The bristles of the brush should be angled toward the gingival margin, with light pressure applied in a circular motion. The occlusal surfaces can be brushed with a back-and-forth motion. Each area brushed should slightly overlap the previous section.
Positioning the child to assure stabilization and ease of access to the oral cavity can be accomplished by using a changing table or by placing the child's head in the lap of the caregiver. As the infant gains more control of the neck muscles, a more face-to-face approach may be attempted. Until that time, support for the head and neck are vital. By cradling the head against the caregiver's chest, one hand can be free to support the chin and one hand free for brushing.
The back of the brush or a finger can be used to retract the cheek and tongue for access to posterior teeth. Finger retraction of the lip will provide access to anterior areas.
Children will show signs of wanting to clean their own teeth by the age of 24 months. The fine-motor skills necessary for the child to adequately perform this activity are not yet developed at this age. The caretaker will still need to be on hand to coach, assist, and complete the procedure.
Toothpaste can be used as a means to deliver fluoride to the tooth surface. The use of a fluoridated toothpaste should always be supervised in this age group. For those under three years old, a smear or rice size amount of fluoridated toothpaste twice a day is recommended by the American Academy of Pediatric Dentistry and American Dental Association.12 A very small amount of fluoridated toothpaste, equal to the size of a pea, should be wiped onto the toothbrush by the caretaker for children over aged 3 to 6 years of age twice a day.12 Caution should be taken to prevent the swallowing of toothpaste during critical periods of enamel formation.
At age 3 to 4, a disclosing tablet or solution can be used with supervision. The stained plaque may help the child visualize the areas that need to be cleaned along with the effort and brush manipulations necessary to accomplish this task.