Who's Brushing Baby's Teeth?

"If they’re not going to open their mouth, what are you going to do?"

 

One creative parent brought home Spiderman toothpaste and talked up the superhero’s super dental habits. What kid wouldn’t want to scale tall buildings with a gleaming set of pint-sized pearlies? Another family brought home a vibrating toothbrush. Every time their little boy saw it, he revved up, exclaiming: “Whirr…whirr…whirr.”

These moms and dads were part of a revealing study from the University of Washington Department of Health Studies on tooth-brushing for the infant and pre-school set - youngsters notorious for turning brush-time into fuss-time. While dental professionals recommend brushing a young child’s teeth twice a day, UW researchers Colleen Huebner and Christine Riedy found that only 55 percent of the parents in their study actually hit that target.

Those who did were more likely to find ways to engage a child’s cooperation. Some made a game of brushing, telling their toddlers to open their “alligator mouth.” Some incorporated singing the ABCs into the routine or used charts and stickers as reminders. One parent just dug into the wallet, explaining: “Maybe if they do it, then I’ll just give ‘em five bucks at the end of the week.”

The UW study, published in the January/February 2010 issue of Pediatric Dentistry, looks at why parents do - and don’t - brush their children’s teeth twice daily, as recommended by experts. The researchers sited their study in a rural southwest Washington State - little is known about home oral hygiene practices in such un-urbanized areas. Their subjects were 44 parents with kids enrolled in early childhood education programs serving low-income families.

They found parents who succeeded in the twice-daily regime typically had a better grasp of children’s oral health needs and often turned brushing into a “fun” daily routine. Those who failed rarely developed such skills. Some held false beliefs about brushing two times a day.  “People say that if you brush more than you’re supposed to, it picks off the enamel or something,” said one parent.

With childhood decay in America on the rise, especially among poor children, it’s important to examine such beliefs and practices, and design dental health promotion materials that reach the broadest possible audience. Those materials are sorely needed as parents try to sort out information and misinformation on everything from when to brush to whether it’s worth even doing.

Why Brush Baby’s Teeth

Until not too long ago, says Huebner, people accepted childhood decay as the norm. “They expected to see cavities in baby teeth. They would say, ‘It doesn’t matter, they’ll fall out anyway.’”

It does matter, hugely.  Those holes that show up in baby’s teeth are the end product of a transmittable disease called dental “caries,” Latin for rotten or rot. Caries is a systemic disease, affecting a baby’s whole body, and is usually passed from mother to child through saliva-swapping interactions, such as sharing spoons or touching hands to mouths. Untreated, the disease can lead to severe pain, tooth loss, infection, or worse.

But it is a disease that can be easily prevented and treated if parents set up a twice-daily brushing regime, using a small smear of fluoridated toothpaste. How tiny? “Teeny-tiny,” says Huebner. A 4.2 ounce tube should be enough to brush a baby’s teeth 14 times a week for a year.

So why isn’t every parent double brushing? In the study, 89 percent of parents blamed the lack of time and uncooperative children. “(Y)ou can’t really fight with a kid that’s 3,” said one parent. “If they’re not going to open their mouth, what are you going to do?”

These parents weren’t dental slackers. Even if they didn’t hit the twice-daily target, more than half had started brushing their child’s teeth before the first birthday, even though most had never had anybody to show them how.  The lack of guidance left some worrying about how to proceed without hurting their baby’s mouth.

Many were also confused about their proper role in tooth-brushing. Only 11 of the 44 parents actually brushed their children’s teeth – although professionals recommend parents either perform or assist in their children’s tooth-brushing. Most did supervise the child’s tooth brushing, sometimes brushing their own teeth at the same time. Some played the game of I-brush-mommy’s teeth, and mommy-brushes-mine.

But seven of the parents were totally hands-off, leaving young children to brush on their own, without supervision.  Not a good idea. Wrote the study’s authors: “Based on our data, it is clear that many parents do not recognize tooth-brushing as a self-help skill that, like feeding or dressing, develops over time.”

Huebner and Riedy engaged local community in every stage of the project, from conducting interviews to working in focus groups, to problem-solve ideas for promoting oral health. Asked what would help them maintain a twice-a-day routine, parents responded that they first needed accurate, non-conflicting information. They wanted childcare providers, health providers, and dental care providers on the same page. “They get very frustrated and confused when health authorities give them different messages,” says Huebner.

Using parents’ feedback, the researchers designed a new weekly parent education program called “Taking Care of Baby Teeth” that they hope to adapt to multiple communities. And they are  pressing ahead with studies in early dental care, a field that, like its subjects, is still in its infancy.

It wasn’t that long ago that dentists refused to see children until they were 4 years old. Now the Academy of Pediatric Dentistry recommends a first dental visit by age 1 and twice-daily brushing after the eruption of baby’s first tooth. “It sounds deceptively simple,” says Huebner, “but we’re just beginning to understand all the reasons that doesn’t happen.”

Further Reading:

• Huebner and Riedy’s study, “Behavioral Determinants of Brushing Young Children’s Teeth: Implications for Anticipatory Guidance,” was published in the January/February 2010 issue of Pediatric Dentistry.
• Huebner’s article, “Parent-Child Tooth-Brushing,” will be published in the fall/winter 2010 edition of “Northwest Public Health,” from the University of Washington School of Public Health