion. Parents should be doing the brushing (not the child).

From around 18 months of age you can begin brushing with a child-strength fluoride toothpaste. Only use a pea-sized amount on the toothbrush. Ensure the toothpaste is specifically for children. Young children should not use adult-strength fluoride toothpaste as they tend to swallow rather than spit out excess toothpaste.

Once teeth start erupting adjacent to each other, floss the teeth that touch each other daily.

Try and make brushing a fun and positive experience. For example, you can play a song, use an appropriate smartphone app, or use a timer to remember to brush for the recommended two minutes. You can also find a toothbrush or toothpaste with a beloved TV character on it.

 

Children (less than 6 years):

Continue brushing the teeth twice daily with a soft, child-sized toothbrush. Parents should be doing the brushing (not the child) to ensure the process is effective.

Continue to use child-strength fluoride toothpaste, in a pea-sized amount.

After brushing, have your child spit out the excess toothpaste (not swallow it), but don’t rinse their mouth with water. This keeps the teeth protected longer.

Parents should floss their child’s teeth daily.

 

Children (over 6 years):

Continue assisting your child with brushing and flossing their teeth until they are around 8 or 9 years of age. Even then it’s a good idea to continue supervising them when they brush and floss.

Use adult-strength fluoride toothpaste.

After brushing, have your child spit out the excess toothpaste (not swallow it), but don’t rinse their mouth with water. This keeps the teeth protected longer.

What toothbrush to use?

The toothbrush should have soft nylon bristles and a small head. Specific brushes for infants and children are available. The toothbrush should be able to reach all the teeth easily.

A good ‘softness’ test is to brush the bristles along the skin on the inside of your wrist. Don’t use any toothbrush on your child’s gums that isn’t soft enough to use on this area.

What toothpaste should children use?

Children six years and under should use a pea-sized amount of specially formulated children’s toothpaste with lower fluoride content. Children should be encouraged to spit, not swallow toothpaste after brushing.

Any normal fluoride toothpaste should be used sparingly with no more than a pea-sized dab on the toothbrush, under supervision to make sure it is spat out.

This is because unlike fluoride in water, fluoride in toothpaste is only meant to work topically. While fluoride is important for healthy strong teeth, children who ingest excessive amounts of it (rather than spitting toothpaste out) when their permanent teeth are still developing under the gums can develop a condition called fluorosis.

Fluorosis

Dental fluorosis (the mottling of tooth enamel) is a cosmetic condition that affects the teeth. It is caused by excessive exposure to fluoride during the ages of birth to 6 years, when the permanent teeth are still being formed under the gums. This is mainly caused by children swallowing fluoridated toothpaste and not spitting it out.

Symptoms of fluorosis range from tiny white spots or streaks that may be unnoticeable, to dark brown stains and rough or pitted enamel. These stains are ‘intrinsic’, meaning they can’t just be polished off by a dentist.

The best way to prevent fluorosis is to supervise children when brushing and ensure they spit the toothpaste out and don’t swallow it.

Children under six should use specially formulated children’s toothpaste which has a lower fluoride content.

Preventing tooth decay in baby (primary) teeth

The enamel of baby (primary) teeth is less densely mineralised than the enamel of adult (permanent) teeth, making them more susceptible to tooth decay. Tooth decay is the main reason that children lose their baby teeth too early, and it is largely preventable by good oral hygiene practices and a healthy diet.

Brushing and flossing your child’s teeth daily is important to prevent them from getting tooth decay. However, managing their diet, especially their snacking habits and how much sugar they consume, is also an important factor in helping to prevent tooth decay.

Tooth decay occurs when foods high in sugar and refined carbohydrates (which break down to starch and then sugar) are consumed. Bacteria in your mouth feed on these sugars and in turn produce acids that attack the outer layer of the teeth (the enamel). This does not only mean processed foods like lollies and soft drinks, it also includes foods high in natural sugars and starches. This is known as an ‘acid attack’ and results in the demineralisation of your enamel and can cause tooth decay.

Saliva provides a natural defence mechanism to help prevent tooth decay, by neutralising the acids produced by bacteria through a process called remineralisation. Saliva also helps to wash away some of the sugar and food particles in your mouth. This ‘attack and recovery’ process occurs every time you eat and drink. However, if you frequently consume sugary food and drinks, saliva may not have time to remineralise the teeth properly after each ‘attack’.

