Conversation with Dr Brazelton on Early Brushing

Article by Dr. Tim Adams in Dr. T. Berry Brazleton Today's Family column, published in the Denver Post.

Early Care for 'Baby' Teeth Vital

Regarding your advice to not push the issue of tooth brushing with a very resistant 20-month-old child because she would be ready by age 4 or 5 to begin brushing through imitation and identification with the parent—

Tooth decay in toddlers is much more prevalent than most parents realize. Children as young as 12 months to 24 months may develop extensive cavities in the upper front teeth as a result of prolonged bottle or breast-feeding and other factors. The parent may be unaware of the condition unless the tooth surfaces are kept clean and are carefully inspected. A thorough cleaning daily by the parent beginning when the first tooth erupts can prevent the development of nursing decay and even arrest existing early cavities.

For the parent whose child resists having her teeth brushed, the following suggestions may be helpful:

1. If the child can use a small hand mirror to observe teeth being brushed, she will feel more involved and may become more interested.

2. Toothpaste may be disagreeable to some children. Using a moistened toothbrush may improve acceptance.

3. Break up the procedure with very small intervals of brushing and short rest periods in between.

4. Use positive reinforcement or rewards when the child cooperates.

5. Let the child hold the toothbrush; cup your hand over hers to accomplish the brushing.

6. If the parent begins brushing the child's teeth daily at 8 months, the procedure will seem familiar and routine by the time the child reaches the "terrible twos. —Timothy W. Adams, Children's Dentist, Denver

Dr. Brazleton responds:

These are valuable tips. They obviously come from a concerned and sensitive children's dentist.

In the past, I have been comforted by the fact that the first teeth are not permanent. For that reason, proper care of the teeth could be postponed until a child was eager and ready to imitate adults around him.

By the time the permanent teeth arrived, I reasoned, the child would be past the negative toddler period and would be more likely to learn tooth care easily from imitating and identifying with adults around him.

Dr. Adams jogs me out of my complacency. He says that early tooth care for deciduous "baby" teeth can be critical to the condition of the permanent teeth.

It is also vital that babies, toddlers and other children not be put to bed with milk or sweetened fluids in their mouths from bottle or breast. These can result in decay and discoloration of future teeth. An empty bottle or one with water can serve the purpose of a lovey.

The earlier a child begins care for his baby teeth, the better. If a parent can institute Adams' suggestions as a game, they will give the toddler a base for later routines.

Nevertheless, I would not push too hard at teaching a toddler. Failure is all too easy. There are too likely to be periods of resistance in the negative, second year. I would suggest that parents let up at such times and bring back the idea after negative periods subside and when the child is motivated again.

Learning by imitation is so easy for a child. Pressure meets with hopeless resistance. Make it a game. If you can give a 2 or 3 year old a chance to learn from you by imitating you, the habit will become his.

Dr. Adams, thank you. Your suggested routines will be of great value to parents. The ultimate goal will be for the child to take care of his own teeth - and be proud to show how well he's done!