Scientific article

Infant and Toddler Oral Care

Jeremy  Dixon, D.D.S.

Early professional dental care and infant oral hygiene practices are essential to enhance the opportunity for a child to be free of preventable oral disease.

Globally, 43% of children have untreated dental caries.1 Prevention for childhood caries needs to begin in infancy. Establishing a dental home (i.e. the first visit to the dentist) should take place no later than 12 months of age. This allows the dentist to evaluate a child’s specific risks for oral disease and also provides a venue for the dental provider to educate new parents on best practices for oral hygiene.

The Dental Home

At the first dental visit, the practitioner will assess the child’s growth and development and can provide anticipatory guidance to the parents relating to the child’s individual risk factors. This allows the dental team to provide preventative recommendations that are personalized to the individual needs of the child. Additionally, establishing the dental home facilitates coordination of specialized care for the child, including emergency care. Studies suggest that children with an early established dental home are less likely to require costly dental treatment and are more likely to receive dental care in an appropriate dental health care facility rather than in a hospital emergency department.2,3 Lastly, research supports a child’s anxiety levels towards dental visits decreases as familiarity with the dental office environment increases.4
Early exposure to the dental setting can lead to happier, more productive and less costly dental care throughout the child’s life.

Oral Hygiene Routines

Routine oral home care should begin even before children get their first tooth. Caregivers should wipe babies’ gums with a soft, clean cloth in the morning after the first feeding and right before bed to wipe away bacteria and sugars that can cause cavities. Stimulating the gum tissue may also provide relief to a teething baby and could help the teeth come in more easily.5 When teeth come in, start brushing twice a day with a small soft bristled toothbrush and a smear or rice-sized amount of fluoride toothpaste. At age 3 it’s recommended to increase to a pea-sized amount of fluoride toothpaste.6

Brushing a young child’s teeth can be technically challenging for the uninitiated caregiver. Many children are actively resistant to the process. For this reason, until they get accustomed to brushing, it’s advisable to start with the caregiver and child seated on a flat soft surface like a couch or bed. Adults are conditioned to brushing their teeth at the sink, but when brushing a resistant child there is more control and better visibility when the child is either seated facing the caregiver or laying down with their head on the caregiver’s lap. 

 For young children, an easy and effective way of brushing is to use the Circular Method. With one hand, place the toothbrush against the tooth perpendicularly while performing 4-5 small circular motions in each area. Particular attention is given to the margin between the teeth and the gum tissue as this is where plaque tends to accumulate. One advantage of this method is that the outer surfaces of the upper and lower teeth can be brushed simultaneously even when the child is biting down. To brush the inner surfaces of the teeth requires the child to open slightly. Brushing the inner surfaces, especially on the lower arch next to the tongue, is off-putting to some children, so it may be helpful to do those areas last. The caregiver's free hand can be used to stabilize the head, gently retract the lips, or as a barrier to the child’s hands from interfering.

 Naturally, when brushing apart from the sink questions arise regarding rinsing the toothpaste. When using the proper amount of toothpaste, rinsing it is unnecessary. In fact, studies suggest that eliminating rinsing maximizes the effectiveness of the fluoride leading to a lower caries risk.7

Conclusion

 An early dental assessment and diligent oral hygiene practices form the cornerstone of a child's oral health. With a staggering number of children worldwide experiencing dental caries, it's imperative to commence prevention from infancy. Establishing a dental home by the age of 12 months not only allows for a comprehensive evaluation of a child's specific risks for oral disease but also serves as an invaluable platform for educating parents on optimal oral hygiene practices.

Jeremy Dixon, D.D.S.

Pediatric Dentist

Dr. Jeremy Dixon is a distinguished pediatric dentist with extensive expertise. A graduate with honors from the University at Buffalo School of Dental Medicine, he holds a Doctor of Dental Surgery and a Certificate in Pediatric Dentistry from Cohen Children's Medical Center.
As CEO of Gramercy Pediatric Dentistry in New York City, he ensures top-quality care in a welcoming environment. Dr. Dixon served as Director of Dentistry at St. Mary’s Hospital for Children, where he advanced dental care for special needs children. He's also an educator, contributing to the Weill Cornell Craniofacial Team and instructing residents at Weill Cornell Hospital. 

With licenses in pediatric advanced life support and sedation techniques, Dr. Dixon is an active member of several esteemed dental societies. His commitment to pediatric dentistry spans over two decades.

1. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022. License: CC BY-NC-SA 3.0 IGO.

 2. Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and treatment costs for children? Pediatr Dent. 2014 Nov-Dec;36(7):489-93. PMID: 25514078.

 3. Allareddy V, Nalliah RP, Haque M, Johnson H, Rampa SB, Lee MK. Hospital-based emergency department visits with dental conditions among children in the United States: nationwide epidemiological data. Pediatr Dent. 2014 Sep-Oct;36(5):393-9. PMID: 25303506.

 4. Greenbaum PE, Melamed BG. Pretreatment modeling: a technique for reducing children’s fear in the dental operatory. Dent Clin North Am 1988;32(4):693-704.

 5. Memarpour M, Soltanimehr E, Eskandarian T. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies. BMC Oral Health. 2015 Jul 28;15:88.

 6. American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2017:181-4.

 7. Sjögren K, Birkhed D. Factors related to fluoride retention after toothbrushing and possible connection to caries activity. Caries Res 1993;27(6):474-7.