How to brush a child’s teeth: from when, how much toothpaste, in what position and what to do when a child refuses to brush

From what age should you brush a child’s teeth?

A child’s teeth are brushed from the moment the first milk tooth appears. This usually happens at around 6 months of age, although in some children it comes earlier or later. The 2017 recommendations of the Polish Society of Paediatric Dentistry (Polskie Towarzystwo Stomatologii Dziecięcej, PTSD) and the Alliance for a Cavity-Free Future call for a soft toothbrush and fluoride toothpaste twice a day, especially before bed.

Even before the first tooth, the PTSD recommends wiping the gums and the lining of the cheeks every evening with gauze wrapped around a finger. This is about cleanliness, but also about getting the child used to someone looking into their mouth.

Brushing in the evening is particularly important, because fluoride then stays in the mouth longer, and during sleep less saliva, which cleans the teeth, is produced. After the evening brush the child should not eat or drink anything except water or unsweetened tea. From the first tooth it is also worth letting the child hold the toothbrush, so that they learn to grip it and put it in their mouth.

How much fluoride toothpaste for a child, by age?

The amount of toothpaste for a child depends on age: up to 3 years it is a smear the size of a grain of rice of 1000 ppm toothpaste, and from 3 to 6 years a pea-sized amount of 1000 ppm toothpaste. This is the recommendation of Polish experts (published in “Nowa Stomatologia” in 2019) and of the PTSD; ppm means parts of fluoride per million, and the concentration is given on the packaging.

The European Academy of Paediatric Dentistry (EAPD), in its 2019 guidelines, moves from a rice grain to a pea-sized amount as early as the age of 2 and recommends that parents help with or supervise brushing at least up to the age of 7. A toothpaste with a higher concentration for a child aged 3 to 6 at high risk of decay is chosen by the dentist.

The amount matters because a small child swallows some of the toothpaste, and according to the PTSD regular swallowing of fluoride toothpaste at around the age of 2 can cause marks on the permanent front teeth. Surveys cited by Polish experts found that 80% of carers of children under 2 and 75% of carers of children aged 2 to 6 use too much toothpaste. The safety of fluoride is discussed in more detail in a separate article.

How do you brush a small child’s teeth, step by step?

A small child’s teeth are easiest to brush standing behind them in front of a mirror, or sitting slightly behind and to the side, with their head supported and tilted slightly back. The first position is given by the PTSD, the second by HealthyWA, the government health service of Western Australia. The youngest children can be laid on their back across the laps of two adults sitting facing each other, knee to knee, as recommended by an NSW Health guide.

For milk teeth the PTSD recommends the Fones method, a circular technique: small circles are made on the outer surfaces of the teeth, and the chewing surfaces are scrubbed with a back-and-forth movement. From the age of 6, when the permanent molars erupt, the PTSD recommends the sweeping (roll) method, from the gum towards the edge of the tooth.

• Put an amount of toothpaste suited to the child’s age on a soft toothbrush.
• Stand behind or beside the child so that you can see all the teeth well, and support their chin.
• Start with the back teeth and then move to the front ones, which according to NSW Health are usually the most sensitive.
• Clean the outer, inner and chewing surfaces in turn, gently including the gum line as well.
• Count to five on each section of the arch and go back to it 2 or 3 times; the PTSD says that brushing this way takes 2 to 3 minutes.
• At the end let the child spit out the foam, but do not rinse their mouth with water, so as not to wash away the fluoride.

A child refuses to brush their teeth: what can you do?

When a child refuses to brush their teeth, do not force them, but try to find out what bothers them and change the approach, without giving up the evening brush. The NSW Health guide suggests checking whether the problem is the brushing itself, the foam or the taste of the toothpaste, and HealthyWA recommends choosing a time when the child is calm and making brushing a game.

If the resistance continues, NSW Health suggests wiping the teeth for a while with a damp cloth and a little fluoride toothpaste until brushing becomes possible again, and talking to a dentist about it. Persistent refusal to brush or bleeding gums is a good topic for a check-up.

• Time 2 minutes with an hourglass or a timer, which the NHS, the UK’s National Health Service, suggests as a bit of fun.
• Guide the child’s hand on the toothbrush so that they feel the right movement; this is NHS advice.
• Share the task, as NSW Health describes: one of you starts, the other finishes, and at the end you check the result.
• Distract with a song, music or a toy, and take breaks when needed.
• Reward a day with brushed teeth with a sticker on a chart, which the NSW Health guide mentions.
• If the foam or the taste is the problem, try brushing with water alone first, and then briefly with a toothpaste that foams less.

Electric or manual toothbrush for a child?

Electric and manual toothbrushes are both acceptable for a child, and the difference in effectiveness is small. A 2025 systematic review (Dağdeviren et al., 12 publications involving children up to the age of 18) found, with moderate-quality evidence, a slight advantage for electric toothbrushes in removing plaque, mainly oscillating-rotating ones, with no significant difference in the condition of the gums.

The PTSD writes that toothbrushes for young children can be manual or electric, with soft bristles, a small rounded head and a wide handle that is comfortable for parent and child. So the choice can depend on which toothbrush the child will actually let you use to brush their teeth for the full 2 minutes.

When should a child start flossing?

Flossing a child’s teeth starts when two teeth touch each other; this is what the American Dental Association (ADA) says on its MouthHealthy site. At first the parent flosses, and according to the ADA the child usually takes over the task at the age of 10 or 11, when their hands are ready for it.

The PTSD similarly states that children can use floss themselves from roughly 8 to 10 years of age, and that before then, already with milk teeth, parents should do it, taking particular care between the permanent molars. The PTSD recommends mouthwashes only for children over 6.

Until what age should parents help brush a child’s teeth?

A parent should brush a child’s teeth up to the age of 7 or 8, and then check and go over the brushing, even up to the age of 10. Polish experts (2019) recommend that parents brush children’s teeth up to the age of 8 and that an adult supervises older children; the PTSD adds that after the age of 7 or 8 carers should go over the brushing, especially of the molars, and check oral hygiene even up to the age of 10.

International advice points the same way. The EAPD speaks of help or supervision at least up to the age of 7, and HealthyWA states that children usually lack the skills to use a toothbrush properly until about 7 or 8 years. The NHS writes that a child should be able to brush their teeth alone from the age of 7, but it is still worth checking that they do it thoroughly for about 2 minutes.

How it works at DentalBlue

At DentalBlue in Białystok, prevention for children includes professional cleaning, sealing and fluoride treatment, and the clinic’s team includes dental hygienists. In the clinic’s price list, “Czyszczenie zębów z fluoryzacją” (tooth cleaning with fluoride) costs 250 zł, “Lakowanie 1 ząb” (sealing, one tooth) 220 zł and “Wizyta Adaptacyjna” (adaptation visit) 250 zł. At the visit it is worth asking to be shown the brushing technique and position on your own child’s teeth, and to have the places that are missed when brushing at home pointed out. The final scope and cost are set at the visit, and prices may change.