Dr Sajjad Hasim Mithiborwal, specialist pedodontist, Prime Medical Centre, Dubai, helps parents understand the many issues surrounding dental health in young children:

Is fluoride toothpaste bad for very young children?

Children under the age of three must not be given toothpastes containing fluoride [and] many usually tend to swallow it because of its flavour. Too much fluoride can cause systemic toxicity in a child’s body.

What is fluorosis? Why does it affect only children?

Fluoride is a mineral and just as calcium strengthens bones, fluoride is meant to make teeth stronger by being absorbed by the tooth. However, it can result in hyper-mineralisation (excess mineralisation) of the tooth enamel in children below eight years and result in white stains on the enamel. Dental fluorosis affects children only below 8 years. The greatest risk is from birth to 8, particularly between 15 and 30 months. Fluoride intake after the age of 8 cannot cause fluorosis.

How much toothpaste is required for children?

International guidelines by the American Association of Paediatric Dentists (AAPD), the European Association of Paediatric Dentists (EAPD), the International Association of Paediatric Dentists (IAPD) and the Emirates Paediatric Dentistry Club (EPDC) are pretty much the same — a rice-grain-size bead of toothpaste for children below 6 and pea-size one for everyone else above 6 years including adults.

We, in Dubai, recommend pea-sized toothpaste blob for everyone. That is because apart from lather and foam and flavour, the tooth paste does not do anything — it is the brushing techniques that really maintain dental hygiene.

How many times a day should children under 6 brush their teeth?

The simple formula is 2x2 recommended by the AAPD. Everyone must brush their teeth twice a day — in the morning after waking up and before going to bed. It is not recommended to brush more than two times. After major meals, it is recommended to gargle with lukewarm water to wash away food particles.

Upto what age should parents supervise brushing?

It is important that parents supervise their children’s brushing routine as the brushing technique is the most important. In order of priority, the most important is the brushing technique, next is the brush and third, the toothpaste.

Parents must be aware their children need to brush for at least two minutes each time. Mothers often come to me saying, “My child brushes his teeth for three seconds”. That is not correct. Parents can introduce a brushing routine where everyone does it together and they can supervise their children’s brushing up to the age of 12 or 14 until permanent teeth emerge.

When is the right time to introduce children to brushing?

Children’s teeth have to be brushed even before they appear. From the time a child is born and begins breast feeding, the mother must take a fine muslin/silk cloth soaked in warm water and gently massage the gums to clean the milk residue from the gums as an infant can get fungal infection on the gums with milk residues.

The mother must do the same after every bottle feed as well until the child has milk teeth. Once the milk teeth emerge, parents can use a small brush that fits over the index finger to clean the teeth. After two years, the child can have a special child-size brush and use this type until the age of 14.

What is the correct way to brush?

Let’s explain this in a child’s language:

1) It’s round and round (an elliptical movement), up and down (vertical movement), inside and outside (to cover inner and outer enamel surface), and in between (to push out food debris).

Give the child a toothbrush and let them play with it for a bit and then move to a 2-minute brushing routine. Once they are trained, teach them to do it by themselves under your watchful eye.

After the age of eight, supervise their brushing technique and ensure it continues to be a full 2-minute duration. The technique is what helps loosen the plaque build-up.

Do ‘fun’ toothbrushes and toothpastes designed for kids make a difference?

No. It’s a novelty factor and a child might be attracted to the colours or the cartoon characters on it and be motivated to brush. When picking a brush, the shape is important.

From the age of 0-2: Use an organic toothpaste with no chemicals. Muslin cloth and later, an index finger, can be used as a ‘brush’.

From age of 2-8: Use a herbal or non-fluoride toothpaste with medium bristles brush. A toothbrush should have a small head so it fits into the child’s mouth and the handle should be broad with a rubber grip for the child to be able to brush well.

From the age of 8: Use a fluoride-based toothpaste making sure fluoride is not more than 500-750 ppm (parts per million; read the label)). The child must not be given more than a pea-sized blob for each brushing. The kid’s toothbrush should be medium bristles and strong anti-skid handle.

Fluoride-based formulas: We recommend fluoride-based toothpastes as fluoride is a mineral supplement that some studies have indicated causes fewer tooth cavities. Usually our teeth have an acid reaction owing to food debris leading to cavities. Studies have shown that using a small amount of fluoride strengthens teeth, lowering the incidence of cavities.

What is the state of dental health in children in UAE, particularly under 10 years of age?

There is very low awareness about dental hygiene in both parents and children in the UAE. I have children as young as two come in for root canal in their milk teeth. Parents are not educated about dental hygiene and only come to us when their child has swelling or pain in his teeth.

The main reasons for poor dental health is the use of bottles and pacifiers in infants that result in bad milk teeth health. For slightly older children, it is the easy availability of junk food and candies and the overindulgence of parents.

The most common problems that children come to us is with pain, swelling, inflamed gums and cavtiies. There must be a protocol introduced by the KHDA to train parents of schoolgoing children in proper dental hygiene. Like an immunisation schedule parents must follow a dental schedule. This must include the compulsory teeth brushing two times a day, regular gargling between meals, controlled eating of junk and candied food and visit to the dentist, once in six months to evaluate dental health.