Episode 91: Toddler Dental Health: Ages 3–6

Eon Engelbrecht: Hello and welcome to Save Your Money, Save Your Teeth with me, Eon Engelbrecht, and Dr Clifford Yudelman from OptiSmile. Today we’re talking about toddler teeth, specifically ages three to six: the independence years.

Eon Engelbrecht: Now, this is the stage where kids want to do everything themselves, including brushing, choosing snacks, and sometimes pushing back when it comes to routines. It’s exactly the stage where small habits can either protect a child’s smile for life or quietly set them up for painful problems—and expensive dental work—later on. So, if you’re a parent, a grandparent, or anyone looking after a child in this age group, you want to stay with us today.

Eon Engelbrecht: We’re going to cover the practical stuff you can actually do at home, from brushing and flossing to diet, dummy habits, and what to do if there’s a bump, a chip, or even a fall. We welcome back, for the first time in 2026, Dr Clifford Yudelman from OptiSmile. How are you, Doctor?

Dr Clifford Yudelman: Good thanks, Eon. So great to hear from you. Hope you had a great Christmas and New Year and we’re all ready to go. So, we did up to episode 90 just before we closed for Christmas, and we’re starting on number 91. The last one, if anyone missed it, was 0 to 3, and we’re carrying on. Be sure also to tune in next week where episode 92 is age 6 to 12, and you’ll have to listen to that to know why that’s called the “ugly duckling” phase.

Eon Engelbrecht: Oh, I think I know. We’re all ready for baby teeth, let’s do it. So, I want to start off, Dr Yudelman, by asking you: why are baby teeth still important between ages 3 and 6 if they’re actually going to fall out later anyway?

Dr Clifford Yudelman: Yeah, so this is one of the biggest misconceptions in dentistry, and it’s a costly one. Baby teeth are not “practice teeth.” Between the ages of 3 and 6, they play several critical roles that directly affect a child’s future oral health and development.

Dr Clifford Yudelman: Firstly, baby teeth actually hold the space for adult teeth. If a baby tooth is lost too early because of a cavity or an infection, the neighbouring teeth in front and behind will drift into that space. Later on, when the adult tooth tries to come in, there’s often no room left. That leads to crowding and the need for orthodontic treatment that could have been avoided. So, they maintain the space for the permanent teeth.

Dr Clifford Yudelman: Secondly, baby teeth are essential for chewing and nutrition. Children at this age are developing lifelong eating habits. If they’ve got painful teeth or missing teeth, it can push them towards softer, more sugary junk foods, increasing the risk of obesity and further decay.

Dr Clifford Yudelman: Thirdly, baby teeth are important for speech development. Certain sounds rely on the front teeth for proper pronunciation. Early tooth loss can affect speech clarity during key developmental years. If a kid loses the two front teeth early, when they make the “F” and “S” sounds, it can affect their development.

Dr Clifford Yudelman: And the last one is very important: an infection in the baby tooth can damage the developing adult tooth underneath. That can result in enamel defects, even a brown spot or discoloration on a permanent tooth, and possibly even weaker adult teeth later on. So, when we look at baby teeth through a long-term lens, protecting them is one of the smartest ways to save money, reduce future treatment, and set the child up for a healthy adult smile.

Eon Engelbrecht: So now they come to you and they say, “Mommy, Daddy, I want to brush my own teeth.” Should I let them, or must I still supervise, Doctor?

Dr Clifford Yudelman: Yeah, as you said, independence at this age is wonderful, but when it comes to brushing, supervision is still essential. The evidence is very clear that children under the age of seven or eight simply don’t have the manual dexterity—the actual capability—to brush effectively on their own.

Dr Clifford Yudelman: That doesn’t mean they shouldn’t brush themselves. It means that brushing should be a shared activity. Let your child brush first so they feel independent and involved, and then, as a parent, you can go back and do a second brush to make sure the plaque has actually been removed. A helpful rule of thumb is: if the child can’t tie their shoelaces properly, they can’t brush their teeth properly either.

