Chapter 3: Health Promotion and Protection
3.1 Health Promotion in Child Care
3.1.5 Oral Health
188.8.131.52: Toothbrushes and Toothpaste
After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).
In facilities where tooth brushing is an activity, each child should have a personally labeled, soft toothbrush of age-appropriate size. No sharing or borrowing of toothbrushes should be allowed. After use, toothbrushes should be stored on a clean surface with the bristle end of the toothbrush up to air dry in such a way that the toothbrushes cannot contact or drip on each other and the bristles are not in contact with any surface (1). Racks and devices used to hold toothbrushes for storage should be labeled and disinfected as needed. The toothbrushes should be replaced at least every three to four months, or sooner if the bristles become frayed (2-5). When a toothbrush becomes contaminated through contact with another brush or use by more than one child, it should be discarded and replaced with a new one.
Each child should have his/her own labeled toothpaste tube. Or if toothpaste from a single tube is shared among the children, it should be dispensed onto a clean piece of paper or paper cup for each child rather than directly on the toothbrush (1,6). Children under three years of age should have only a small smear of fluoride toothpaste (grain of rice) on the brush when brushing. Those three years of age and older should use a pea-sized amount of fluoride toothpaste (7). Toothpaste should be stored out of children’s reach.
Small smear of fluoride toothpaste Pea-sized amount of fluoride toothpaste
Photo Credit: National Center on Early Childhood Health and Wellness
When children require assistance with brushing, caregivers/teachers should wash their hands thoroughly between brushings for each child. Caregivers/teachers should wear gloves when assisting such children with brushing their teeth.
COVID-19 modification as of September 20, 2021
In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, toothbrushing may resume if programs can implement strategies to reduce the possibility of transmitting the virus to others via salivary droplets during brushing.
Refer to modifications in CFOC Standard 184.108.40.206 Routine Oral Health Activities for guidance on resuming tooth brushing in group care settings.Additional Resources:
Early Childhood Learning and Knowledge Center. Centers for Disease Control and Prevention. Toothbrushing in Head Start Programs During the COVID-19 Pandemic
RATIONALEToothbrushes and oral fluids that collect in the mouth during tooth brushing are contaminated with infectious agents and must not be allowed to serve as a conduit of infection from one individual to another (1). Individually labeling the toothbrushes will prevent different children from sharing the same toothbrush. As an alternative to racks, children can have individualized, labeled cups and their brush can be stored bristle-up in their cup. Some bleeding may occur during tooth brushing in children who have inflammation of the gums. The Occupational Safety and Health Administration (OSHA) regulations apply where there is potential exposure to blood. Saliva is considered an infectious vehicle whether or not it contains blood, so caregivers/teachers should protect themselves from saliva by implementing standard precautions.
COMMENTSChildren can use an individually labeled or disposable cup of water to brush their teeth (1).
Toothpaste is not necessary if removal of food and plaque is the primary objective of tooth brushing. However, no anti-caries benefit is achieved from brushing without fluoride toothpaste.
Some risk of infection can occur when numerous children brush their teeth and spit into the sink that is not sanitized between uses.
Tooth brushing ability varies by age. Young children want to brush their own teeth, but they need help until about age seven or eight. Adults helping children brush their teeth not only help them learn how to brush, but also improve the removal of plaque and food debris from all teeth (5).
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS220.127.116.11 Routine Oral Hygiene Activities
18.104.22.168 Oral Health Education
22.214.171.124 Sharing of Personal Articles Prohibited
126.96.36.199 Storage and Labeling of Personal Articles
Centers for Disease Control and Prevention. 2005. Infection control in dental settings: The use and handling of toothbrushes. http://www.cdc.gov/OralHealth/InfectionControl/factsheets/toothbrushes.htm
American Dental Association, Council on Scientific Affairs. 2005. ADA statement on toothbrush care: Cleaning, storage, and replacement. http://www.ada.org/1887.aspx.
- American Academy of Pediatric Dentistry. 2004. Early childhood caries (ECC).http://www.aapd.org/assets/2/7/ECCstats.pdf.
- American Dental Hygienists’ Association. Proper brushing. http://www.adha.org/oralhealth/brushing.htm.
12345 First Smiles. 2006. Oral health considerations for children with special health care needs (CSHCN). http://www.first5oralhealth.org/page.asp?page_id=432.
- Davies, R. M., G. M. Davies, R. P. Ellwood, E. J. Kay. 2003. Prevention. Part 4: Toothbrushing: What advice should be given to patients? Brit Dent Jour 195:135-41.
- American Academy of Pediatrics, Section on Oral Health. 2014 Maintaining and improving the oral health of young children. http://pediatrics.aappublications.org/content/134/6/1224.
Content in the STANDARD was modified on 2/6/2013, 04/22/2013, and 3/10/2016.
COVID-19 modification as of September 20, 2021