Do you know when is the best time to start brushing your child’s teeth? What type of toothpaste should your child use? And which toothbrush is suitable for your child?
All these questions about tooth brushing pop up from time to time and yet, you have no ideas about it? Let’s find it out here!
Here we are not recommending any “best toothbrush or toothpaste”. We believe that the overall mouth health of the child does not depend only on the brand of the toothbrush or toothpaste. Instead, the right timing to start tooth brushing, the appropriate amount of certain toothpaste ingredients, the amount of toothpaste, and the type of toothbrush are the important things to be considered so that you can make smart choices when deciding the brand to be used.
The Right Time for Your Child to Start Brushing
According to the latest guideline released by Public Health England, it is advisable to start brushing twice daily as soon as the first baby tooth erupts in the mouth [1]. The first tooth usually begins to come out at about 6 months of age, but it can vary from child to child. Of course, children at this young age are not likely to be able to brush on their own, so parents are advised to help to brush preschoolers’ teeth and supervise school-age children brushing until they are 7-8 years old [2].
Choosing Toothpaste and Using the Right Amount
Fluoride vs non-fluoride toothpaste
Fluoride is a mineral that can strengthen the teeth against tooth decay [2,3]. Fluoridated toothpaste is a good source of fluoride and it ensures that children are obtaining a sufficient amount of fluoride. However, many parents are concerned about the tendency for young children to swallow toothpaste while brushing, and they think it may cause harmful effects to the teeth or the body.
That is true, toothpaste should not be swallowed excessively because it can lead to dental fluorosis (appearance of faint white lines or patches on the teeth) of adult teeth that have yet to come out or other health issues (eg. gastric irritation, skeletal fluorosis, birth defects etc) [4]. However, the scientific guidelines still recommend using fluoridated toothpaste for children as soon as the first baby tooth erupts as it is essential in preventing tooth decay [2,4,5].
Why does natural toothpaste not recommended? Click here to find out.
What about the risk of fluorosis? The key to preventing fluorosis is the amount and concentration of fluoridated toothpaste used, which is covered in the next section.
Correct amount and concentration of fluoridated toothpaste according to different age groups
As mentioned above, fluoridated toothpaste is still the main recommendation in many scientific guidelines as fluoride has long been proven to be able to help teeth fight against decay. The following table shows the suggested amount and concentration of fluoridated toothpaste used for different age groups [2,5,6]. The “ppm” stands for parts per million, which is the unit used for fluoride concentration in the toothpaste. This number is usually shown at the label of the toothpaste package.
| Age (year-old) | Fluoride concentration (ppm F) | Amount of toothpaste used |
|---|---|---|
| 0-3 | 1000-1500 | A smear layer |
| 3-6 | 1000-1500 | A pea-sized amount |
| >6 | 1350-1500 | A 2cm ribbon |
Sometimes, the dentist may advise to use toothpaste with a higher concentration of fluoride for those who has higher risk of getting tooth decay (as assessed by the dentist). The recommended concentration of fluoride is as shown below.
| Age (year-old) | Fluoride concentration for people with higher risk of getting tooth decay (ppm F) | Amount of toothpaste used |
|---|---|---|
| 0-3 | 1350-1500 | A smear layer |
| 3-6 | 1350-1500 | A pea-sized amount |
| 6-10 | 1500 (up to 10 year-old) | A 2cm ribbon |
| >10-16 | 2800 | A 2cm ribbon |
| >16 | 2800/5000 | A 2cm ribbon |
To get an idea of how much is a “smear layer” or a “pea-sized” amount of toothpaste, the pictures below can be your guide.
According to the SIGN guideline [6], the maximum intake of fluoride that should not produce bad effects on health for children up to 8 years old is at 0.10mg/kg/day. To give you an idea of how much toothpaste is considered safe if it is swallowed, I describe the following scenario. Let’s assume that a baby at 6-month-old (the age when usually the first baby tooth erupts) who weighs 7kg swallowed 100% of toothpaste used each time he brushes his teeth, which is around 0.1ml of 1000ppmF toothpaste, it allows 7 brushing episodes with 1000ppmF toothpaste per day before reaching harmful level.
Of course, this is a hypothetical scenario and should not be seen as definitely safe to swallow that amount of toothpaste. But it gives us an idea that as long as the children are using the correct amount and concentration of fluoridated toothpaste, as well as spitting out the excess (if possible), fluorosis and unfavourable health effects are unlikely to happen. To achieve this, close parental supervision of tooth brushing in young children is essential [2].
