How many times has your child told you that they brushed their teeth only to find a dry toothbrush when you inevitably go check? How many times did you tell your own parents that you brushed your teeth when you, in fact, did not? Brushing teeth might be the most lied about subject in my home. As far as I know, there has not been a research study on why children lie about brushing their teeth, but it seems to be a universal phenomenon.  Honestly, brushing your teeth is like any other good habit. It must be taught, practiced, and repeated to become a daily habit. Your children do not know or understand the long-term effects of not brushing their teeth, nor do they see an immediate reward for brushing. For all of us, not practicing good oral health has its consequences at least once every six months if you are seeing a dentist. The lack of good oral health can lead to long-term health consequences and years of dental work that can not only be painful but costly. However, children do not have the forethought to know this or the ability to understand it.

This is why it is so important to establish good oral health habits at home. Good oral health is crucial to your child’s overall health and development. As parents, the way we approach oral health in the home can help to establish life-long habits for our children. While it can be difficult and time-consuming to help your children brush their teeth daily, it is a habit that can help prevent them from having to experience difficult and traumatizing dental procedures now or later in life.

Betsy Hillyard, CCLS (Certified Child Life Specialist) and oral health program coordinator at Cook Children’s Center for Community Health has three tips to encourage parents as you establish good oral health habits at home. As parents, modeling good oral health, having realistic expectations, and having the right tools available can help to make the daily practice of oral health easier for children.

1. Model good oral health. As parents and caregivers, much of what we teach our children stems from what we do. If your children don’t see you brushing your teeth, flossing or prioritizing your own oral health, they are not likely going to want to do it. However, children are often motivated by what they see adults doing and often want to do those things simply because an adult is doing them. Allowing your young children to brush their teeth alongside you can be a great way to encourage them while also monitoring their brushing times and techniques. It is also important to start modeling from a very young age. You can start brushing even your baby’s teeth with a toothbrush (no toothpaste) to begin to get them used to it.  Modeling frequency and times will help your children be able to establish their routine. If you brush your teeth 2 times a day every day, before leaving the house and again before going to bed, your children will likely adopt this same routine. It’s important to model whatever your expectations are. This is true for any habit you are trying to teach your children. It is also encouraged that you monitor your child’s oral health routine until they are 9 years old.
2. Have realistic expectations. If oral health has always been a challenge for your family, it is important to start somewhere, and it is never too late to start implementing good oral health practices. If your child is currently not getting their teeth brushed at all during the day, start with making it a priority to get at least one time a day in and increase to 2 times a day. If your children don’t spend enough time brushing their teeth, it may be good to have them try to brush for at least 30 seconds and then adding more time as they accomplish their goals. Take time to celebrate the one time a day or the 30 seconds that your child can brush. The goal would be to work up to 2 minutes of brushing time, 2 times a day. If your child has mastered brushing their teeth, but flossing is not happening, start with a goal of flossing once or twice a week and work your way up to daily. It’s important to keep oral health a positive topic with your kids. Giving them manageable and attainable goals will help to build their confidence. Positive reinforcement is always helpful when establishing a habit. Using brushing incentive calendars is a great way to keep your expectations realistic while rewarding any goals your child accomplishes. Setting a goal like brushing ten times a week and flossing twice could mean a small prize or extra screen time at the end of the week.
3. Have the right tools available to your kids. Brushing your teeth can be much more fun if you love your toothbrush and the flavor of your toothpaste. This is a great place to allow your child to have choices. While it is important to get your child the right sized toothbrush, allowing your child to pick a toothbrush that they love with their favorite color or character can help. Also, it is important to choose a flavor of toothpaste that your child likes. I know my girls often found minty toothpaste to be way too “spicy” for them when they were younger. Just make sure that you choose a toothpaste that is approved by the ADA (American Dental Association). Finding some type of timer that works for your children is also helpful. It can be a simple sand timer or there are apps with brushing timers for kids. When encouraging flossing, I find that for myself and for my girls that flosser holders are much more user friendly than string floss. They also make flossers in fun colors. My girls get flossing done more easily and frequently with flossing holders available. Anything that can aide your child in meeting their brushing and flossing goals is a win!

As always, it can be helpful to use books and videos to help encourage your children’s oral health.

