Your response to Betsy could be based on the following information:

Plaque removal is often a neglected part of the preventive program for infants. Plaque started forming as soon as Jessie's first tooth began to erupt. The plaque contains bacteria, many of which contribute to carious infections. Some plaque bacteria can cause gingival infections. Daily removal of this plaque will reduce the numbers and the virulence of the bacteria in Jessie's mouth, thus leading to a reduced risk for caries and gingivitis. Additionally, using a toothpaste with fluoride (remember that it has to have the seal of approval from the American Dental Association) will help to prevent caries in Jessie's mouth.

Positioning of the baby is the first step in efficient and effective plaque removal for Jessie. The two-person, knee-to-knee position illustrated here and described in the next section of this course is an ideal method of performing toothbrushing for the baby.

If it is not possible to have another person assist, the baby should be reclining when the brushing is performed. Perhaps an appropriate setting is one that is similar or identical to the area that is used for changing diapers. The main difference would be that the brushing should be done from behind the baby or to the side. Another suggestion is to have the child place his or her head in the parent's lap as the parent sits cross-legged on the floor. Jessie's teeth should be brushed for a minimum of two minutes to insure that all plaque is removed from the teeth. Betsy should brush Jessie's teeth with small circular motions with the brush up against the teeth, covering both the inside and outside surfaces of the teeth, as well as the chewing surfaces.

The parent or caregiver must take responsibility for this activity. A goal can be to have the child take more responsibility over the years, but initially plaque removal on a child is an adult's responsibility. Initially, a baby has only a few erupted anterior teeth and naturally enjoys putting anything into her/his mouth - this is a prime time to introduce a small toothbrush.

The adult's enthusiasm and willingness to tolerate some resistance on the part of the child will go far in establishing lifetime habits for the child.