Dr Clifford Yudelman: Young children tend to focus only on the front teeth. They miss the gum line, they rush the process, and plaque that’s left behind—especially near the gums and in between the teeth—is what causes cavities and inflammation. You should use a pea-sized amount of fluoride toothpaste. We’ve done some podcasts about that. Use age-appropriate toothpaste; they have special toothpaste with less fluoride for ages three to six. Brush twice a day with supervision. It has been shown to really reduce cavities in this age group. This small daily habit has an enormous long-term payoff. And speaking of payoff, it will save you a lot of money long-term.

Eon Engelbrecht: Now, I believe there’s something called the knee-to-knee brushing technique. How does this help reluctant toddlers, and what is it?

Dr Clifford Yudelman: So, the knee-to-knee technique is one of the most effective tools we have for brushing young children’s teeth, especially when cooperation is limited. It’s widely used by paediatric dentists because it’s safe and controlled. It’s reassuring for the child.

Dr Clifford Yudelman: Two adults sit facing each other with knees touching. The child lies back with their head resting on one adult’s lap whilst their legs rest on the other adult’s lap. This position gives excellent visibility and gentle control without force.

Dr Clifford Yudelman: For a single parent, a modified version can be done. If you sit on a bench or a low chair and the child sits facing away from you, their back towards you… their necks are so flexible, they can pop their head back onto your lap. Then, you use your right hand (if you’re right-handed) as if you’re brushing your own teeth. It feels very natural. The benefit is the child feels supported rather than restrained. You can see the teeth clearly, you can brush along the gum line, and you can finish quickly. From a psychological point of view, that reduces the power struggles. Brushing becomes a routine health task, not a negotiation. Studies have shown that consistent parental involvement in brushing significantly lowers early childhood cavities. It’s not about being strict; it’s about being calm, efficient, and protective during a stage where children can’t yet manage their own oral hygiene.

Eon Engelbrecht: And then, Dr Yudelman, at what age should thumb sucking or dummy use stop to prevent something like long-term bite damage?

Dr Clifford Yudelman: Most children naturally stop thumb sucking or dummy use between the ages of two and four. Up to that point, the risk of permanent damage is relatively low. Once these habits persist beyond the age of four, the risk of bite change increases significantly.

Dr Clifford Yudelman: Prolonged sucking habits can cause an open bite (where the front teeth don’t touch), protrusion of the upper teeth, and a narrowing of the upper jaw. These changes can affect speech, chewing, and future orthodontic needs. There’s a big push now regarding “airway dentistry”—I think it’s being a bit oversold—but basically, you need good habits like nose breathing to grow the palate properly.

Dr Clifford Yudelman: The evidence shows that the duration and intensity of the habit matter more than the habit itself. A child who lightly sucks a dummy occasionally is very different from one who does so fervently for hours. By age four, it’s advisable to start gentle habit-breaking strategies. You can try positive reinforcement. Limit the dummy use to when they’re sleeping only, and then take it out.

Dr Clifford Yudelman: Never shame them. There are ways to do this. I remember a book called David Decides. It’s a kiddie story I used to loan to parents. They’d read it, and the child would decide to stop. You can even use ChatGPT these days to make up a story or an animation to help them decide to stop. If the habit persists beyond age five, early dental or orthodontic assessment is recommended. Intervening early can prevent the need for braces later.

Eon Engelbrecht: Now Dr Yudelman, how do we handle the first dental trauma if a toddler falls, for example, and bumps a front tooth? What do we do?

Dr Clifford Yudelman: Actually, over Christmas, I was assisting a parent where a child got hit with a swing. We sent them straight to the Red Cross Children’s Hospital. Trauma in toddlers is extremely common. The most important thing is to stay calm.

Dr Clifford Yudelman: If a baby tooth is chipped, displaced, or pushed inwards, you generally do not want to try and reposition it yourself. Unlike adult teeth, baby teeth sit close to developing permanent teeth, so incorrect handling can cause damage. Often, if a baby tooth is badly displaced, it will be removed. One doesn’t go to great lengths to save baby teeth if it involves splinting.

