Maggie McKay (Host): Kids and brushing their teeth, how do parents make it fun? Let's find out with Dr. Robin Onikul, Medical Chairman of the Department of Dentistry at Children's Mercy, Kansas City.

Welcome to the Parent-ish Podcast, where experts at Children's Mercy, Kansas City talk about the little everyday things parents experience with their babies, teens, and in-betweens. Thank you so much for joining us today, Dr. Onikul.

Dr. Robin Onikul: Thank you for having me. I'm excited.

Host: Yeah, me too. So for parents with infants, what are some early signs that they can take to prepare their babies for future dental hygiene even before they have teeth?

Dr. Robin Onikul: I just wanted to start with that by the time they're about six months old is when they're going to start getting teeth. So, you want to prepare them before that so that you get used to being in their mouth without any teeth so they can't bite you. And then, you can start really early on with just a little bit of a washcloth, a damp washcloth, wiping their gums, and you get used to being in there.

Host: And as soon as they start having teeth, you can start doing a little bit of brushing with a small toothbrush, a soft bristle toothbrush. But by the time they're age three, they, if they're typically developing, should have all their baby teeth, which number 20, 20 baby teeth. So, starting at six months, You'd like to start a little bit before to just wipe their gums and then keep wiping their gums. And if they start getting a couple of teeth in at four to six months, you can wipe their teeth as well after you feed.

Dr. Onikul, at what age should parents start brushing and flossing their child's teeth? And when can children start taking over these tasks themselves?

Dr. Robin Onikul: As I said a little bit earlier, you should start right away by the time they're two months old and you're more likely to be more comfortable with the infant. You start wiping their gums first and they will start having teeth at about six months, and you can start brushing right then with just some little warm water and just taking the toothbrush and going back and forth on their gums and their teeth after they finish eating. And whether it's nursing or bottle feeding, it's both the same.

And then, as they're getting more and more teeth, you continue to do that. Children should not be able to have toothpaste, putting it on themselves. It should be kept in a place where the Tylenol or any other medication, because it does have fluoride in it. But for a small child, when they start getting their teeth around age one, two, more teeth in there, you can start brushing them with a little bit of a little smear of toothpaste and wiping it off afterwards with a washcloth.

When they can start brushing their teeth by themselves, we used to say when they can tie their shoelaces, when they can write cursive, which is about seven years old, but children don't have many shoes that have shoelaces much anymore, and they don't write script anymore. So, it's about seven or eight years old, and you should still be watching them and helping them along. Flossing the teeth when teeth in the back start touching, when they start getting their molars is when you should start flossing their teeth. You could start with the front teeth and it makes it a little easier for them. and then, you could do it little by little if you do it like every couple of days, and then you do it more often and it becomes routine for them.

Host: That's smart. So, what are some creative ways to make brushing teeth a fun and engaging activity for kids of different ages? Because that's kind of the challenge, I thought, when my son was little.

Dr. Robin Onikul: Yeah. That can be a challenge. We have to remember that this is really non-negotiable that they really do, you know, just like you have to wash your hair and comb your hair and that kind of thing, brushing the teeth is the same kind of thing. And that's why starting early is really important, because then it becomes routine.

But having said that though, I do know that it can be quite difficult at different stages. And so, some of the things that you can do is, first of all, modeling if you have an older child or yourself brush your teeth while they're brushing their teeth, make it fun, put some music on to let them brush their teeth to the music. You can also do a reward chart with stars and then at the end of whatever period of time you want, you can give them a little reward, a little prize. Hopefully, not a food prize like candy, but some kind of reward that they would like, a little treasure chest of something that they might want to attain, something that they're looking forward to getting.

And you set up the time schedule or whatever, it depends on their age and all that. I would say younger children, if you do it once a week. And then, as they get older, you can extend it out and make the little reward a little bit bigger, but modeling and reward and music. The other thing that you can do is have them go with you to the store to pick out the toothbrush that they would like. Having them pick out the toothbrush and maybe the toothpaste that they would like. That might be an incentive for them as well.

Host: Okay. And how can parents use the concept of the tooth fairy to encourage their children to maintain that good dental hygiene? Because you knew we'd have to talk about the tooth fairy today, Dr. Onikul.

Dr. Robin Onikul: Sure, sure. And it's really interesting in different cultures, the tooth fairy does different things. But in our culture, basically, when you leave the tooth under the pillow, or a tooth certificate, or something like that, the tooth fairy usually comes and either brings coins, or paper money, or sometimes a little gift.

So, my philosophy on that is the tooth fairy will pay more for clean teeth than dirty teeth. So, you just have to make that something that you talk to your child about, "Oh, you're about ready to lose your tooth. And it has to stay clean because the tooth fairy does not take dirty teeth." So, that's one of the way to do that.

