Brushing is the most effective method for removing bacterial-latent plaque from your child's teeth and gums. Getting food and plaque debris off their teeth and gums in a timely manner prevents the development of harmful acidic waste products, thus minimizes the possibility of decay.  Research has proven that brushing within 20-minutes following the consumption of a surgery food or drink will dramatically decrease the possibility of dental decay.  Therefore, we highly recommend brushing after every meal and/or any between meal snacks where a fermentable carbohydrate was consumed. 

MYTH: Brushing too much will cause your gums to recede. Parents sometimes inquire about brushing too much.  It is simple; you can never brush too much.  We do however, stress the use of proper brushing techniques, as this can lead to gingival recession.  Make sure your child uses a soft toothbrush with light pressure while brushing in a circular motion along the margin between the teeth and the gum line.  This light brushing technique may cause some minor blanching of the gingival tissues. This is fine, as long as light pressures are being utilized.

MYTH: You should avoid brushing your gums and teeth if they are bleeding.

False!  Gingival bleeding is a symptom associated with the development of sick or unhealthy gums.  This is actually a sign that your not brushing a certain area enough.  When you repeatedly miss an area, typically at the border between a tooth and the gum line, plaque builds-up.  This plaque contains caustic bacteria which subsequently irritates and attacks the gum tissues, causing gingival inflammation and bleeding upon brushing and flossing.  The remedy to eliminating these symptoms is to focus on brushing and flossing this  area with an understanding that these tissues will heal themselves once the irritant or plaque is removed.  After only a few days, you should find a notable change is both the bleeding and the discomfort associated with cleaning this area.  Should symptoms not subside after 3-4 days of attentive brushing and flossing, you should make an appointment with your pediatric dentist to evaluate the area.

Infants.  Soon after birth, begin cleaning your baby's teeth after nursing using a washcloth, gauze or soft infant toothbrush and water.  Avoid using all toothpastes on your child until he/she begins to erupt their first primary teeth.  At this point, you can begin utilizing a non-fluoridated toothpaste.  This helps to familiarize the infant with the bubbling action of the paste, while adding some attractive flavoring.  Working on spitting these bubbles out into the sink can begin around 18-months or when your child begins to mimic your actions.  We recommend using a toothpaste containing fluoride once your child reached age two.  At this point you can brush with a non-fluoridated toothpaste in the morning, while beginning to use the fluoridated paste prior to bed time.  Continue to work with your child on spitting into the sink.  Once they have mastered this process, they can begin brushing with fluoridated toothpaste only.

Children.  Children truly don’t develop the dexterity associated with properly brushing all sides of the back teeth until about age 9-10.  However, we recommend that from day one you allow your child to take an active role in their brushing.  At ages 2-4, this may mean having a parent first brush their teeth while the child watches in a mirror and allowing their child to mimic them afterwards.  Parents can expect to be responsible for 100% of their child’s effective brushing until he/she reach age 4 or 5.  Once they begin kindergarten, the child can then take a more active role in this procedure.  By age 7, parents can expect their child to complete only about 50% of the effective brushing.  Obviously every child is an individual and will require various levels of help, depending upon multiple factors.  It is important that parents understand this and establish a brushing & flossing evaluation regimen for their children until they are sure these tasks can be completed regularly and effectively.  Each child’s ability should be regularly assessed by their parent or guardian and aid is provided accordingly.  Some teens may require help on a weekly basis, some need periodic evaluations and other will require parents to take a more active role.  During the early teenage years, boys tend to become less focused on personal hygiene and may require increased help.

Brushing Techniques Since everyone's teeth are different, we recommend visiting our office before choosing a specific brushing technique.  Here are some popular techniques that have been proven to be effective:

• Use a circular motion to brush 2-3 teeth at a time, gradually covering the entire mouth.
• Place the toothbrush next to the teeth at a 45-degree angle and gently brush in a circular motion - not up and down (this kind of motion wears down the tooth structure and can lead to receding gums, or expose the root of the tooth). Brush all surfaces of the teeth - front, back, top, and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
• Don't forget the other surfaces of the mouth that are covered in bacteria - including the gums, the roof, and floor of the mouth, and most importantly, the tongue.  Brushing the tongue removes trapped bacteria and other disease-causing germs and may also freshen your breath.
• Remember to replace the brush when the bristles begin to spread because a worn toothbrush will not properly clean the teeth.
• Effective brushing usually takes about 2-3 minutes.  Believe it or not, studies have shown that most people rush during tooth brushing, spending less than a minute.

Toothbrush & Toothpaste Selection

Toothbrushes today come in about as many sizes and shapes as one can imagine.  There are angled heads, raised bristles, oscillating tufts and handles that change colors and play music with use.  There are manual and electric toothbrushes.  While toothbrush manufacturers present various claims of superiority over their competition, there is absolutely no evidence that any one type of toothbrush design is better at removing plaque and food debris than another.  We tell our parents that the most effective toothbrush is the one that your child is most likely to use.  With this, the most important thing to remember when shopping for a toothbrush for your child is finding one that he/she actually wants to use.  We recommend allowing the child to select their brush themselves, as this tends to increase their interest in using the brush.  If a child achieves unsatisfactory results from a particular toothbrush, it's more likely they either aren't brushing long enough (typically the case with children), or they are possibly using an incorrect brushing technique.

