Brushing is one of the main ways you can keep your child's teeth healthy. You should brush your child's teeth with fluoride toothpaste twice each day to help prevent tooth decay (cavities). Begin brushing as soon as your child's first tooth begins to show.

Tips for brushing your child's teeth

• Brush your child’s teeth after breakfast and before bed.
• Use a child-sized toothbrush with soft bristles and fluoride toothpaste.
• For children under age 3, use a small smear of fluoride toothpaste.
• For children ages 3 to 6, use fluoride toothpaste the size of a pea.
• Young children like to do things by themselves. It’s good to let children brush their teeth while an adult watches. But children under age 7 or 8 cannot brush their teeth well yet. An adult needs to brush the child’s teeth too.
• Find a position where your child is comfortable and you can see your child’s teeth while you brush. For example, sit on the floor with your baby’s or young child’s head in your lap. Or stand behind your child in front of the mirror.
• Gently brush your child's teeth using small circles. Brush all surfaces of the teeth, including the insides and outsides.
• After brushing, have your child spit out the remaining toothpaste but not rinse. The small amount of toothpaste that stays in your child’s mouth is good for the teeth.
• If you are having trouble brushing your child’s teeth, use a timer, a counting game, or a song while brushing. You can also ask the staff at your child’s dental clinic for help.

Some children with disabilities need extra help brushing their teeth. There are many ways to position a child for brushing. These may change with a child’s age, and they depend on the child’s physical or medical condition. Try different positions for brushing your child’s teeth to find one that works for your child and you.

Tips for different positions to brush your child’s teeth:

• On the floor. Place your child on the floor, sitting up. Sit right behind him or her, on a chair or stool. Tip the child’s head back into your lap. If your child will not sit still, gently place your legs over your child’s arms to keep him or her still. You can also lay your child on the floor, with his or her head on a pillow or on your lap. Kneel or sit behind your child’s head. If you need to, use your arm to keep him or her still.
• In a beanbag chair. If your child can’t sit up, place your child in a beanbag chair. Use the same position described above for sitting on the floor.
• On a bed or sofa. Lay your child on a bed or sofa, with his or her head in your lap. Support your child’s head and shoulders with your arm. If your child will not stay still, another person can gently hold his or her hands and feet.
• In a chair or wheelchair. Stand behind the chair or wheelchair. Use your arm to brace the child’s head against the chair or wheelchair or against your body. You can use a pillow to make the child more comfortable. Or, sit behind the chair or wheelchair and tilt it back into your lap. Remember to lock the wheels of the wheelchair.
• Warning: Some children make extra saliva during toothbrushing. To prevent the child from choking on saliva, make sure the child’s head is not tilted far back. Whichever toothbrushing position you choose, hold the child’s head upright or to the side. That will help stop saliva from running down the child’s throat. This warning is especially important for children who have a poor swallowing reflex or poor tongue control.

Having a regular bedtime routine helps children know what to expect at the end of the day. Brushing children’s teeth is an important part of the routine.

Set a Bedtime Routine

Getting their child to bed can be stressful. The child makes excuses to delay going to bed. Some children throw tantrums, ask for a snack, or leave the bedroom.

To help parents set a bedtime routine that takes the battle out of getting children to bed, use the Brush, Book, Bed program. It promotes three simple and clear messages that Head Start staff can share with parents:

• Brush. Brush the child’s teeth or supervise the child’s brushing. For children under age 3, use a smear of fluoride toothpaste to brush teeth. For children ages 3 to 6, use a pea-size amount of fluoride toothpaste. For more information about fluoride toothpaste amounts, see Healthy Habits for Happy Smiles: Brushing Your Child’s Teeth. After brushing, do not give the child anything to eat or drink before bed.
• Book. After brushing, let the child pick one or two books. Read the books aloud to the child in a comfortable spot.
• Bed. After reading, put the child to sleep in his or her bed. Sleep is important for children’s health and well-being.

It is important to stress to parents that consistency is the key to this approach. It may take some time to establish the routine. Once the routine is set, bedtime will become more pleasant for the parents and the child.

Choosing Books

Spending 15 minutes reading aloud every day can improve a child’s language development. It also promotes positive social and emotional development by creating a strong parent-child bond. Reading books about oral health is a good way to do both of these things and teach children about oral health at the same time.

A wide variety of children’s books about oral health can be found in public libraries, bookstores, and discount stores. Books can be used to teach children about teeth and what they do, healthy foods and drinks, brushing teeth, visiting a dental office, and dentists’ and dental hygienists’ jobs.

