Whilst the benefits of brushing twice daily with fluoridated toothpaste are well known, national statistics suggest that Irish parents often wait until children are in school before the first dental visit. Guidance on the safe use of fluoride toothpastes and toothbrushes for preschoolers is often overlooked as a result. This increases a child’s risk of dental fluorosis, fluoride toxicity and physical injury to the mouth from pastes and brushes. By the age of three, up to one third of Irish children may have developed decay. Preventive care in this age group presents specific challenges. These include how preschoolers cope in the dental chair, the way baby teeth develop decay and how preventive care is approached.
Fluoride is highly effective for the prevention of dental disease. It is available in many toothpastes, some mouthrinses, professionally applied varnishes and in most mains water supplies. The ingestion of inappropriate levels fluoride in toothpaste can harm children’s dental and general health in the short (acute fluoride toxicity) and long term (dental fluorosis). It is important to note that when used appropriately fluoride is safe for children.
Recommendations for the appropriate concentration of fluoride toothpastes for young children are controversial. Whilst low dose fluoride toothpastes have been developed for the paediatric market due to safety concerns, scientific evidence for the efficacy of such products is not convincing. This is often a difficult decision for parents to make alone, as there are contradictory messages on the internet and amongst the available guidelines. Professional advice based on an individual risk basis is the ideal situation.
Injury to the mouth due to children falling or slipping with toothbrushes (weapons) is relatively common. The maxillary frenum is the fleshy attachment between the inside of the upper lip and the gum above the upper central incisors. The frenum thickness varies between children. When injured it can bled heavily causing distress to both parents and children. In some cases it can require sutures to arrest bleeding.
I recommend positioning the child between your legs on the floor and using a small brush to clean the teeth. I routinely give parents instruction on how to do this safely. This is also a good position to adopt for putting in eye drops or ear drops. It reduces the chances of the brush slipping and makes it easier to see what you are doing. Some toddlers have a bad habit of chewing on brushes which can damage the bristles making the brush ineffective at cleaning the plaque away. It is usually when a child is chewing the brush that they slip and damage the mouth. The brush provides a moist environment for bacteria therefore, it is better to rinse and dry it before putting it out of reach. On a final note, remember to dispose of toothbrushes if your child has a strep throat.
This is why it makes sense to think of toothpaste and toothbrushes as being more like drugs and weapons in the hands of small children. It highlights the importance of early visits for professional guidance on fluoride use and how to safely maintain oral hygiene for preschoolers and infants. We provide a comprehensive infant preventive schedule for all children from ages 0-16 years.