Dr Khushnuma Cyrus Karkaria is a consulting Orthodontist. She also specialises in clear aligner therapy and is a certified Invisalign provider. She runs a Multispeciality Dental Centre at Santacruz West, Mumbai along with her husband and consults at several clinics all over Mumbai as a visiting Orthodontist. Having recently embraced motherhood, she strives to strike a work life balance between nurturing her passion and her little angel. I requested her to share her expert advice and she was kind enough to oblige. Excerpts from the interview:
1. When does dental hygiene practice for babies actually start?
You have to start brushing your child’s teeth as soon as the first teeth start showing in the mouth. Usually the lower front teeth come out first at around 6-8 months of age. You have to understand that there is a lot of variation in the timing among babies. Just like some kids start crawling sooner and some later, variations in milestones applies to the teeth as well. Sometimes the upper front teeth start appearing first. Some children don’t get their teeth till they are a year old. As a parent you should not be too worried about this, but if they have not erupted by 1 year you can have a consultation with your dentist and if they deem necessary they would take an xray of the region and just check that the teeth are present and close to erupting in the mouth.
2. How is dental hygiene for toddlers different from us adults?
The process of eating is so different for toddlers compared to adults. For need of a better term, I would like to call it as assisted eating. As the child is being introduced to food, we help them initially and slowly they start to hold a spoon and then start eating on their own. Most kids, in a short while, want to eat on their own, hold the spoon on their own and its good to encourage them to start eating on their own, even though the mess created sometimes makes you think otherwise. Its very similar yet different in the case of dental hygiene. Toddlers need to have assisted brushing. So you are initially brushing their teeth on your own, with time they start to hold the brush and you guide them and slowly they will want to brush on their own without assistance. This is where its different from eating as you have to insist on brushing for them. Let them hold the brush, but you have to guide them.
Why is it different from eating here? It’s because your toddlers hands don’t have the dexterity and ability to make coordinated movements which are required to clean the teeth well, whereas while eating they just need to take the spoon to the mouth which doesn’t require much dexterity. So you have to assist them upto maybe 4-5 years of age, and then switch over to monitored brushing upto about 7-8 years of age, where you are letting them do it on their own, but observing them so that they are not lazy and skipping the correct routine of brushing.
3. What toothpastes and toothbrushes do you recommend for toddlers?
Upto 2 years of age, we recommend using a non flouridated toothpaste. Adult toothpastes are flouridated, as fluoride helps protect against cavities. However, toddlers tend to swallow everything and fluoride can be toxic for them. So you can’t use adult toothpastes for them. Upto 2 years of age, you use non flouridated toothpastes, then from 2-6 years of age there are toothpastes available which mention on the pack that its suitable for 2-6 year olds. These have fluoride but less than adult toothpastes, so even if they don’t spit out the whole thing and swallow some bits of it, it won’t create a problem for them. After 6 years of age or when the first permanent teeth start erupting, they can use the same toothpaste you use for yourself, with higher quantities of fluoride. As the first permanent teeth start to erupt at this age, it’s important that they start with adult toothpastes.
Initially, when you start brushing for them you can start with a finger brush and slowly move to a soft toothbrush for children (these are specially made for children with small brush heads so they fit in easily and with cartoon or car or doll designs so it holds their attention)
You can also use battery operated brushes now available. These can be introduced after 1 year of age, if they insist on brushing on their own and don’t allow you to brush. The coordinated movements of the brush will take care of most of the plaque in the mouth.
4. Quick tips on getting kids to brush their teeth without protests?
This is a tough one. As kids react very differently and different methods suit different kids and parents better. Most parents would like to seat the child in the lap facing away from them, rest their head against their tummy and you get a good view from top as you brush. In the same position, you can recline them a bit more and let them sleep in your lap and you get a good view of most of the upper teeth too. Take very little of the toothpaste, as a lot of paste makes them uncomfortable. If possible, have the other parent standing opposite you and brushing their own teeth together, so they can watch and learn. You can put on some music or sing them a song while brushing to distract them. The important thing is don’t force things, let it be a fun activity and they will take to brushing.
5. What are the important things to keep in mind for their oral hygiene?
Most of the parents I see are at either of the two extremes. Some allow eating as many chocolates as they want and others don’t allow sweets at all.
I would say you need not be too strict about what they eat and let children be children, but what you can avoid is frequent snacking. So if they are having foods like chocolates or wafers or biscuits which are the worst in terms of forming cavities, you must only allow them once a day at one time. Our saliva is meant to neutralise the acids formed by these foods, however if they keep snacking every one or two hours, the saliva doesn’t get a chance to work. So allow them a snack time for biscuits or chocolates or wafers, but only once and insist on gargling immediately after.
A lot of parents like to give honey dipped pacifiers or milk with sugar right before the child sleeps. This is the worst thing you can do for their teeth and its a strict no-no. The last thing before bedtime has to be brushing or if required some water. Then your toddler’s teeth are protected through the night.
6. Any message for the parents?
Four very important points to remember
- A lot of parents are guilty of not giving too much importance to tooth brushing initially. They feel that since they are milk teeth and are going to fall after a certain period of time and be replaced anyways with a permanent tooth that they can afford to not take good care of them. What they don’t realise is that the milk teeth are very important for holding the space for the permanent teeth to come. If they are lost early, other teeth shift into this space and create a lot of alignment issues later on. As an orthodontist (braces specialist) myself, most of the patients I get usually have some or the other issues of alignment due to early removal of their milk teeth, so I cannot stress enough on the importance of keeping the milk teeth in place till the new ones come in.
- Secondly, parents must remember to keep checking their toddlers teeth for cavities while brushing. The moment you start seeing any blackish or brownish discoloration on their teeth, which does not go away with brushing, you should take them to your dentist for a check up. At the early stage your dentist can just manage it with a filling. Later as decay progresses, you will be left with only two options either a root canal or removing the whole tooth. So go for routine checkups every six months, once all 20 milk teeth have erupted in the mouth or whenever you notice any decay.
- Thirdly and most importantly, a lot of parents like to scare their children in the name of dentists. They tell their kids that if they don’t brush their teeth, they will get decayed and pain them and then they would have to take them to the dentist who will give them painful injections. It works very well as a deterrent when you want them to brush, but God forbid if they have a bad cavity and you have to take them to your dentist, you will have a very tough time as they have been conditioned with fearing the dentist. A lot of children are so afraid that we need to sedate them in a hospital set up to even work on them. This can be prevented very easily by not imprinting a negative attitude about dentists on them at a young age. You can always cajole them into brushing better with other methods.
- Lastly, I would like to conclude by saying that start imbibing the habit of brushing twice daily at their young age. In my years of experience, I have seen the good habits of brushing well, inculcated at a young age, stay with them through their adult age. So catch them young and instill the value of brushing as much as you would try to impart other good values to your kids.