• I Care for My Teeth by Martha E. H. Rustad
• Caring for Your Teeth by Sian Smith
• Daniel Tiger’s Brushing Teeth Song by PBS

Brushing teeth and flossing are habits that help your child’s overall health for their lifetime. While it can be challenging to establish any good habit, it is important to remember that the effort and time you take to help your children will allow them to continue healthy habits into adulthood. If you run into any challenges or difficulties (i.e. thumb sucking, pacifiers, dexterity with the toothbrush, etc) with your child’s oral health, it is important to reach out to your child’s dentist as they can help you navigate this. Happy brushing!

A child’s smile holds enormous potential for fostering emotional well-being, communicating happiness and building connections with others. It can also be a powerful indicator of physical health.

“There is a clear connection between oral health and overall mental and physical health,” said Tonya K. Fuqua, DDS, director of oral health for the Center for Community Health, led by Cook Children’s. “Teeth can be very telling about what is going on in a child’s life, the socioeconomic barriers they face and underlying health issues they may have. That’s why it’s so important for the dental health of children to be as high a priority as their physical health.”

Connecting the dots between oral and physical health to improve a child’s overall wellness is the purpose of a grant awarded by the American Academy of Pediatric Dentistry (AAPD) Foundation to Cook Children’s Health Care System’s Renaissance Neighborhood Health Center and the Center for Community Health’s Save-A-Smile Program. Cook Children’s is one of only two recipients nationwide to receive the grant.

“The AAPD Foundation is dedicated to making dental care accessible to all children by supporting nonprofit clinics providing routine cleanings, advanced treatments and ongoing care that helps kids in need,” said Douglas Keck, DMD, MSHed, AAPD Foundation president, pediatric dentist, and dental director of a Federally Qualified Health Center in Florida. “Our support of Save-A-Smile and its medical dental interface initiative represents a pivotal step in bridging the gap between oral health care providers and primary health care practitioners. By working together, we aim to provide sustainable compassionate care for children in need.”

The grant supports a three-year pilot project aimed at developing best practices for bridging the gaps between pediatric medical and dental care. It makes way for a community health worker (CHW) to be embedded with Renaissance Neighborhood Health Center to educate and support families while identifying and addressing any barriers that keep them from completing care.

Cook Children’s Renaissance Neighborhood Health Center is a primary health care home for children living in southeast Fort Worth. The center has both a dental and medical clinic under one roof, making it the ideal location to conduct the pilot. Many within the center’s patient population are considered financially vulnerable and qualify for government-supported health programs such as Medicaid and Children’s Health Insurance Program (CHIP). They may also face non-medical drivers of health such as food insecurity, housing issues and adverse childhood experiences.

Making Connections

Juanita Valles is the community health worker assigned to this medical/dental integration project at Renaissance.

“Families tell me their problems and I listen,” Valles said. “Right now, everyone is struggling financially. Sometimes they need transportation to appointments, childcare, clothing, diaper assistance, car seats for the kiddos, household items or even dental care for the parents themselves. That’s where I come in.”

When a family has a need, Valles works to clear the path to make it easier for them to follow through with medical and dental care. She even goes so far as to make in-home visits with her trusty stuffed assistant, Leo the Lion, when working to educate a family and overcome barriers.

“I take Leo with me everywhere I go and use him to show kiddos how to brush their teeth the right way,” she said. “We also teach them to drink lots of water and stay away from sugary drinks.”

Children with untreated dental problems often have difficulty with pain, eating, sleeping, self-esteem, school attendance and grades. Cook Children’s 2021 Community Health Needs Assessment revealed that more than 175,000, or 1 in 7, children living in Cook Children’s eight-county service area were not able to get the dental care they needed. This rate is 9 times higher than national estimates and 5 times higher than state estimates. Stated barriers included inadequate dental insurance coverage, difficulty scheduling and lack of education and resources for dental care.

“You really relieve all barriers by addressing the social service component of why families may not get the dental care they need for their kids,” Dr. Fuqua said. “And the pediatrician’s office is the perfect place to start because children often visit their pediatricians more frequently in their first years of life than they do dentists.”

Leveling Up

Results from year one of the pilot, which began in January 2023, have already triggered system-wide change, Dr. Fuqua says. Dental screening questions were implemented across all of Cook Children’s Health Care System for well-child visits ages 0 to 3. Children in the pilot project who screen positive are connected with the community health worker. Other opportunities to scale-up and implement new solutions for year two include streamlining pilot data collection and analysis, refining criteria for patient referrals to the community health worker and examining system-wide dental screening data.

