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.”

I have more than once used the "you don't want to be the kid that smells" tactic on my kids and once they are school age it usually works to get them to brush their teeth. In elementary school most kids don't care about life long health but they do care about friends and teachers. I prefer not to use star or sticker charts as I find they are more work for parents--but if this works in your family go for it.

Toddlers are another creature entirely. I suggest that parents start cleaning babies teeth early not only for health but to get them used to it. Under 1 year it can be as simple as wiping the teeth with a wet washcloth, but at 1 year I have families starry using a toothbrush. There are lots of little tricks out there to keep toddlers brushing. My favorites are singing or counting while brushing--same song every night--they love routine. Once toddlers get into the "I can do it myself now" stage, get 2 toothbrushes. Let the toddler "brush" with one and the parent can use the other at the same time to really brush. Does all of this fail sometimes--yes. I have I held my toddlers down to brush their teeth--yes. Have I skipped teeth brushing--yes.

For all kids one of the most important things a parent can do to protect the teeth is to keep kids off of sweet drinks--that means no juice--and not letting them fall asleep with a bottle or cup of milk after age 1 year.

I have seen many toddlers and young children over the years require anesthesia and surgery to repair decayed teeth. This is entirely preventable with good dental care. Please ask your pediatrician if you need help in carting for your childs teeth or contact one of the Cook Children's dentists.

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What if you then found out that you had been lied to about that day care’s license?

In fact, they didn’t have a license at all.

Fortunately cases like this are rare.

But what about a more common case where your child is bitten once or a few times at day care? What if your child is the one who is biting?

I reviewed the Texas Department of Family and Protective Services Minimum Standards for Child-Care Centers. Here is what I found:

• Parents should be notified about minor injuries when the child is picked up from day care (biting is included in this category).
• Relevant ongoing education is required for employees (and specifically mentions biting).
• Decisions about child/caregiver ratio must take into account situations where there are tricky situations. For biting, it suggests that a caregiver be assigned with training in redirection or that an extra caregiver be assigned.
• Biting is specifically prohibited as a means of discipline for a child (day care workers cannot use the old “just bite them back” techniques for biting).

What can you do?

Three tips if your child is being bit:

1. If it’s a one-time thing, try your best to let it go. I know this is hard but biting does happen and can happen in the blink of an eye even in very closely supervised environments.
2. If you start to notice bites over time, mention your concerns and assess what the day care is doing to prevent the issue.
3. If the bites are severe or very frequent, I would feel very confident suggesting that your child’s day care follow the steps as outlined in the Child Care Guidelines. This might mean that the day care needs a specialized or extra caregiver for the “problem” room.

Three tips if your child is the biter:

1. Do not feel guilty. Sometimes the day care will make it seem like your parenting is the problem. The reality is that you cannot do anything at home to teach a toddler to not bite at day care. Discipline in the toddler age does not work that way.
2. Discuss your child’s triggers with the day care. Biting usually occurs in predictable situations for children. You might be able to help them prevent biting in the first place.
3. Learn what works to distract your child. Children need to be distracted when they are biting. It’s clear from studies that direct punishment does not work well with toddlers. Teach the day care what strategies they can use.

“Proper dental care actually begins before the baby’s first tooth appears,” said Tonya Fuqua, DDS, director for the Save a Smile program, led by Cook Children’s. “As soon as the baby’s born, it’s extremely important to make sure that parents begin wiping the child’s mouth and gums with a nice clean baby wash cloth. The cloth should be soft and easy to get wet.”

The early cleaning with the cloth removes any remaining milk from babies’ mouths and helps them become accustomed to something going in their mouth for cleaning. So when babies begin getting teeth and brushing starts, they will be used to the parents placing their hands in the mouth for brushing.

Once you see the first baby tooth, you can begin using a toothbrush. You aren’t doing a lot, but you are introducing that feel of the bristles in the mouth so that as the baby develops more teeth, he or she will be used to a toothbrush in the mouth. Make sure you are using a soft bristled, age appropriate toothbrush. As your child has more teeth, a routine should be established of brushing two times a day, the morning and at bedtime. Dr. Fuqua gave us 10 other helpful tips parents should know about when caring for their child’s teeth:

1. Know the rules of twos. You should always brush your children’s teeth twice a day – every morning and every night for two minutes, regardless of how many teeth are in his or her mouth.
2. Did you know: A baby should never be put to bed with a bottle or sippy cup filled with anything other than water.
3. When should you schedule your first dental appointment? Find a dental home and take your child to the dentist by age 1 or earlier if you notice problems.
4. How dangerous is tooth decay (cavities)? Tooth decay (cavities) are the No. 1 long-lasting disease in young children – even more than asthma.
5. Can you catch a cavity? Germs that cause tooth cavities can be passed from parent or caregiver to a child. Choosing healthy behaviors from an early age will help prevent tooth decay (cavities) and improve a child’s overall health throughout his or her lifetime.
6. How do you prepare your child for visiting the dentist? Read your child a book about going to the dentist, schedule a tour of the offices before the first visit and role play at home on what to expect for the visit.
7. How long should you supervise your child’s brushing and flossing? As general rule, keep up with your child’s brushing and flossing activity until he or she is about 9 years old.
8. Which toothbrush should you get for your child? Choose a soft or extra soft toothbrush with the right size handle and head for his or her mouth.
9. How often should a toothbrush be changed? Every 3 to 4 months, when the bristles become worn or after there has been an illness.
10. What toothpaste should you use for your child? Use a rice-sized smear of fluoride toothpaste when the first tooth appears around 6 months until age 3. Then use a pea-size amount of fluoride toothpaste.

For more information:

The Children's Oral Health Coalition is working hard in the community to educate parents on the importance of caring for their children’s mouth and the impact their children’s oral health can have on their overall health. Find dental health resources here.