So, tooth decay is caused by how frequently your child snacks, as well as how long their teeth are exposed to sugars.

We are not saying to never give your child sweet treats, however you should limit their consumption of sugary foods and foods high in refined carbohydrates.

If you do give your child a sugary snack, it’s best to do so as ‘dessert’ immediately following a meal. This is because there is usually increased amounts of saliva in the mouth around mealtime, making it easier to wash food away from the teeth. You should also offer your child water to drink afterwards to further help wash sugary particles away from the teeth.

The frequency of snacking is also far more important than the quantity consumed. If you are going to give your child sugary foods or drink, your child is better off consuming them in one sitting, rather than snacking on them continuously throughout the day. Time between meals allows saliva to wash away food particles that bacteria would otherwise feast on, and remineralise the teeth. Frequent snacking on the other hand, provides a constant sugary food source to feed the bacteria. This can lead to plaque, which can cause tooth decay.

Some of the worst sugary snack choices are hard lollies such as lollipops and sticky substances such as caramels, as they are sucked over a long period time or stick to the teeth easily. This causes sugar to linger on the teeth longer, rather than being washed away.

Be on the lookout for tooth decay

You can easily check your child’s teeth for tooth decay by lifting their top and bottom lips so you can see their teeth. Look for white patches, which are the warning signs for tooth decay, and can usually be reversed if caught early. Grey, brown or black spots indicate more serious decay. If you notice any potential signs of tooth decay, or you are otherwise concerned, contact your dentist who can provide a thorough examination.

Preventing tooth decay in babies

Even babies can develop tooth decay, especially if bottles and dummies are used incorrectly.

You should never allow your child to fall asleep with a bottle containing anything but cool, boiled water. This includes milk, formula, fruit juice, cordial or soft drink. Even natural sugars found in milk and formula can be harmful when they cling to a child’s teeth for a long period of time. The flow of saliva also decreases during sleep which otherwise usually helps to wash away sugars.

The teats of bottles and dummies should never be dipped into sweet syrups such as honey.

Children should also be encouraged to use cups instead of bottles by the time they approach 12 months of age. When a child sips from a cup, the liquid moves past the teeth quickly and does less harm. In comparison, when a bottle is sucked slowly the liquid tends to linger in the mouth for longer.

Healthy snacking for children

To develop strong teeth (and for their overall growth and wellbeing) your child requires a healthy, balanced diet containing minimal high-sugar and high-refined carbohydrate foods.

We aren’t saying to never give your child sweet treats, however you should keep their consumption of sugary foods to a minimum, and choose healthier snack options the majority of the time. This will also help your child get used to eating a healthy diet, which can positively affect their food choices as they grow older.

Also, reduce the frequency that sugary foods are consumed in, and try and ensure they are eaten within an appropriate timeframe. Remember, it’s better for sugary foods to be consumed promptly in the one sitting rather than multiple times per day, or over a prolonged period of time.

Healthy snack tips:

  • Snacks are meals in between main meals, so they should be light and low in sugar.
  • Fresh is best. Dried or packaged foods are generally higher in sugar than their fresh alternatives (for example grapes versus sultanas).
  • When choosing snacks, be aware of how much sugar is in them. Always read the label: if sugar is listed in the top three ingredients it’s usually not a good choice.
  • Limit fruit to two servings per day. Fruit is healthy, however it still contains natural sugars.
  • Avoid snack foods that linger on the teeth, for example sticky or chewy foods, which make it difficult for saliva to wash the sugars away.
  • Avoid snack foods that are consumed over a long period of time, such as lollipops and hard candies, causing the teeth to be bathed in sugars.
  • Give your child water with every meal to help wash away lingering food and keep the mouth hydrated.