In the first 10 months of the pilot, more than 1,000 patients responded to dental screening questions during a well-child check and subsequently scheduled a dental appointment at Renaissance. Of those, 429 patients completed initial dental appointments at Renaissance. In that same time, Valles attempted or completed contact with families 247 times and provided tailored oral health instruction in person or by phone to 50 families.

“That's the beauty of this program and having a community health worker,” Dr. Fuqua said. “It's not as simple as just saying, ‘Oh, your kid needs help and here's where to go.’ These families have so many barriers and so many reasons why they haven't gotten a child to the dentist, but Juanita and this program make a way for them.”

About Cook Children's Neighborhood Clinic Renaissance

At Cook Children's Neighborhood Clinic Renaissance, we're here to help you raise a healthy child from infancy through the transition to adulthood. We offer well checks, immunizations, school and sports physicals, injury treatment, and care for both short-term illnesses and longer-lasting conditions.

If your child needs additional help, we can connect you with more than 60 Cook Children's specialty clinics. We're always ready to answer questions and share resources. Feel free to reach out. We're looking forward to your visit with us in Fort Worth. Learn more about our pediatricians, services and support here.

About Save-A-Smile – Cook Children's Center For Community Health

Save a Smile was founded in 2003 by Cook Children’s to address a gap in oral health services for underserved children. Save a Smile is an innovative, nationally recognized, collaborative program dedicated to providing restorative and preventive dental care to children from low-income families in the community through volunteer dentists. Children eligible for the program are pre-kindergarten through sixth grade at high risk for dental disease from schools pre-selected by the Save a Smile program and participating school districts. 

Three little girls’ lives were changed when Save a Smile provided more than $11,000 in dental care to restore their smiles. Britani, Skarli and Ashley Ortiz were in so much pain from dental decay that they frequently went to the nurse’s office at school to ask for ice packs. The Save a Smile program at their school identified the Ortiz sisters because each girl had multiple abscesses and was in emergent need of dental care.

Save a Smile, which started in 2003, is in 21 elementary schools in Hurst-Euless-Bedford, Fort Worth and Keller ISDs. Save a Smile provides dental screenings at schools and identifies children who are in emergent need or pain. Save a Smile has provided over $10 million in dentistry to children in the community.

Depending on the severity of the problem, the age of the child, translation requirements and financial/insurance status, a referral is made to the appropriate volunteer dental provider. Dental care is given in the volunteer dentists' private offices, free of charge to the families. Children with CHIP or Medicaid are connected with a Medicaid/CHIP provider selected through their coverage.

The Ortiz sisters were identified as patients in the 2019-2020 school year, but some of their dental procedures were delayed due to the pandemic. After more than 15 appointments and procedures, the girls received their final appointments in June 2022. They are 5, 6, and 7 years old.

“I told my sister to be brave and to not be scared,” Ashley Ortiz, 6, said. “They are very nice people. I was happy to be in this place because they’re so nice.”

Tonya K. Fuqua, D.D.S., is the Director of Child Oral Health under the Center for Children’s Health, Children’s Oral Health Coalition and Save a Smile program. She was also the dentist who volunteered to provide dental care for the girls.

Dr. Fuqua knew the girls were afraid of going to the dentist since they had never been before. She noticed how brave they became by the last appointment.

“I got to see the transformation from dental disease to happy smiles, so I think that warms all of our hearts when we think of it that way,” Dr. Fuqua said. “When we think how the smile connects to the rest of the body, it does impact the child, from not being able to eat or to learn or to not be in pain.”

The Ortiz sisters were some of many children across the country who got behind on dental appointments and care due to the pandemic and dental office closures.

“These teeth that were just going to need fillings or stainless steel crowns now needed extractions,” Dr. Fuqua said. “Even one of the girls needed multiple extractions. That’s sad and that’s where COVID has taken us.”

The 2021-2022 school year was one of the first years that Save a Smile had well over 500 kids identified as a “class one, severe or urgent” category for needing dental care. Dr. Fuqua said that so many children have infections and abscesses. Usually, in previous years, there were 300 to 400 children considered class one.

Save a Smile has more than 86 volunteer dentists who provide children with comprehensive treatment as needed, whether it’s fillings, surgery, root canals, orthodontics, etc.

