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Section Questions and Answers

Oral Hygiene and Plaque

"Achieving and maintaining oral health requires... daily oral hygiene practices such as brushing and flossing." - U.S. Surgeon General's Report

  1. Does dental plaque collect on children's teeth?
  2. Why is it important to remove plaque from children's teeth?
  3. When should a programme of home care (oral hygiene) start?
  4. Is there a "right" way to brush teeth?
  5. How often should teeth be brushed?
  6. Why is it necessary to clean between the teeth?
  7. When should children start using toothpaste?
  8. When should children start to clean their own teeth?
  9. Can plaque be removed with chemical mouthwashes?
  10. Is the use of electric toothbrushes recommended?
  11. How do disclosing tablets indicate the effectiveness of home care?
  12. Is it advisable to clean the tongue?
  13. How can I be sure I am taking proper care of my child's teeth?
  14. When should a child start going to the dentist?
  15. What will happen at my child's dental appointments?

 
1. Does dental plaque collect on children's teeth?

  • Plaque collects on children's teeth just as it does on adult teeth.

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2. Why is it important to remove plaque from children's teeth?

  • It is essential to remove plaque to prevent dental decay and gum problems.
    • The bacteria in dental plaque cause tooth decay and gingivitis.
    • The risk of tooth decay and gum problems is increased when plaque is is allowed to build up on a child's teeth.

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Healthy gums
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Gingivitis

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3. When should a programme of home care (oral hygiene) start?

  • Home care should begin as soon as the first tooth erupts. It calls for thorough tooth cleaning.
    • The surfaces of the tooth should be wiped gently.
    • A piece of clean gauze or muslin wrapped around a finger is recommended.
    • As more teeth erupt a small soft brush can be used.

See Toothbrushes

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4. Is there a "right" way to brush teeth?

  • We recommend two methods for brushing teeth. They both use the same angled position of the brush.
    Place the brush at a 45-degree angle towards the junction of the tooth and the gum. This is the position for brushing the sides of the teeth.
  • One suggested method is to brush gently in a circular movement.
  • Another technique is known as the gentle scrub method.
    • The brush is moved backwards and forwards horizontally in very short strokes.
    • Each stroke no more than the width of one tooth.
    • Brush all the tooth surfaces of all the teeth.
    • Brush behind the front teeth with an up and down movement using the end of the brush.
    • Brushing should be unhurried and thorough.

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Toothbrush position

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5. How often should teeth be brushed?

  • Teeth should be brushed at least twice a day, preferably after breakfast and before bedtime.
  • It is good to remember that plaque removal depends equally on thoroughness and frequency.

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6. Why is it necessary to clean between the teeth?

  • Plaque sticks very firmly to the surfaces between the teeth, and it is essential to remove it by flossing.
  • Parents must be involved in this part of home care.
  • Some children have wider spaces between their baby teeth than others. These will not need the same degree of flossing. This spacing is quite normal.
  • Why it is important to use dental floss
    • Dental floss is the best way to clean the tooth surfaces between the teeth.
    • Different types of floss are available, such as regular floss, dental tape and super floss.
    • Floss is also available on a plastic holder, in the shape of a bow. It forms "the string of the bow" and it makes flossing very manageable.
    • Children can soon master flossing with floss holders.

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Superfloss
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Dental tape
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Regular floss
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Floss holders
  • Here are a few tips for flossing as demonstrated below:
    • Use a 12-15inch (30-40cm) length of floss.
    • Wrap the floss around your middle fingers.
    • Hold the floss between the thumb and forefinger of each hand.
    • Leave about 2 inches (5cm) of floss between the hands.
    • The floss must be taut when it is used.
    • Gently guide the floss across the contact point between the teeth.
    • When the floss is in position between the teeth, rub it up and down a few times against each tooth surface, one after the other.
    • This is then repeated for all the teeth in the mouth.
    • Care must be taken prevent bleeding caused by the floss cutting into the gum.
    • A sharp downward thrust of the floss will damage the gum.
    • Your dentist will be happy to show you how to floss, and to advise which floss is best for your child.
    • A proper home care programme will consist of brushing and flossing.

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Floss on hands
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Floss up
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Floss down

See Cleaning Between the Teeth

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7. When should children start using toothpaste?

