Oral Hygiene for Infants & Toddlers
Preventing Early Childhood Caries (ECC)

Objectives: Participants will...

• Be able to suggest to the caretakers most comfortable positions for infant oral hygiene.
• Learn about the best devices and techniques for cleaning baby’s teeth and gums.
• Understand why daily removal of plaque is essential to prevention of ECC and why oral hygiene supervision is indicated until the child has mastered the correct method.

The keys to prevention of ECC are effective oral hygiene technique, use of fluoride dentifrice, early detection of signs of demineralization, prompt alerting of mother or caregiver to the potential hazard, with instructions for home care and early referral to the pediatric dentist for other preventive measures.

ECC is caused by lack of oral hygiene as well as by frequent and long exposure of an infant’s teeth to liquids that contain fermentable carbohydrates or sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a daytime nap, or at night, with a bottle containing a sweet liquid can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If baby must have a bottle as a comforter at bedtime, it should contain only water. Never give a pacifier dipped in sugar or honey. Baby should be weaned from bottle to cup by age 12 months.

Newborns to Age 18 Months

The knee-to-knee position provides comfort and stability for the child and excellent visibility for the infant oral examination.

Effective oral hygiene techniques practiced from infancy help to establish good oral health habits for the child’s lifetime. Oral hygiene can easily be accomplished while baby is lying on a changing table or in bed or with baby’s head on mom’s lap while she’s sitting on the floor. Parents can also utilize a knee to knee position, in which one parent assists by wrapping the child’s legs around his/her body and gently holding down the child’s arms. Whatever the position, caretaker visibility in the mouth and infant comfort are important.

Whether baby is fed by breast or bottle, mother should wipe the gum pads and new teeth, under the tongue and inside the cheeks, after every feeding with a moist gauze pad, a clean washcloth or a finger tender. Mothers who breast feed on demand should do this frequently. This will reduce the number of bacteria in the mouth capable of converting into acid the lactose in either human or bovine milk or other fermentable carbohydrates. It will also prevent demineralization of the tooth enamel by the acid formed and consequent incipient caries.

Advise mother to inspect baby’s teeth during cleaning. Any change in color or texture of the tooth surface, e.g., variations of white spots near the gum line of the upper anterior teeth, a sign of demineralization, suggests incipient pathology and the need for early referral to a pediatric dentist. Once the posterior teeth erupt, a moist soft bristle toothbrush can be used gently to remove plaque and any other food debris from all surfaces of the teeth.

Toddlers & Young Children

By age 2, the child should start learning to brush. On a small soft-bristle toothbrush, caretaker should apply a pea-size drop of fluoride dentifrice and brush child’s teeth carefully. Children under the age of six have difficulty expectorating. They tend to swallow significant amounts of toothpaste. To avoid excessive ingestion of fluoride and potential fluorosis, caretaker should apply the toothpaste, explain the procedure to the child and help perform the child’s oral hygiene until (s)he appears to have mastered the technique at about age six.

Additional Online Resources
• Baby Bottle Tooth Decay
• Care of Children's Teeth