“We can’t do it without these private-practicing dentists saying yes, to opening up their doors to seeing hundreds of children for thousands of dental appointments and a ton of dental work being done,” Dr. Fuqua said. “We want to keep kids out of our emergency rooms at Cook Children’s and out of our Urgent Cares if we can – not for dental pain.”

Save a Smile community health workers will pick up students and take them to appointments if they don’t have transportation.

Jesusa Campos, Community Health Worker at Save a Smile, connects with families in need and met the three girls.

The girls’ parents were unable to attend the appointments, so Campos was there to coordinate between the parents and the dental offices. Sometimes within one week, Campos picked the girls up from school and drove them to multiple appointments.

She’s happy that the girls are doing better now and that they learned how to take care of their teeth.

“I love being able to help them to strive in life,” Campos said. “I can’t imagine having a toothache and having to go to school every day. I like helping them out and making sure they can continue healthy habits.”

During the early months of the pandemic and related closures, your child may have had a dentist appointment postponed. But now, the office is calling to reschedule that visit. You might be wondering if it is a good idea to visit the dentist right now?

The answer is “YES!”

Your dentist is an important part of your family’s health care team. Regular dental checkups provide a chance for dentists to identify any potential dental problems before they become worrisome. It’s also a great time for your whole family to learn about important habits that support not just a healthy mouth, but a healthy body too! And, don’t forget about that awesome new toothbrush you receive when you visit the dentist!

Children should have their first dental visit when their first tooth comes in, or no later than their first birthday. Then, visit the dentist every 6 months, because prevention is the best way for your child to stay healthy. However, if you see brown or black spots on their teeth or if your child mentions mouth or tooth pain, then call your child’s dentist right away.

So, what can you expect when you visit the dentist, in light of COVID-19?

Dental offices are receiving evidence-based guidance from The American Dental Association (ADA), the U.S. Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) regarding infection control.

Tonya Fuqua, DDS, director of Child Oral Health for the Center for Children’s Health, encourages parents to ask any questions they may have about current safety procedures.

“Call the office and ask questions about what procedures are in place to keep your child safe,” Dr. Fuqua said. “Knowing what to expect can help both you and your child feel more comfortable!”

You may also receive a phone call before your appointment to ask questions about your child’s recent health. Dr. Fuqua says that on the day of the appointment, “you may be asked those questions again, and you and your child will most likely have your temperatures checked. Your child may be asked to rinse with a special mouthwash at the dental office, so have fun practicing swishing and spitting at home before the appointment.”

The staff will be wearing personal protective equipment such as face shields, masks, eye protection, gloves and gowns. Let your child know that the people they usually see at the dentist’s office might look different dressed in all that protective equipment, but they are still the same people behind the masks. Looking at staff photos on the office’s web page before the appointment can help your child remember who takes care of them at the dentist.

You can also take a few steps to help support safety at the dental office. If you or anyone in your family are not feeling well, are running a fever or have any other COVID-19 type symptoms, please call the office to let them know before you go in. Because typically only one adult can accompany the child for the appointment, limit others who come with you that day (they will most likely have to wait in the car). Everyone over age 2 should wear a mask at all times and of course, wash your hands before and after the visit.

If your family has let toothbrushing routines slide, now is a good time to get everyone brushing 2 times every day, for 2 minutes each time. Kids can make and decorate brushing charts or calendars to help strengthen those good habits! Floss between your teeth 1 time every day. Children should begin to floss as soon as they have two teeth touching. Other mouth-healthy habits for the whole family include choosing water or unflavored milk instead of sugar-sweetened drinks, eating healthy meals and snacks, and limiting sweets and candy.

Remember, good oral health can lead to good overall health. Things may look a little different at the dentist’s office, but be reassured that your dentist will continue to provide the highest quality of care in the safest manner possible.

More on this topic:

• Dental Care
• Oral Health Education
• Neighborhood Clinic Dental
• Protecting Your Young Athlete From Dental and Facial Trauma
• How to Get Your Kids to Brush Their Teeth

It was reported by the American Academy of Pediatric Dentistry that sports accidents account for 10-39 percent of all dental injuries in children! These injuries can happen to a child’s face and teeth from falls, collisions, contact with hard surfaces and sports equipment. Activities such as riding a bike, skateboarding, hover boarding and jumping on a trampoline can result in injuries that affect the teeth and the face. The upper lip, gums and front teeth are more prone to injury. These teeth are subject to fracture, nerve damage, becoming loose and even falling out.