Most children simply do not brush long enough.  To effectively clean all areas of the mouth, your child should brush his/her teeth a minimum of two to three minutes 2-3 times a day.  Hidden camera research has shown that children brush for about 30-40 seconds when instructed to brush for 2-minutes.  With this, we recommend creating a timing method; possibly for the length of your child’s favorite song or by obtaining a two minute timer.  With ideal brushing techniques, this will guarantee proper cleaning of all exposed tooth surfaces.

Which toothbrush is best for my child? In general, a toothbrush head should be small (1" by 1/2") for easy access to all areas of a child’s mouth, teeth and gums.  It should have a long, wide handle for a firm grasp.  It should have soft nylon bristles (natural bristles tend to harbor bacteria) with rounded ends so you won't damage your gums.  We recommend that medium and hard bristle toothbrushes be avoided due to their excessively abrasive nature.

Toothbrushes should be changed every 3-4 months.  If your child becomes ill, you should change the toothbrush once the illness has subsided.  Be sure to change the toothbrush (or toothbrush head if it is an electric toothbrush) before the bristles become splayed and frayed.  Not only are old toothbrushes ineffective, but they may harbor harmful bacteria that can cause infection such as gingivitis (bleeding gums) and periodontitis (inflammation or infection of the gums that goes untreated and spreads to the ligaments and bone that support the teeth).  Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.  We also recommend placing toothbrushes in the dishwasher or in boiling water a few times a month to kill harmful bacteria that live within the moist bristles.

What toothpaste is the best for my child?  We typically recommend sticking with the most recognizable toothpaste brands;  Aim, Crest, Oral-B & Colgate.  As these companies maintain the strictest protocol for quality, utilize the most absorptive type of fluoride (sodium fluoride) and all have obtained the ADA seal of approval.  This seal indicates that the American Dental Association has evaluated this product and determined that it is safe and effective for use in the prevention of dental decay.  Because children’s toothpastes do not differ in their fluoride content as compared to adult toothpastes, it is perfectly fine for your child to use these products as well.  Like in the selection of the toothbrush, we recommend allowing your child to take an active role in selecting their toothpaste, as this too will increase their desire to want to brush their teeth.

Flossing

Flossing is a method for removing bacteria and food debris from between the teeth where a toothbrush is unable to reach.  It generally entails using a thin piece of synthetic cord inserted and moved up and down between the sides of two adjoining teeth.

Flossing also increases blood circulation into the gingival tissues.  Many dentists believe that flossing is the single most important weapon against the development of plaque and calculus.  Pediatric dentists agree that once primary teeth erupt in contact with adjacent teeth, its time to begin flossing.  This may be as early as a year if the front teeth have no spacing between them.  However, this usually should begin around age 2 ½ to 3 years old when the primary molars are fully erupted and the back teeth erupt side-by-side.  Daily flossing is an excellent and proven method for complementing your child's brushing routine and helping to prevent cavities, periodontal disease, and other dental problems which later in life.  Developing a regular flossing routine at an early age is the key for developing ideal lifetime oral hygiene habits.

Mouth Washes & Oral Rinses

Some mouth rinses can have therapeutic benefits; others are only cosmetic in nature.  Some products have both attributes.  The Food and Drug Administration even classifies mouth rinses this way.

In general, some therapeutic rinses containing fluoride have been shown to actually fight cavities, plaque and gingivitis formation.  On the other hand, cosmetic rinses temporarily treat breath odor, reduce bacteria and/or remove food particles in the mouth.

In any case, make sure to look on the label of a mouth rinse to see that it is accepted by the American Dental Association.  We also recommend reviewing the contents of oral rinses prior to selecting an oral rinse for your child.  Many mouth washes contain alcohols which have been found to be linked to oral and gastrointestinal cancers.  Because of this, we typically we recommend that children stick to fluoride rinses only, as these items are alcohol-free.

Surgery or oral disease can sometimes lead to complications for which a good quality over-the-counter rinse is indicated.  Individuals who have difficulty brushing due to physical deficiencies such as handicaps  
Even rinses that are indicated to treat plaque or cavities are only moderately effective.  We only recommend using oral rinses as an adjunctive to a routine brushing & flossing regimen, as rinses are not completely effective in removing plaques, calculus or cavity causing bacteria.  Prior to initiating an oral rinse regimen, we always recommend discussing this process with your dentist before beginning.