Read books that meet the following recommendations:

• Information in the book is correct. If you are not sure the oral health information in the book is accurate, ask your state dental hygienist liaison (DHL).
• The book says positive things about oral health. Find a book that has positive messages and images about oral health. For example, a book about a dentist, dental hygienist, or dental office receptionist who is friendly can help a child feel good about dental visits. A book about a dentist or dental hygienist that praises a child for not having tooth decay is better than one about having a cavity filled.
• The book does not use words that might make a child afraid of dental visits. Look for words like shot, hurt, needle, pain, and other words that might scare a child. Do not read books with these words to a child because it might make the child afraid of dental visits.
• The book uses words that a child can understand. Make sure the book has short sentences and simple words. Check that the meanings of oral health terms are explained so a child can understand them.

Parents and educators play an important role in helping children develop positive oral health habits that can last a lifetime. Scheduling time for children to brush their teeth with fluoride toothpaste during the program day ensures that children brush at least once a day. This can make a big difference in their lives. Brushing with fluoride toothpaste helps prevent tooth decay.

Brushing can done at the classroom table or the sink. A quick and structured approach to brushing in the classroom is to have children brush at the table as a group.

Follow these steps for hygienic toothbrushing in the classroom for children of all ages:

• Handle toothbrushes carefully to avoid spreading bacteria. Make sure that each child has their own soft-bristled toothbrush with a small head, preferably one designed specifically for children. Label the toothbrush with the child’s name.
• Wash hands with soap and water for at least 20 seconds before and after brushing children’s teeth or helping them brush.
• Wear a new pair of gloves before brushing each child’s teeth or helping them brush.
• When dispensing toothpaste from a tube, put toothpaste for each child on the rim of a disposable cup or on a clean piece of wax paper. The toothpaste is then scooped from there onto the toothbrush. This prevents cross contamination by not allowing the toothbrush to touch the tube opening. Or, make sure each child has their own labeled tube of fluoride toothpaste.
• After brushing, rinse toothbrushes individually with water to clean the bristles. Store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other. Don’t soak toothbrushes in bleach mixed with water or other disinfecting solutions. Doing this may spread germs. Don’t disinfect toothbrushes in dishwashers or microwaves or by using ultraviolet devices. These methods can damage toothbrushes.
• Replace a toothbrush when the bristles become worn or frayed, about every 3–4 months, or after a child’s illness.

Follow these steps for hygienic toothbrushing for children of different ages:

Children Ages About 6 Months to Age 2

• Brush each child’s teeth with a smear (grain of rice size) of fluoride toothpaste as soon as the first tooth comes into the mouth, usually around age 6 to 10 months.
• Don’t rinse the child’s mouth with water. The small amount of fluoride toothpaste that stays in the mouth helps prevent tooth decay.

Children Ages 3–5

• Help children brush their teeth with a pea-sized amount of fluoridated toothpaste.
• After brushing, have children spit the remaining toothpaste into a disposable cup, but don’t have them rinse.
• Encourage children not to place toothbrushes directly on the classroom table or other surfaces.
• Don’t let children play with toothbrushes.
• After children brush, make sure they wash their hands with soap and water for at least 20 seconds.
• After children brush at the classroom table or sink, clean and sanitize the area.

Tooth decay can be prevented or managed if children have dental visits early — ideally by their first birthday — and if parents take good care of their child’s teeth between dental visits. The age 1 dental visit is key for building a lifetime of good oral health. Dental visits for children can be simple, and staff can tailor them to be “kid-friendly.”

The goal of the first dental visit is to make the experience welcoming and pleasant. The dental clinic staff may ask you to sit in the dental chair and hold your child in your lap. Or staff may use the knee-to-knee position to look into your child’s mouth.

During the visit, dental clinic staff may:

• Describe what they’ll do and ask you if you have any questions
• Use a small mirror to look in your child’s mouth for any problems, such as tooth decay
• Check your child’s bite and jaw growth to make sure they’re developing correctly
• Clean your child’s teeth and apply fluoride varnish to prevent tooth decay
• Give tips on brushing your child’s teeth and how much fluoride toothpaste to use
• Discuss ways to feed your child to prevent tooth decay
• Offer tips for preventing injuries to your child’s head, face, and mouth, and what to do if an injury occurs

Each year, over 1.2 million children from birth to age 6 in the United States (5% of all children in this age range) experience homelessness.

