Text alternative: How to care for your children’s teeth

To help your child brush their teeth, you will need:

How to safely set your child up for toothbrushing

How to position your child for toothbrushing will depend on your child’s age and ability. Some people find that standing behind your child and supporting their head can be helpful. Other people prefer assisting from the front or side.

• Check with them that they are comfortable and as upright as possible.
• Test several positions that you can use to clean your child’s teeth.

If your child is in a wheelchair, stand behind the wheelchair and recline it as far as the child can tolerate to improve the carer’s vision and access to the mouth. Remember to lock the chair wheels.
If the child is lying down, try to raise or tilt their head very carefully to one side, using extra pillows.​

STOP: if the toothbrushing routine isn’t working for any reason. Try and work out what the problem might be and see if it can be overcome. Do not force toothbrushing if your child is not ready to progress. Talk to your dental practitioner about different ways to keep teeth and gums healthy. It may be that you revert to wiping your child’s teeth with a damp facecloth and applying a smear of fluoride toothpaste for a while until toothbrushing is possible.
 
Important tips:

• Be calm, patient, encouraging and positive.
• Try and make toothbrushing fun!
• It’s good to take breaks if they are needed.
  
  

Tips to help with toothbrushing

Encourage your child to try and relax their lips and cheeks. This might best be achieved by asking them to have a swallow and give you a big smile. Introduce the toothbrush at the corner of their mouth. The front teeth are usually the most sensitive, so try starting with the back teeth first. Your child’s lips and cheeks can be gently pulled back, to allow you to see their teeth. Say which teeth you are brushing. For example, you might say: “I’m starting with your back teeth. I’ll brush the top teeth, starting inside and then outside.”
 
If you are using an electric toothbrush, simply place the head of the toothbrush on the gum line and move the toothbrush around the mouth to make sure that all surfaces of the teeth are reached. If you find that access is difficult, try brushing different parts of the mouth at different times. For younger children, it may be easier to brush their teeth by laying the child on their back, between two carers who are sitting knee to knee. Some children may respond to rewards such as a sticker chart or a toothbrushing chart.
 
Be sure to brush all surfaces: top and bottom, left and right, front and back.

• Brush in the morning and at night before going to bed. If you can only manage once a day, then it should be at night, after eating.
• Use a pea-sized amount of fluoride toothpaste on a soft toothbrush.
• Brush on the outside of the teeth
• Using a circular motion. Start on one side and go all the way to the other side of the mouth.
•  Brush on the inside surface of every tooth making sure that you clean down to the gums.
• Gently brush the surfaces of the top and bottom teeth. Start on one side and follow all the way to the other side of the mouth.

STOP: When you have finished brushing, encourage your child to spit out the toothpaste if they are able to, but don’t rinse their mouth with water.
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Bleeding gums

If your child’s gums bleed when you are brushing their teeth, this usually means that their gums need to be brushed more, not less. By brushing twice a day, you should notice that the health of their gums will improve, and the bleeding should reduce or stop. If bleeding continues, you should see your dental practitioner.
 

What if your child is refusing toothbrushing?

Try and work out if it’s the brushing activity, the frothing of the toothpaste or the taste of the toothpaste that’s the issue. Try brushing with water first to remove the plaque and then have a quick brush with a low foaming toothpaste or wipe some toothpaste on your child’s teeth with your finger.
 

What about cleaning between the teeth?

This is good as it helps remove food and dental plaque from between the teeth. It can be difficult to clean between your child’s teeth. Try using a floss holder. If you are able to, try and do this once a day.
 

Swallowing problems (Dysphagia)

Some children have difficulty with swallowing. Before brushing their teeth, please check their mouth. Do this by using a toothbrush, wipes or swabs to clear away any food. Make sure to check their cheeks. It might be more comfortable for your child to have their head tilted forward for brushing. Try and brush twice a day with a small smear of fluoride toothpaste on it.
You may want to try some toothpastes with low flavour and low foaming properties. Ask your dental practitioner about what product is suitable. Remove any excess saliva with a clean towel. Be sure to have suction available for toothbrushing if it is regularly used for someone with severe dysphagia.
 

Gagging

Some children have a strong gag reflex. Try using just a smear of fluoride toothpaste or pouring some fluoride mouth rinse into a cup and dipping the head of the toothbrush into it to brush their teeth. You may wish to try some toothpaste with low foaming and low flavour properties. A few granules of salt on the tongue can help reduce the gag reflex. In some cases, applying pressure midway between the chin and the lower lip can also help.
 

Dry mouth

Some children have a dry mouth because of their medical history or the medication that they take, such as stimulants for Attention Deficit Hyperactivity Disorder. Saliva has a protective effect against tooth decay. Dry mouth can also make it hard to chew and swallow food. Offer water regularly through a drink bottle or a spray bottle filled with tap water. There are also some products available through your local pharmacy that can help.
 

Children not fed by mouth

It is important to have a very clean mouth for children who do not use their mouth to eat. Dental plaque and bacteria left in the mouth can lead to bigger problems like chest infections or aspiration pneumonia. Brushing your child’s teeth every day will help make their mouth feel more comfortable and help reduce bad breath.
 
Important: Even if your child is tube fed, clean their teeth, gums and tongue every day.
 

Let’s look at challenges

If you are having difficulties brushing your child’s teeth, try using a gentle electric toothbrush or a 3-sided toothbrush. This will limit the amount of time that you are brushing their teeth. Some children will take longer than others to become comfortable with daily toothbrushing. You may need to consider a slow, familiarisation process for someone with anxiety or mouth sensitivities. Try using an electric toothbrush on the child’s fingernails first, so they get used to the vibration. Electric toothbrushes are often more efficient for a quick clean.​

Food and Drinks

What we eat and drink can have a big effect on teeth. When we eat foods high in sugar, the sugar and bacteria in the mouth produce acid. This acid weakens the teeth and can cause tooth decay. If we eat frequently our mouths are in a constant state of acid. Instead, try and avoid snacking and give the teeth a rest between meals. This allows saliva to help reverse the damage.
Try to avoid:

• Foods that stay in the mouth for a long time or get stuck between teeth or in the grooves of the back teeth such as muesli bars, fruit straps, lollies and biscuits.
• Drinks that are sipped for long periods of time (except for water).
• Soft drinks, fruit juice and cordial.

 

Children with restricted diets

Some children with disability have a very restricted diet with only a limited variety of foods that they can eat. Daily nutritional supplements are often recommended by medical practitioners. If these are used in a bottle or sippy cup, it is important that your child is not going to bed with these, as having this liquid pooling around the mouth, while sleeping, is a cause of dental decay in children. Try and give dietary supplements just before mealtimes where possible, as many contain sugar and the action of chewing afterwards will help clear the sugar from the mouth.
 

Tips to help keep teeth healthy

• Drink tap water throughout the day.
• Tap water contains fluoride, which helps protect the teeth
• Eat more fruit and vegies.
  

Dental Check-ups

Regular dental check-ups are important. If you notice any change in your child’s mouth or any behaviour changes, especially when you are brushing their teeth, please arrange a dental appointment as soon as possible.
 

Dental Emergency

Go to the closest hospital emergency department for:

• Swelling in the face or neck
• Bleeding from the mouth that will not stop
• A serious injury to the face.
  

Public dental services are free for all children under 18 years, who live in NSW and have a Medicare card. To access NSW Public Dental Services call: 1800 679 336

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