Proper tooth brushing technique involves holding the brush at a forty five degree angle towards the teeth and gums with very short horizontal vibrations (four to five times). Move the brush back and forth with short strokes, about half a tooth wide. Brushing should start in the very back of the mouth, brushing one tooth at a time.


Whether your child is breast or bottle fed, be sure to wipe the gum pads and new teeth, under the tongue and inside the cheeks, after every feeding with a clean washcloth, moist gauze pad, or gentle finger. Be sure to also inspect the mouth, taking care to look for any significant changes in the color or depth to the tooth surfaces and be sure to report such findings to Dr. Ruelf upon detection. Once teeth are visible, use a moist soft bristle brush to begin cleaning them. You should use only a very light smear of toothpaste to minimize swallowing it. Dr. Ruelf will answer any specific questions you may have about taking care of your baby’s teeth.


Generally, begin to teach your child how to brush by age 2. Brush your child’s teeth at least twice a day using water and a half a pea-sized amount of toothpaste on a soft child’s toothbrush. For most toddlers, getting them to brush their teeth can be quite a challenge. Some suggestions for making brushing less of a battle can include:

Let him/her pick out a few toothbrushes with favorite characters and give him/her a choice of which one to use each time. (This will give your child some feeling of control over the situation.)
Let him/her brush his own teeth first. You will likely have to “help out.”
Use a stepstool and mirror to help him/her be proud of the results.
Read some children’s books about tooth brushing.
Have everyone brush their teeth at the same time.
Be persistent even if your child is resistant. The key to success is being consistent; brush your child’s teeth the same time, the same way, every day until they cooperate.

Middle Childhood to Teenage Children

At this age, children generally have the skills to brush on their own around seven or eight years old. Flossing can be more challenging and your child may be a teenager before they master this skill correctly.


It is important to remember that tooth decay is caused when bacteria in the mouth are exposed to sugar. Even infants can develop tooth decay with prolonged exposure to liquids that contain sugar, such as both bottle and breast milk or sweetened drinks.

Therefore, your child should not sleep with a bottle containing any of these liquids. If your child does need a bottle to sleep, fill it with only water. Care should be taken after each feeding to cleanse the mouth of residual sugars. Also, remember that the bacteria which cause cavities can be spread by sharing utensils, pacifiers, toothbrushes, or any other potentially contaminated surface exposed to your child’s mouth.

Older children should also limit the amount of sugary foods and drinks. Soda has both high sugar and acid content, making it a major contributor to tooth decay. Encourage your child to drink water after drinking an occasional soda and after every snack. Limiting snacks to no more than three times a day also keeps mouths from having prolonged periods of high acidity.

Remember to Avoid:
Regularly sipping on sugary or carbonated drinks
An abundance of sticky foods and hard candies
Remember to Have:
Plenty of water throughout the day to help buffer against acidic conditions in the mouth, as well as help clear trapped food particles.
A well balanced diet with plenty of calcium-fortified foods, helping to reduce done loss. Crisp fruits and vegetables, which help remove plaque from teeth.


As soon as teeth begin to touch and there is no spacing between teeth you should start flossing your child’s teeth. Flossing is difficult to do correctly. We do not promote the concept of using flossing aides.

A non-waxed floss should be used. Floss should be dispensed in a length of fourteen to eighteen inches. The floss should be taken between the teeth and then tightly wrapped in the shape of “C” or backward “C” depending on which direction you are going as you pull the floss back through the teeth. As in brushing it is best to start in the very back and systematically do each set of teeth. New floss should be used for each set of teeth as you proceed so it is best to wrap the entire length of floss around your fingers and unwind unused floss. As difficult as it might be to do correctly, we do not feel any child has the dexterity to floss correctly until they are thirteen to fourteen years of age.

Flossing with Braces

Flossing with braces can be a challenge for many young patients. Patients must begin by accessing the teeth and guns by threading the floss below the archwire. This is accomplished with a ‘floss threader’, or alternatively, floss that has a rigid end. Dr. Ruelf provides his patients demonstrations of this process and assists them in getting the hang of it quickly.

Common Mistakes

The most common mistakes made while flossing are the following:
Not flossing teeth on both sides of the gap
Flossing too hard
Not flossing under gumline
Not flossing everyday
Not flossing behind back teeth


Children between six months and 16 years may require fluoride supplements. Bottled, filtered and well waters will vary in the amount of fluoride they contain. Depending on certain factors such as your child’s age, risk of decay and the types of liquids your child drinks, Dr. Ruelf will help you access a fluoride treatment plan that is best for your child.

Sources of Fluoride

Community drinking water contains a fluoride concentration that will effectively deter dental caries. To check whether your tap water at home is fluoridated, you can follow this link. You may also utilize this link to determine whether your child’s school water system provides fluoridated water.

Bottled water is often fluoridated. The FDA requires that water bottles state whether they contain fluoride directly on the label. So if you’re in doubt, just check. Nonetheless, bottling facilities are not required to notify consumers as to the concentration levels of fluoride therein.

Toothpaste and mouthrinse are also excellent sources of fluoride. Higher concentrations of these products are available via prescription, as well as supplements. For patients who live in non-fluoridated communities, higher strength prescriptions may be recommended by Dr. Ruelf.

Lastly, there are a variety of professional fluoride applications such as varnishes, gels, foams, and pastes. These products work particularly well because the application process utilized by the dentist better incorporates the fluoride into the enamel of the tooth itself, which helps develop a more acid-resistant enamel.


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