Healthy snack examples:

  • Plain water is the best choice. If you start your child drinking water early, and limit the options of alternative sugary drinks, they are more likely to enjoy drinking it.
  • Low-sugar yoghurt (read the label as many can be filled with sugar! Generally Greek or natural yoghurt is a good choice).
  • Fruits
  • Crunchy fruits and vegetables (such as apples and carrots), as their texture helps to clean teeth as they are eaten.
  • Vegetables cut into sticks (such as carrots, celery, cucumber, capsicum and green beans) on their own, or with dip. However, read the packaging on the dip if you aren’t going to make it at home. Vegetable or hummus-based dips are generally a good choice.
  • Wholegrain crackers, or rice/corn ‘cakes/thins’ with dip or a spread such as natural nut butter.
  • Hard cheeses (such as cheddar).
  • Lean meats (can be rolled up with cheese and cucumber).
  • Plain popcorn (when they are old enough).
  • Nuts and seeds (when they are old enough).

General Information

What is the difference between plaque, tartar and calculus?

Plaque:

Plaque is a soft, sticky, colourless film containing millions of bacteria that builds up on teeth daily. It begins developing on teeth between 4 to 12 hours after brushing. Plaque is what causes the “fuzzy/furry” feeling you might notice on your teeth at times.

When not removed with proper brushing and flossing, the build-up of plaque can trap stains on your teeth and irritate your gums, weakening the connections holding your teeth in place.

Also, the bacteria in plaque digest the food and drink residues left on your teeth. Bacteria convert sugars and starches from these residues into acid. This acid can slowly penetrate through and dissolve the enamel (hard outer shell) that protects your teeth, and may eventually cause the enamel to break down resulting in holes called cavities.

 

Calculus/Tartar:

Calculus and Tartar are different terms for the same substance that forms during the second stage of plaque accumulation, where the bacterial film begins to harden.

If plaque is not thoroughly removed by brushing and flossing it will accumulate. When plaque accumulates, it mineralises (hardens) and turns into calculus (tartar). Calculus also traps stains on your teeth and is often a brown or yellow colour.

Calculus is so strongly bonded to the teeth that the only way to remove it is using special dental tools. You will not be able to remove it yourself at home.

As the plaque and tartar increase, the gum tissue can become red, swollen and cause bleeding when you brush your teeth. This is called gingivitis, an early stage of gum (periodontal) disease.

If not removed from the teeth, calculus can lead to periodontitis.

What toothbrush should I use?

You should use a soft toothbrush with a small head.

The small head can access your back teeth better, which allows for proper brushing.

Soft bristles help minimise damage to teeth and gums. Medium and hard bristles are more likely to cause abrasion to teeth and gums.

The best way to store your toothbrush

After brushing, first thoroughly rinse your toothbrush with tap water to remove any remaining toothpaste and debris.

Store the toothbrush in an upright position and allow the toothbrush to air-dry until it is used again. This is because the bacteria that cause gum disease are anaerobic, meaning they live in a low oxygen environment and are killed by exposure to air. If more than one brush is stored together in the same holder, keep them separated to prevent cross-contamination.

Do not routinely cover your toothbrush or store it in a closed container. This does not allow the toothbrush to receive adequate ventilation, which creates a moist environment ideal for the growth of bacteria (microorganisms).

What’s better: manual or electric toothbrushes?

It’s a personal choice, they are both equally effective at removing plaque and debris when used correctly.

How often should I replace my toothbrush?

Replace your toothbrush (or replace the toothbrush head, if you have an electric toothbrush) every three months, or sooner if you notice it becoming frayed and worn.

Normal wear and tear causes frayed bristles which:

  • Don’t clean teeth as thoroughly. Clinical research shows that new toothbrushes can remove more plaque than worn toothbrushes.
  • Can have built-up bacteria
  • Can damage your gums

If your toothbrush frequently appears frayed before 3 months, discuss your brushing habits with your dentist as you may be brushing too hard.

What toothpaste should I use?

Use a toothpaste that contains fluoride, as it helps to harden tooth enamel and reduces your risk of tooth decay.

How often should I brush my teeth and how long for?

You should brush your teeth at least twice per day (morning and night) with fluoride toothpaste for at least two minutes.

This is because saliva (which keeps cavity-causing plaque off teeth) dries up at night, so it’s important to clean all the plaque off your teeth before sleep. Plaque may also build up while you sleep so you need to brush first thing in the morning to get rid of it (and other bacteria that cause ‘morning breath’).