Fluoride

For decades, fluoride has been held in high regard by the dental community as an important mineral that is absorbed into and strengthens the outer protective layer of a tooth, the enamel.  Fluoride is the only natural mineral that has been proven to help prevent dental decay within tooth structures.  In fact, since its widespread supplementation into the municipal water supplies of most metropolitan cities within the United States, dental decay has decreased dramatically.  Those cities and locations with fluoridated water supplies show decreased prevalence of cavities while displaying no significant increases in any attributed harms.     In nearly every U.S. community, public drinking supplies are supplemented with very small doses of sodium fluoride, as this practice is acknowledged as safe and effective in fighting cavities.

There are two types of fluoride; topical and systemic.  Topical fluoride is commonly found in toothpastes and oral rinses.  Topical fluoride is applied to the teeth for a set period of time during which it is absorbed into the outer protective layer of the enamel of the tooth.  The presence of topical fluoride in the saliva interacts at several stages during the carious process to inhibit progression or enhance its reversal.  Systemic fluoride is consumed through the stomach via the consumption of fluoridated water, fluoride containing foods or supplements.  This fluoride is absorbed through the gut into the bloodstream where it is delivered in small amounts to the developing permanent dentition.  Research has shown that there is a direct link between the fluoride content found within enamel and the caries protection afforded by its uptake.  It has been found that there are two critical periods for fluoride incorporation into the enamel surface.  These periods are during the final stages of crown formation and during the concluding phase of tooth development just prior to the tooth’s eruption into the mouth.  The longer a tooth is exposed to fluoride during its development, the greater the concentration of fluoride incorporated into it.

Though most of Arizona’s drinking waters containing optimal fluoride levels, it unfortunately doesn’t taste good due to increased amounts of various minerals.  Though it is completely safe to consume this water without filtration, most families utilize filters to eliminate these minerals and thus improving its taste.  Many of these filtration processes do, however, partially or completely remove its fluoride content, thus limiting or eliminating its overall benefit.  With this, we recommend obtaining a fluoride testing kit from any of our offices to evaluate your home’s tap water.  Should we find that your family is obtaining less than ideal levels of systemic fluoride or if your family is completely avoiding tap water by drinking unfluoridated bottled water, we may prescribe a fluoride supplement to optimize your child’s exposure.  This, in turn, will ensure they receive an ideal amount of systemic fluoride during the most important stages of permanent tooth development. 

Some private wells in Arizona may contain naturally fluoridated water.  Occasionally these levels are greatly elevated and may pose a risk to the development of your child’s permanent dentition.  We also recommend obtaining a lab evaluation of your wells’ fluoride content to allow us to adjust the quantity of fluoride your children are receiving.

Fluoride Varnish

Fluoride varnishes contain a concentrated dose of sodium fluoride (5% NaF) which, when placed on the teeth topically, facilitates remineralization of the enamel surface.  The American Academy of Pediatrics and the American Academy of Pediatric Dentistry agree that the application of fluoride varnish on the teeth of high risk infants & toddlers is warranted as a strong preventive tool.  It is a non-invasive procedure which disrupts the progression from deminieralization to cavitation and reverses incipient or early dental lesions.

While the use of fluoride has long been accepted as a highly effective preventive agent, delivery of topical fluoride to very young children has not been practical with gels or mouth rinses.  Fluoride varnish finally provides an acceptable system of topical delivery to this population.  It sets almost immediately on contact with saliva leaving little concern about ingestion.  Its mild taste and quick application make it a nearly ideal produt.

What exactly is fluoride?   Fluoride is a safe compound found naturally throughout the earth’s crust; from the water we drink and air we breathe, to many kinds of natural and manufactured foods.

Why is fluoride important to teeth?   Fluoride is absorbed into structures such as bones and teeth, making them stronger and more resistant to fractures and decay.  A process in your body known as "remineralization" uses topical fluoride to repair or reverse damage caused by dental decay.   While systemic or ingested fluorides are used to help with the proper development of the permanent teeth.

How do I get fluoride?   Drinking public water will provide a certain measure of fluoride protection.  But for years, health professionals have endorsed the practice of supplementing our intake with certain dietary products, and topical fluorides in many toothpastes and some kinds of rinses.  Certain beverages such as tea and soda may also contain fluoride. Certain kinds of dental varnishes and gels may also be applied directly to teeth to boost fluoride intake.


Current Fluoride Controversy
 
It is generally not safe to regularly swallow toothpastes, rinses or other products containing topical fluoride as these can cause an additive effect on the GI system as well as problems during the development of permanent teeth.  In rare cases, over-exposure to high concentrations of fluoride over extended periods of time may result in a relatively harmless condition known as “fluorosis,” which can leave various levels of enamel staining.  Though these teeth are actually stronger and more resistant to dental decay, it can pose an esthetic or cosmetic concern.

Various other concerns have been raised in regards to the overall safety of fluoride exposure, however these theories have never been confirmed by an accredited research organization.  Researched conducted throughout the world, including by the Center for Disease Control (CDC), American Dental Association (ADA) and American Medical Association (AMA) all endorse the safety and efficacy for use of fluoride in recommended doses.  In fact, fluoride was selected as one of the most important finding in the area of medicine over the past century due to its overall effect on the disease of dental decay.