Host: It's amazing how much the tooth fairy has gone up as far as what they leave. I am shocked by-- my son has grown up now-- but when he was little, you know, everybody kind of left a standard, maybe a dollar, but now it's crazy. It's like, I don't know, $5. Anyway, that's a lot of teeth.

Dr. Robin Onikul: I do have a story about that. I usually ask my patients, "Did tooth fairy come? Did they leave you anything? And sometimes they forget and the parent chimes in and they'll say, "Oh, the tooth fairy left $20. And I said, "You realize that your child is going to lose 20 of those teeth." And there was a shocked look on that face. So, I would say that's why I ask if they left paper or coins, because I'm older than that and we used to get quarters.

Host: Same here. Yeah. And, you know, to a kid, a lot of dimes seems like more than a dollar or a lot of quarters.

Dr. Robin Onikul: That's exactly right. That's exactly right.

Host: So, that was my strategy, but what strategies can parents use to handle resistance from their children when it comes to brushing and flossing? Because not every child is on board with brushing and/or flossing.

Dr. Robin Onikul: Oh, absolutely. And, typically, developing children, we just have to make it kind of a little bit of tough love, like it's not an option and there comes the rewards and those kind of things. Modeling, you as a parent can brush in front of them. It's really non-negotiable, but they can have all the control of which tooth they want to brush first. If they want to have some screen time, you get extra screen time if you brush your teeth, those kind of things. It can be kind of a little bit of a struggle. But I think overall, if you start early enough, that's the key is that it becomes a habit and ritual.

Host: Right. That's a good point. So, you mentioned earlier letting them choose their own toothbrushes and toothpaste at the store. What should parents consider when making these choices? How important is it to let them choose?

Dr. Robin Onikul: I think if they want to choose, you know, there's a lot of character brushes out there these days with all their favorite Spider-Man or the princesses and those kind of things. And they can choose it and they have to just use it, and they need to be soft-bristled brushes. Most of them are. But every once in a while, you'll see one that says an M for medium. You really don't want that, because that can irritate their gums. Because you have to remember it's not just a toothbrush, it's a tooth and gum brush. You want to brush their gums as well. And you want to use toothpaste that there's different flavorings. And for children, most of them are bubble gum-flavored.

Host: I'm skeptical on that, those flavors, in the toothpaste. Are they okay?

Dr. Robin Onikul: Yes, they are okay. You want to get a toothpaste that has an ADA, American Dental Association, seal of approval. I'm not one way or the other Crest Colgate, Procter and Gamble. I don't care as long as it has an ADA seal of approval. You want to try to avoid for the younger children up to the age eight is whitening toothpastes. Those are a little bit more irritating potentially to the gums. So, that's why there are children's toothpaste. They do have the same amount of fluoride. And as I said, the toothpaste should be kept where you keep all your other medications away from the child, so that they don't eat it, because some of them taste like bubble gum.

Host: Yeah. Right.

Dr. Robin Onikul: And other flavors.

Host: And what are some key dental health facts that parents should keep in mind as their children grow? How do these facts help in maintaining their good oral hygiene?

Dr. Robin Onikul: Number one and number 101, they need to be seen by a dentist by age one or somebody has to take a look. It could be a nurse, their nurse practitioner, their primary care doc. Somebody needs to look at their teeth to see if things look normal-developing. Routine checkups, I can't enforce that enough for all kinds of reasons. Timing for if everything is okay, if there's possible orthodontic needs, referrals, sealants for their permanent teeth so they don't get decay. It's one of these preventable things that if you take the few minutes a day to clean your teeth and a few minutes a year to go to the dentist, you're going to have a lifetime of wonderful beautiful teeth. And as they say, just brush the teeth that you want to keep. So, there you go

And by the time they're 12 to 14 about years old, they will have lost all their baby teeth. And that's the forever teeth coming in and there are 32 of them including those wisdom teeth. So, you want to keep those teeth, you get one shot at trying the primary teeth, the baby teeth. And then, those second teeth are forever. So, if you have good oral hygiene from early on, it will last a lifetime. Your teeth should last you a lifetime.

Host: Good point. Well, thank you so much for sharing your expertise. This has been so helpful and very useful information.

Dr. Robin Onikul: You're very welcome. Thank you.

Host: Again, that's Dr. Onikul. And to find out more, please visit childrensmercy.org/parentish. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. That concludes this episode of the Parent-ish Podcast. For more parenting tips and tricks, visit us at parentish.org, where we help you celebrate the craziness and challenges of parenthood.