Correct brushing technique

Spend at least 2 minutes brushing your teeth. A good guide is to spend at least 30 seconds per quadrant of your mouth (upper left, lower left, upper right, lower right). Ensure that all areas of your teeth are cleaned thoroughly: the inside, outside and biting surfaces of each tooth.

  1. Squeeze a pea-sized amount of toothpaste onto the toothbrush.
  2. Aim the toothbrush at a 45-degree angle to the gumline (rather than the top of the tooth) as this will allow the toothbrush to clean under the gumline where plaque starts to form.
  3. For the outer and inner surfaces of the upper and lower teeth, gently move the toothbrush in a circular motion.
  4. For the flat chewing surfaces of the upper and lower teeth, brush in a gentle back-and-forth motion.
  5. For the inner (back) surfaces of the upper and lower front teeth, brush in short vertical up-and-down strokes.
  6. Brush your tongue to remove bacteria and freshen your breath.
  7. Spit the toothpaste out after brushing, but do not rinse your mouth out with water. This allows the fluoride to stay on your teeth longer and provide greater benefit.

 
Video: Brushing technique – Lower teeth

 
Video: Brushing technique – Upper teeth

 

 

What if you are using an electric toothbrush?

For any steps where it says to manually brush in a circular motion, the electric toothbrush does this part for you. Instead of brushing in a circular motion, just hold the brush on the tooth and move the brush slowly along the teeth making sure to get all the surface areas.

Do this by slowly guiding the moving brush head from tooth to tooth, following the contours of each tooth and the curve of the gums.

What does flossing do?

Flossing, or interdental cleaning as it’s officially known, allows you to get into the tight spaces between your teeth and gums to remove plaque and debris where a toothbrush can’t.

Why should I floss?

Flossing is an important aspect of preventive dentistry that can help prevent tooth cavities, tooth decay, gum disease and bad breath.

Nearly half of the surface of your teeth lies between them. Therefore, if you rely solely on brushing, you miss cleaning a large portion of your teeth.

Flossing is equally important as, if not more important than brushing. This is because the plaque (bacteria) between your teeth is more likely to cause tooth decay and gum disease than the plaque on the outer surfaces of your teeth.

Whilst plaque can still accumulate on the outer surfaces of your teeth if you don’t clean them properly, because they are exposed a number of factors (including saliva, cheek and tongue movement, and drinking water) will help to remove the plaque. In contrast, the tight surfaces between your teeth solely rely on flossing to remove plaque.

How often should I floss?

Once a day, ideally at night before bed.

Correct flossing technique

  1. Break off about 45cm of floss.
  2. Wind it around the middle fingers of each hand. Hold the floss tightly between your thumbs and forefingers.
  3.  Gently guide the floss into the space between your teeth using a zig-zag motion. Do not snap the floss onto your gums.
  4. Around one tooth, curve the floss into a C shape, hold it firmly and slide it up-and-down.
  5. When you reach the gum line, gently slide it into the space between the tooth and gum.
  6.  Bring the floss back to the contact point between the teeth, and form it into a C shape around the other tooth.
  7.  Slide the floss up-and-down over this tooth, and into the space between the tooth and gum.
  8. Repeat this entire process with the rest of your teeth, ‘uncoiling’ fresh sections of floss as you go.
  9. Don’t forget to floss the back of your last (rear) molars on each side.

 
Video: Flossing technique

 
Video: Flossing close-up

Do I need to use mouthwash?

The short answer is no, you do not need a mouthwash to maintain your oral health.

However, mouthwashes may have a favourable effect on your breath and general feeling of wellbeing.

The alcohol they contain will have a mild bacteriostatic (reduced mouth microorganisms) effect and may have a generalised mild reduction in plaque.

It should be noted that mouthwash is no substitute for careful tooth brushing and flossing.

What mouthwash should I use?

Make sure it has a mild alcohol content only. Most mouthwashes have too much alcohol which can dry out tissues in your mouth, making them more susceptible to bacteria.

Is chewing gum beneficial?

Yes, but it must be sugar-free gum.

Here is a summary of the benefits of chewing gum:

Chewing sugar-free gum, especially after meals, can help reduce your risk of tooth decay as it stimulates the salivary glands to produce more saliva, with helps neutralise decay-causing acid attacks.