Not all sports-related injuries can be avoided, but most of them can be prevented! Wearing helmets, facemasks and mouthguards have been shown to greatly reduce the severity of dental and facial trauma. The National Federation of State and High School Associations only mandate mouthguard use for certain sports such as football, ice/field hockey, lacrosse and wrestlers wearing braces. But it is very important that proper protective equipment and mouthguards be worn for all sports that have the risk of injury (baseball, softball, basketball, soccer, volleyball, gymnastics to name just a few).

A mouthguard is made to protect the lips, gums and teeth from damage. They work by absorbing the energy from an impact and dissipating the remaining energy. There are many different types of mouthguards and if you are thinking of getting a mouthguard for your child, it is important that you visit your dentist. The best mouthguards are the ones that are custom made at the dental office. A mold is taken of the teeth and a mouthguard is made that is the right fit and comfortable for your child. If a custom mouthguard is not feasible for you, then there are many other mouthguards that are available over the counter. Even though they may not be a perfect fit, they will still provide offer some protection.

Bottom line, please protect your child’s face and teeth with the proper protective equipment while they are playing sports and having fun!

The CDC states that fluoride found in toothpaste prevents dental tooth decay (caries or cavities), but too much can create discolor and white lines or streaking (dental fluorosis) of the teeth.

Sheela Patel, D.D.S, and Shawne Barron, D.D.S, pediatric dentists for Cook Children’s, give the following advice to parents on how to take care of young children’s teeth:

1. Before teeth appear in your baby’s mouth, wipe down the gums with a warm, damp washcloth after feedings.
2. When the first tooth appears, begin to use a tiny amount of fluoride toothpaste, placing a smear that is the size of a grain of rice on the toothbrush that you are using.
3. After age 3, then begin using a “pea-sized” amount of fluoride toothpaste, and yes, it is always prudent for mom or dad or caregiver to dispense the toothpaste to ensure that the correct amounts are dispensed.
4. We recommend a toothbrush with a small head, soft bristles, and to replace toothbrush every 3 to 4 months, or when any sickness has occurred.

Their suggestions are in line with the guidelines from the CDC and the American Academy of Pediatrics.

The study from the CDC looked at the brushing habits of more than 5,100 children and adolescents aged 3 to 15 from 2013 to 2016.

The survey found:

• Nearly 80 percent of children began toothbrushing after the age of 1.
• Approximately one third brushed once daily
• Nearly 40 percent of children aged 3-6 years used too much toothpaste.

“Good dental health is critical for everyone, regardless of age,” Dr. Patel said. “It's important to remember that the health of you and your children’s teeth and gums can have a direct impact on their overall health. While poor dental hygiene can lead to gum disease, cavities and tooth loss.”

Good dental health is critical for everyone, regardless of age. It's important to remember that the health of you and your children’s teeth and gums can have a direct impact on their overall health. While poor dental hygiene can lead to gum disease, cavities and tooth loss, the bad news doesn’t stop there.

Several studies show that the bacteria in your mouth from periodontal disease (gum disease) can contribute to various health concerns.

Here are 5 health concerns you may not have realized that are currently being studied:

1.Heart disease - People who develop gum disease as a result of poor dental health, have a higher risk of also developing heart disease. The bacteria that causes gum disease can cause inflammation as it travels through the blood stream which in turn can cause a stroke or heart attack. And those individuals who already have existing heart conditions are even more prone to developing endocarditis (an infection of the heart) which can be life threatening.

2.Respiratory disease - Scientists have found that bacteria in the mouth can be taken into the lungs and cause respiratory diseases such as pneumonia.

3.Pregnancy - New research suggests a possible link between gum disease and babies born with low birth weight or premature babies. And optimal oral hygiene during pregnancy may decrease the amount of cavity-causing bacteria that can be transmitted to the new baby.

4.Alzheimer’s - There is current ongoing research that states that the bacteria originating from gum disease can travel to areas of the brain which can trigger Alzheimer’s later in life.

5.Malnutrition - Gum disease and pain can often lead to people not getting the adequate amount of calories and protein needed to maintain a healthy diet. Therefore it is not uncommon for children and elderly to suffer from malnutrition if they are experiencing dental pain.

So make sure you take care of those pearly whites for a great smile and healthy body!