Dr Clifford Yudelman: Check for concussion, lacerations, or bleeding, and see a dentist as soon as possible. If you leave it for a few weeks and infection sets in, that can be much more traumatic and expensive.

Eon Engelbrecht: And then I also want to ask you: is it necessary to floss baby teeth once the gaps between them close?

Dr Clifford Yudelman: 100%. Once the baby teeth start touching—specifically the back ones—you need to floss. There are just four little spots (between the first and second baby molars in each quadrant) that need flossing. That is where they get cavities. Many parents are surprised to learn that cavities between baby teeth are common and often invisible until they are advanced.

Dr Clifford Yudelman: It’s not about perfection but consistency. If you floss once a day, it significantly reduces decay risk. Research shows that early flossing habits help children transition more easily into adult routines.

Eon Engelbrecht: Doctor, what would you say are the best healthy snacks for this age group to avoid grazing cavities?

Dr Clifford Yudelman: Great question. The frequency of sugar exposure matters more than the amount. Grazing keeps the mouth in a constant acidic state. The best snacks are low in sugar and stimulate saliva: cheese, yoghurt, nuts (where age-appropriate), and cut-up vegetables like carrots or cucumber.

Dr Clifford Yudelman: Beware of sticky snacks like dried fruit; people think it’s healthy, but it’s high in sugar and clings to the teeth. Crackers are also terrible as they collect between teeth and ferment. Fruit rolls are terrible. Juice, even diluted, is a major contributor to decay. Water between meals is the safest option. Create clear snack times rather than allowing constant grazing.

Eon Engelbrecht: And Doctor, how do you manage dental anxiety if a four-year-old is scared of the dentist chair?

Dr Clifford Yudelman: Dental anxiety often starts with the unknown. At this age, the goal is familiarity. Early visits should focus on positive experiences—sitting in the chair, counting teeth, meeting the team—without invasive procedures.

Dr Clifford Yudelman: Parents play a big role. Avoid using words like “pain,” “needle,” or “hurt.” Children mirror adult anxiety. A calm introduction now can prevent decades of avoidance later.

Eon Engelbrecht: And are sealants recommended at all for baby molars, or is it only for adult teeth?

Dr Clifford Yudelman: It depends on who you ask. Paediatric dentists might routinely seal baby molars, especially if the child has a history of cavities or deep grooves. Sealants can reduce decay by up to 80%.

Dr Clifford Yudelman: However, in my practice, if a child has a good diet, good hygiene, and no history of cavities, sealing all eight baby molars might be an unnecessary expense. If not done properly, poorly bonded sealants can actually cause more cavities. Always check with your dentist for your specific situation.

Eon Engelbrecht: And Doctor, what is a pulpotomy in a baby tooth, and why would you save the tooth rather than extract it?

Dr Clifford Yudelman: Very important. A pulpotomy is a baby tooth version of a root canal, but much more conservative. It involves removing the infected portion of the nerve while keeping the rest of the tooth.

Dr Clifford Yudelman: Saving the tooth maintains space, chewing function, and comfort. Extracting baby teeth too early leads to space loss and orthodontic problems. A well-performed pulpotomy has a high success rate and allows the tooth to function normally until it falls out naturally. The philosophy is simple: preserve what nature gave us whenever possible.

Eon Engelbrecht: Dr Yudelman, thank you so much. That was another great episode, and we appreciate all your knowledge.

Dr Clifford Yudelman: Yes, thank you. I’m looking forward to the “Ugly Duckling” next week.

Eon Engelbrecht: Yes, looking forward to that as well. And that was Save Your Money, Save Your Teeth with Dr Clifford Yudelman from OptiSmile. If you only take one thing from this episode, let it be this: you’re not just looking after baby teeth, you are protecting the foundation for healthy adult teeth. If you found this useful, please share it with another parent. Thanks for listening, and join us again next time. Remember to take care of your teeth, and they will take care of you.