According to the McKinney-Vento Homeless Assistance Act, homelessness is defined as lacking a stable, regular, and adequate nighttime residence. Children experiencing homelessness include those sharing housing with other people for economic reasons or because their family lost their housing. Children who live in motels, hotels, trailer parks, campgrounds, parks, emergency or transitional shelters, cars, public spaces, abandoned buildings, substandard housing, or bus or train stations are also considered homeless.

Families may become homeless for one or more of the following reasons:

• Lack of affordable housing
• Low wages and unemployment
• High cost of housing, transportation, food, health care, and mental health and addiction-treatment services
• Domestic violence and other unsafe living conditions
• Emergencies and natural disasters like storms, tornadoes, hurricanes, landslides, and fires

Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Housing is an important social determinant of health. The cost, stability, quality, and safety of housing can affect health. The physical environment, safety, and social makeup of the neighborhood where a family lives can also affect health, as can moving often and living in overcrowded conditions. Families experiencing homelessness may have difficulty obtaining food, so they may experience hunger or malnutrition. Children in these circumstances may also experience health challenges, including behavioral health issues; developmental delays; and mental health, oral health, and other health concerns.

Head Start programs serve many children who are experiencing homelessness. Staff play an important role in identifying these families and connecting them to resources to support their health, including their oral health.

Every family, regardless of whether they are experiencing homelessness, has a wealth of strengths that stem from their behaviors, beliefs, experiences, and values. Families are often doing many things to support their child’s health, and staff should recognize and honor their strengths. As Head Start staff form respectful and trusting relationships with families, it is important for staff to consider different cultural perspectives and how each family’s past oral health experiences and current situation may influence their family’s health behaviors.

Staff can share information about local, state, national, and federal programs that provide public benefits to families experiencing homelessness and help them sign up for services. Staff can also help connect families to community-action, culture-based, faith-based, and nonprofit organizations that support nutrition and oral health care for families experiencing homelessness.

Impact of Homelessness on Children’s Oral Health

Families experiencing homelessness may face barriers to meeting their child’s oral health needs, including accessing oral health care. These families may find it difficult to carry belongings, including toothbrushes and toothpaste. They may also have trouble finding places where they can brush their teeth or may lack access to safe drinking water.

Children experiencing homelessness, especially if they move often, are less likely to visit a dentist compared to children from families with low incomes who have stable homes. Lacking access to oral hygiene products and regular oral health care can lead to oral diseases and pain, which, in turn, can result in children having problems with eating and speaking, being distracted from learning, feeling embarrassed about their appearance, and missing school. Although most children experiencing homelessness are eligible to receive oral health care under Medicaid, not all children eligible for Medicaid receive oral health care.

Families experiencing homelessness may also have unreliable sources of healthy food, which can have a negative impact on their oral health. Families who cannot afford to buy healthy foods or do not have a kitchen to store and cook food may rely on prepared foods that typically are highly processed, low in nutritional value, and high in sugar. Children who frequently eat foods high in sugar are at high risk for developing tooth decay.

Some children with disabilities need extra help to take care of their teeth. Young children, especially those with a physical, emotional, behavioral, intellectual, or communication disability, may not have the fine motor skills they need to clean their teeth well. It’s important to brush and help your child with toothbrushing.

Tips for brushing your child’s teeth and making it a good experience:

• Choose a toothbrush made for children. Look for toothbrushes with soft bristles and a small head made for brushing a child’s teeth. Let your child pick a toothbrush that is a favorite color. Or let your child pick one that has a favorite character on the handle.
• Use oral hygiene aids. If it is hard for your child to hold a toothbrush, look for a toothbrush with a thick handle, or make the handle thicker by putting it inside a tennis ball. The toothbrush handle can also be strapped to your child’s hand with a hair band or Velcro. Another way is to place a hand over the child’s hand to guide the toothbrush as the child brushes.
• Use fluoride toothpaste that your child likes. Fluoride toothpaste comes in different flavors and colors. Find one that your child likes and feels good in his or her mouth.
• Use the right amount of fluoride toothpaste. An adult should always place toothpaste on the toothbrush. For children under age 3, use a smear (size of a grain of rice) of toothpaste. For children ages 3 to 6, use a pea-size amount of toothpaste. Encourage your child to spit and not swallow the remaining toothpaste.
• Make toothbrushing fun. Sing a song while brushing your child’s teeth. Or count or say the alphabet while you brush your child’s teeth. You can also tell a story, say a nursery rhyme, or make animal sounds while brushing.