Is Flavoured toothpaste favourable?
The product shelves in the department store often separate “children toothpaste” from “regular toothpaste”. Is there any difference between them? And what type of toothpaste is suitable for children?
To make children like using the toothpaste, toothpaste companies often add flavouring agents and sweeteners into the “children toothpaste”. Despite their benefits in increasing children’s motivation to brush teeth due to the pleasant taste, they bring no nutritional value but certain harmful effects. Possible harmful effects include stomach discomfort and diarrhoea caused by sorbitol (an artificial sweetener), as well as allergic reaction caused by a commonly used flavouring agent called cinnamon [7]. In addition, flavoured children toothpaste can make children more likely to swallow the toothpaste due to its pleasant taste.
(If you are interested to know whether children toothpaste is safe to be swallowed, click here.)
On the other hand, some regular toothpastes may contain higher levels of abrasive used to remove surface stains from teeth. This higher abrasive level may not be necessarily useful for children [8].Besides, as stated above, there is a different amount of fluoride needed for each age group, but some children toothpastes in the market does not have a sufficient level of fluoride (at least 1000ppm fluoride) in their products. All these features necessitate a thoughtful consideration in selecting toothpaste for children.
To give a piece of general advice, an ideal children’s toothpaste should have the correct amount of fluoride, the appropriate level of abrasive [8], minimal flavouring agent and sweeteners.
Choosing the Right Toothbrush for Child: 101 Guide
The following table shows the simple guide to choosing a toothbrush for your child:
| Appearance | There is no best appearance, but it can be fun to let the children choose the character, cartoon and colour themselves. |
| Bristle | Soft or ultrasoft. Angled arrangement of long and short filament [7]. |
| Handle | Anti-slip grip, soft grip, thicker than adult size. |
| Head | Small, tiny head that can access to those hard-to-reach areas. |
| Weight | Light weight. |
| Manual/ powered | Powered toothbrushes were more effective than manual toothbrushes for plaque removal in children [1,9]. However, teeth can be cleaned effectively with either type of toothbrush [1]. |
In addition, finger brushing with a damp cloth is an alternative for children with only a few teeth, but be careful to make sure they don’t bite on the fingers while brushing.
Now you have the right toothpaste and toothbrush, how can you make sure your child is brushing the teeth effectively? Read this article to find out 6 Things to Check to Make Sure You Have Brushed Teeth Properly.
Summary
In summary, start brushing your child’s teeth with fluoridated toothpaste which has a suitable concentration of fluoride and other compositions as soon as their first baby tooth erupts. As soon as they have learned to spit out toothpaste (usually around the age of 3 years), children should be encouraged to spit out excess toothpaste, and not to rinse with water after brushing [1]. Lastly, it is recommended for the parents to supervise their children when they brush to ensure the correct brushing and the appropriate usage of fluoridated toothpaste.
References
- Updated Delivering better oral health published. Br Dent J [Internet]. 2021 [cited 2021 Nov 27]. Available from: https://www.nature.com/articles/s41415-021-3549-z
- American Academy of Pediatric Dentistry. American Academy of Pediatric Dentistry Fast Facts [Internet]. 2013 [cited 10 December 2021]. Available from: https://www.aapd.org/assets/1/7/FastFacts.pdf
- American Dental Association. Taking care of your child’s smile. The Journal of the American Dental Association. Elsevier Inc. 2014;145(5):504.
- Ullah, R., Zafar, M. S., & Shahani, N. Potential fluoride toxicity from oral medicaments: A review. Iranian journal of basic medical sciences, 2017;20(8), 841–848.
- Prevention and Management of Dental Caries in Children. Dental Clinical Guidance. 2nd ed. Scottish Dental Clinical Effectiveness Programme; 2018.
- Scottish Intercollegiate Guidelines Network (SIGN). Dental interventions to prevent caries in children. Edinburgh: SIGN; 2014.
- Behind the Dazzling Smile: Toxic Ingredients in Your Toothpaste. Draft Horse Studio; 2016.
- Stovell AG, Newton BM, Lynch RJ. Important considerations in the development of toothpaste formulations for children. Int Dent J. 2013;63(2):57-63.
- Davidovich E, Shafir S, Shay B, Zini A. Plaque Removal by a Powered Toothbrush Versus a Manual Toothbrush in Children: A Systematic Review and Meta-Analysis. Pediatr Dent. 2020;42(4):280-287.
