Brushing & Flossing

Brushing & Flossing for Children - A Pediatric Dentist’s Guide

The teeth your child has now matter - and the habits they form now matter even more. At Nickel Pediatric Dentistry, Dr. Andrew Nickel - a board-certified pediatric dentist in Vero Beach, FL - sees the long-term difference between kids whose families nailed the brushing-and-flossing basics early and those who didn’t. This page walks you through what works at each age, the technique questions parents ask most, and the rules that actually move the needle.

When to Start Brushing

Start brushing the moment the first tooth comes in - usually around 6 months. Use a soft infant toothbrush and a rice-grain-sized smear of fluoride toothpaste twice daily. (This is the current AAPD recommendation, updated in 2014 - earlier guidance to wait until age 2 or 3 is outdated.)

Once your child can reliably spit (typically around age 3), graduate to a pea-sized amount of fluoride toothpaste. Continue brushing for them or with them until their dexterity catches up - usually around age 6-8.

How to Brush a Wriggly Toddler

This is the question parents actually need answered. Toddlers don’t sit still. Most parents try to brush their child standing up, the toddler jerks their head, and brushing becomes a struggle. Here’s what works better:

• The lap-back technique: sit on the floor or a couch, lay your child face-up across your lap with their head resting on your knees. You’re now looking down into their mouth from above - the same angle a dentist works from. Their mouth opens naturally, you can see what you’re doing, and they’re held safely in place.
• Two toothbrushes: give your child a brush to chew on while you brush with the other. Their brush keeps their hands occupied; your brush does the actual cleaning.
• Sing or count. A 30-second song, counting to 30, or a short brushing app - whatever holds attention long enough.
• End with a small reward - a sticker, a high-five, a song. Brushing is a positive thing, not a punishment.

Brushing Technique That Actually Matters

For older children who can stand and brush themselves:

• Soft-bristled toothbrush sized for the child’s mouth
• Pea-sized fluoride toothpaste (rice-grain for under 3)
• Two minutes, twice a day - morning and bedtime are non-negotiable
• 45-degree angle at the gum line, gentle circular motions, not aggressive scrubbing
• All surfaces: outer, inner, chewing - most kids skip the inner and chewing surfaces
• Tongue: brush it lightly; this matters for breath and bacteria

The single most important factor isn’t technique - it’s whether the brush actually touches every tooth, every day.

When to Start Flossing

Flossing should begin once two teeth start touching - usually around age 2 to 3, sometimes earlier or later depending on how your child’s teeth come in. Once two teeth are in contact, a toothbrush can’t reach the surface where they touch - and that’s the most common place a cavity forms.

Until your child can tie their own shoelaces, you do the flossing. That’s a useful benchmark for fine motor skill - most kids can manage the dexterity to floss properly somewhere between ages 6 and 10.

How to Floss a Child’s Teeth

For very young children, the easiest tools are floss picks - the small Y-shaped or fork-shaped plastic flossers with a piece of floss strung across them. They’re easier than wrapping floss around your fingers in a small mouth.

For traditional floss:

• 18 inches of floss, wound around your middle fingers
• A clean inch between fingers for each pair of teeth
• C-shape the floss against the side of one tooth
• Slide gently down to the gum line, then back up
• Move to the next tooth with a fresh inch of floss

Floss before brushing is slightly more effective - a 2018 study in the Journal of Periodontology found this loosens debris that brushing then sweeps away. The ADA says order doesn’t matter much. Pick the routine your child will actually follow.