  • Parents should clean baby teeth with a soft brush after the age of nine months.
    • Toothpaste can be used, but only a small scraping. The minimum amount is recommended.
    • It should be wiped from the teeth straight afterwards, using a muslin cloth.
  • Small amounts, roughly the size of a pea can be used when the child is able to rinse out after brushing.
    • Toothpaste should not be swallowed but rinsed out after brushing.
    • The small amount of toothpaste that is swallowed after rinsing is harmless.
    • Children should not use fluoride toothpaste unsupervised until they are competent at rinsing after brushing.

See Toothpastes

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8. When should children start to clean their own teeth?

  • Children should be taught and encouraged to brush their teeth as early as possible.
    Brushing should be supervised, or done for them until they are sufficiently competent to do it on their own.
  • The age will vary from child to child. Two-year-olds can have fun trying to copy their siblings or parents.
    • Help and supervision should start early on and should continue for as long as is necessary.
    • A six-year-old child may have the manual ability to brush teeth without assistance, but supervision should continue.
    • It is unreasonable to expect young children from five to ten years old to be interested in brushing well without being supervised.

See Toothbrushes and Brushing

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9. Can plaque be removed with chemical mouthwashes?

  • There are mouthwashes that claim to remove plaque. Your dentist may recommend one.
  • Good brushing and flossing will usually be sufficient.

See Mouthwashes

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10. Is the use of electric toothbrushes recommended?

  • Electric toothbrushes can clean teeth and remove plaque efficiently.
    • They introduce an element of fun to the regular daily routine, and can be recommended if a child is not very motivated or efficient at brushing teeth.
    • Children from about the age of seven are capable of using electric toothbrushes under supervision.

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11. How do disclosing tablets indicate the effectiveness of home care?

  • Disclosing tablets can be used after brushing to check that all the plaque has been removed.
    • These are brightly coloured tablets, which are chewed and then rinsed out.
    • If the teeth are not clean, a pink stain will show where more brushing is needed.
    • If the brushing has been thorough, little or no stained dental plaque will be seen.
    • The disclosing tablets are only used occasionally, to confirm how well the teeth are being cleaned.

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Plaque staining on baby teeth

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12. Is it advisable to clean the tongue?

  • Tongue cleaning is a method of removing food particles, white or coloured coatings, and bacteria from the tongue's surface.
    • Tongue cleaners are recommended for scraping the surface of the tongue, where bacteria can convert food particles into bad smelling sulphur gases.
    • They are designed to remove the coating from the tongue.
    • Tongue scrapers are easy to use and come in different sizes for adults and children.
    • They are available from pharmacies or drug stores.
    • A post-nasal drip and a cold can cause coating of the surface of the tongue. The coating may be quite thick and can cause halitosis.

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Tongue cleaner
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Tongue cleaning

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13. How can I be sure I am taking proper care of my child's teeth?

  • If the oral hygiene program for your child is working, few if any problems will be detected at the regular dental check up visits.

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14. When should a child start going to the dentist?

  • Children should be taken to the dentist from the age of three.
    • Visits should be at regular six-monthly intervals.
    • This early start will prevent any major problems from developing.
    • First experiences are important.
    • The worst way of introducing the child to the dentist is when the first visit is a painful experience.

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15. What will happen at my child's dental appointments?

  • The first visit to the dentist is important. A dental check up that requires no treatment can be fun.
    The child may fear future dental appointments if the first one is frightening.
    • It is advisable for the parent to be present at the first appointments to comfort and encourage the child.
    • The dentist will initially explain quietly what he is going to do.
    • Brushing and flossing will be demonstrated. Any changes to be made to brushing and flossing will be advised at future visits.
    • The dentist will discuss diet, sugar intake, and general health matters relating to the child's oral condition.
    • Teeth and gums will be checked regularly to detect and treat problems that may be developing.
    • Decay preventing procedures can be performed, such as the placement of fissure sealants in permanent molar teeth.
    • Fluoride varnishes can also be painted onto teeth.
    • Tooth and jaw growth will be monitored.
    • Plaque will be removed and the teeth polished. Decayed teeth will have to be filled.
    • Posters are displayed which have been specially designed for young children. They are brightly coloured and rely on pictures rather than words to show dental procedures.
    • Many dentists give small rewards and incentives to children.
    • Stickers or buttons saying something like "I was a brave girl (or boy) at the dentist" can be worn with pride by a small child.
    • Making a collection of these small rewards can give a child something to look forward to at the next dental appointment.

See Fissure Sealants and Diet and Decay

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