Maintaining oral hygiene in pediatrics is essential for preventing dental caries, supporting speech development, and promoting overall health.
Indications
- Children receiving:
- Chemotherapy
- Corticosteroids
- Antibiotics
- Oxygen therapy
- Child requiring oral suction
- Intubated child
- Fluid restricted or nil by mouth (NBM)
- Dehydrated child
Principles of Pediatric Oral Hygiene
| Age Group | Oral Care Recommendations |
|---|---|
| Infants (0–12 mo) | Wipe gums with a soft, damp cloth twice daily. Begin brushing with a soft brush when first tooth erupts. |
| Toddlers (1–3 yrs) | Brush twice daily with a rice-sized smear of fluoride toothpaste. Supervise brushing. |
| Preschoolers (3–6 yrs) | Use a pea-sized amount of fluoride toothpaste. Teach spitting, not swallowing. |
| School-age (6+ yrs) | Encourage independent brushing and flossing. Supervise until consistent technique is established. |
Best Practices
- Brush twice daily with fluoride toothpaste.
- Floss once teeth begin to touch.
- Avoid sugary snacks and drinks, especially before bedtime.
- Schedule the first dental visit by age 1 or within 6 months of the first tooth.
- Use fluoridated water when available.
Watch For
- White or brown spots on teeth (early signs of decay).
- Bad breath, bleeding gums, or reluctance to eat.
- Thumb-sucking or pacifier use beyond age 3 (may affect alignment).
Parental Role
- Model good oral hygiene habits.
- Make brushing fun with songs, timers, or reward charts.
- Choose child-friendly toothbrushes and flavored toothpaste (fluoride-containing).
General Principles
- Inspect the mouth at least daily, noting the presence of Candida, ulcers, breaks in oral mucosa, saliva consistency, condition of teeth, tongue, gingival, and lips.
- Note pain or difficulty in using voice or swallowing.
- Consider using an assessment tool.
- Commence brushing routine with eruption of first teeth.
- Brush child’s teeth at least twice a day.
- Help and supervision will be required until around the age of 7 years.
- Antibacterial mouthwashes and antifungal preparations may be necessary for some children.
Equipment Needed
A clean tray containing:
- Soft pediatric toothbrush
- Fluoride toothpaste
- Jug with water
- Sterile water (for < 1 year baby)
- Gauze pieces in bowl
- Glycerin
- Torchlight to assess the condition of oral cavity
- Kidney tray
Preparation
- Explain the procedure to the child.
- Assess the condition of the mouth and need
for care. - Encourage the involvement and self-care where appropriate.
Procedure
- Perform hand hygiene.
- Gently brush teeth and gum with pediatric toothbrush and fluoride toothpaste for at least 2 minutes; use tiny smear of toothpaste and pea-sized amount for children.
- Encourage the child to spit after brushing; if they are able to, do not swallow.
- Rinse mouth with water (use sterile water for babies <1 year); if child is unstable to spit, gauze or swab may be used for this purpose or moisturizing the mouth.
- Orally intubated children should, where possible, have endotracheal (ET) tube moved to alternate side of the mouth daily.
- Apply emollient to lips.
Post procedure Care
- Praise the child for cooperation.
- Replace the articles and discard the wastes
- Record the procedure with date and time and observations made in oral cavity.
Special Considerations
- Introduce flossing once teeth begin to touch.
- For children with braces or appliances, use interdental brushes or water flossers
- Special needs children may have increased risk due to motor impairments, reflux, or chronic medication use.
- Fluoride use must be carefully monitored to prevent fluorosis while ensuring cavity protection.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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