In today's post I am going to talk about neonatal oral care, the assessment of your newborn’s mouth, tongue and face for neonatal problems, and when to take your baby to the dentist for the first time.

You should start wiping your child's mouth as soon as they are born. You can use a moist face cloth or gauze to gently wipe their mouth. They will not mind this action as they are inclined to suckle anyway. It will quickly become routine for your child and make it easier to transition to a toothbrush when their first teeth come in, which is usually around 6 months. Teeth can already be present by the time a baby is born or they may not come in until the baby is one year old.

When the first teeth arrive in the mouth it is time to consider switching to a brush. There are huge variety of brushes on the market ranging from ones that fit over your finger to normal looking toothbrushes. I recommend using a small toothbrush because using one that is too large can cause discomfort for your child. You must be gentle when brushing your child's teeth. Aggressive brushing is uncomfortable and will be met with resistance. Plaque is very soft and is easy to remove, so there is no need to brush very hard. Children don't generally form tartar, and even if they do, it can only be removed with a scaler, so be gentle!

Ideally, you should brush their teeth after every meal, minimally twice daily. As they mature, they will want to start brushing their own teeth, so let them. They will not do a very good job, so you still need to keep brushing their teeth as you did before.

 The age to stop brushing their teeth for them varies. I jokingly tell parents to brush and floss their children's teeth until they can pay for their own dental visits. The reality is that most children do not do an adequate job and it seems to get worse as they progress into the teenage years. I find mechanical toothbrushes to be very helpful once a child is old enough to use one. They make them for children, and they can start using them as early as age 3. Sonicare and Oral-B are two of the best brands out there.

The best way to determine when you can stop brushing your child's teeth is to ask their hygienist how well they are doing. If your child's mouth is consistently healthy, then you can stop. The earliest age that this can occur is around 6 years of age. At some point you will have to stop brushing your child's teeth. If your child is not brushing adequately, there is a classic book (with an accompanying website) dedicated to enabling parents to set behavioral expectations. It’s called smart discipline. It is an amazing resource to move forward and avoid confrontation with your children and I highly recommend checking it out.

Toothpaste is an optional item for children and adults. If you want to use toothpaste, I recommend staying away from most of the commonly available toothpastes, especially those with fluoride. There are just too many questionable chemicals and additives in most toothpastes for my comfort level. I have DIY articles on this website here and here if you are interested in making your own toothpaste. If you don’t want to make your own toothpaste, I suggest Primal life organics dirty mouth tooth powder. Trina Felber has many great all-natural, holistic dental and skin care products to offer. Use the code DRSOLOMON for 20% off!

Flossing is generally not necessary, as there should be spacing between your child’s teeth. Primary teeth without spacing is a sign of dental arches that are too small. You will need to floss their teeth if they are touching and you should bring your child to the dentist to see if they are candidates for arch expanders.

The rule of thumb for the correct age to bring your child for their first dental visit is when they get their 1st teeth and no later than one year of age. You should use a pediatric dentist. They have special training in the oral development of children and young adults and are better equipped to diagnose issues early on than a general dentist. You would never consider taking a child to a general doctor vs a pediatrician, so the same should apply for your child’s dental care.

There are exceptions to the first tooth rule. Your newborn is assessed immediately upon delivery to make sure they can breathe properly. One of the first actions is to suction fluid from the mouth and throat, and to have the oxygen content of the blood monitored. As part of the initial airway assessment, the presence of a tongue tie should be identified. The Kotlow assessment classifies tongue ties in 4 classes according to the length of free tongue (the distance from the tip of the tongue to the attachment of the frenum). Class I (12-16 mm) is mild, Class II (8-11 mm) is moderate, Class III (3-7 mm) is severe, and Class 4 (<3 mm) is complete. A distance of >16 mm is considered clinically acceptable.(1) Severe cases can limit nursing and need to be addressed immediately. Milder cases can lead to breathing problems, speech impediments, crooked teeth and facial deformity.  It is easy to remedy by using a quick and simple laser method, typically done buy a pediatric dentist.

Small dental arches (micrognathia) can lead to breathing problems and many of the same issues as a tongue tie. The best time to address facial development is in a young developing child. Early treatment is usually limited to appliances and exercises. As children approach 10 years of age facial development can still be addressed but will require longer treatment and more invasive procedures possibly including surgery.

Malformations of the tongue, jaws and face can be life threatening and are assessed immediately after birth. Because many malformations including those of the mouth and face are caused by nutritional deficiencies and poor lifestyle choices by the parent, hopeful parents should start on a healthy lifestyle regimen before conception. Because the subject of prenatal lifestyle and nutrition is so complex, I will devote next week's post to that subject.