Here is a more detailed explanation: 

Saliva helps keep the mouth moist. It increases in flow when we eat which allows us to chew and swallow our food, and helps to wash away any remaining food particles and debris. Saliva also has a protective effect by neutralising acids released by the bacteria in plaque (which are harmful to tooth enamel) and re-mineralising teeth as it contains calcium and phosphate, which helps to strengthen tooth enamel.

Both the act of chewing gum and the flavour of artificial sweeteners in the gum stimulate ten times the normal rate of saliva flow. Increased saliva flow results in more acids neutralised, more food particles washed away and higher rates of calcium and phosphate produced. Clinical studies have shown that chewing sugar-free gum for 20 minutes after meals or snacks can help prevent tooth decay.

Why sugar-free? Sugar-containing gum will also increase saliva flow, but the bacteria in plaque will feed off the sugars and create more of the decay-causing acids that you are trying to neutralise.

Chewing gum regularly is also similar to strength training; it makes your saliva gland cells larger and more efficient. This means you won’t only increase saliva when you are chewing, but also during ‘rest periods’ when you are not chewing anything; which has a big influence on reducing the amount of acids and bacteria in your mouth.

Oral health and overall health

Your oral health and overall health are connected. Poor oral hygiene can not only lead to dental decay and gum disease, but studies are showing that poor oral health is significantly associated with other chronic systemic diseases 1.

Your mouth contains a balance of both good and harmful bacteria. Regular brushing, flossing and professional cleans help to reduce and remove the harmful bacteria. On the contrary, poor oral hygiene can lead to an overgrowth of harmful bacteria. Poor oral hygiene also leads to inflamed and bleeding gums, which can allow the harmful bacteria to enter into your bloodstream and affect other parts of your body.

Some conditions that may be linked to poor oral health include:

  • Cardiovascular disease
  • Respiratory disease
  • Stroke

  • Kidney disease
  • Osteoporosis
  • Cancer

Diet and tooth decay

Everything you eat and drink can have a major effect on the health of your teeth and gums, particularly whether you develop tooth decay, which is a preventable disease.

Foods high in sugar and refined carbohydrates (which break down to starch and then sugar), feed the bacteria in your mouth which in turn produce acids that can attack the outer layer of your tooth (the enamel). This does not only mean processed foods; it also includes foods high in natural sugars and starches. This is known as an ‘acid attack’ and results in the demineralisation of your enamel and can cause tooth decay.

Saliva provides a natural defence mechanism to help prevent tooth decay, by neutralising the acids produced by bacteria through a process called remineralisation. Saliva also helps to wash away some of the sugar and food particles in your mouth. This ‘attack and recovery’ process occurs every time you eat and drink. However, if you frequently consume sugary food and drinks, saliva may not have time to remineralise the teeth properly after each ‘attack’.

Therefore the greater risk is the frequency in which these foods are consumed, rather than the quantity they are consumed in. By limiting snacking throughout the day, you can reduce the occurrences of ‘acid attacks’.

Drinking water throughout the day, including after meals, can also help reduce your risk of tooth decay in a number of ways. Water helps keep your mouth hydrated which can prevent a dry mouth. It also helps wash away leftover food (and sugar) residue from your teeth, as well as diluting the acids produced by bacteria in your mouth. If your local water also contains fluoride you are even helping to strengthen your teeth at the same time.

Here are some healthy snack ideas that are good for your teeth:

‘Detergent’ Foods:

Healthy foods that are firm or crisp help to clean the teeth as they’re eaten and they also stimulate saliva flow. Examples are raw apples, carrots and celery.

Alkaline foods: 

The higher the pH level (the more alkaline) on the surface of the teeth, the more they are protected against enamel erosion. Dairy products like cheese and milk help to neutralise the acids in your mouth. They also stimulate saliva flow and the calcium and phosphates they contain help to re-mineralise the teeth.

Yoghurt is also good but read the label first as many can be filled with sugar. Generally Greek or natural yoghurt is a good choice.

 

Reference

1. Dental health services Victoria: Links between oral health and general health – the case for action (2011).

The general information provided by VC Dental is intended as a guide only. It is not to be taken as personal, professional advice. Before making any decision regarding your dental or medical health, it is important to consult with your dentist or medical practitioner.