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Toothbrushing in Head Start Programs During the COVID-19 Pandemic

The following best practices were informed by the COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, prepared by the Centers for Disease Control and Prevention.

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Head Start programs should promote effective oral hygiene for all infants and children receiving services. Toothbrushing in group care settings can resume if the program can implement the following strategies and best practices:

  • Program staff who brush infants’ and children’s teeth or help children brush should be fully vaccinated against COVID-19 and should wear a properly fitted mask covering their nose and mouth. They may also consider wearing face and eye protection, such as a face shield, for additional protection.
  • For toothbrushing at the classroom table, seat children as far apart as possible, with staff supervising the brushing. After brushing, clean and sanitize the table. If toothbrushing at the classroom table is not possible, a small group of children can brush at the sink, one child at a time, with staff supervising. After each group of children brushes their teeth, clean and sanitize the sink. The toothbrushing area should be disinfected at the end of the day.
  • Encourage children to avoid placing toothbrushes directly on the classroom table or other surfaces.
  • Wash hands with soap and water for at least 20 seconds before and after brushing or helping infants and children brush their teeth. If soap and water are not available, staff can use hand sanitizer that contains at least 60% alcohol. After children brush, ensure that they wash their hands with soap and water for at least 20 seconds, or, for children over age 2, use hand sanitizer that contains at least 60% alcohol.

Programs should continue to follow these steps for hygienic toothbrushing:

Infants (Ages About 6 Months to Age 1)

  • Make sure that each infant has their own infant-sized, soft-bristled toothbrush. Label the toothbrush with the infant’s name.
  • Replace each infant’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
  • Wear a new pair of gloves for brushing each infant’s teeth.
  • Brush infants’ teeth with a smear (grain of rice size) of fluoride toothpaste as soon as the first tooth comes into the mouth.
  • When dispensing toothpaste from a tube, put toothpaste for each infant on the rim of a disposable cup or on a clean piece of wax paper, and scoop the toothpaste from there onto the infant’s toothbrush. (This prevents the toothbrush from touching the mouth of the tube.) Or, make sure that each infant has their own labeled tube of fluoride toothpaste.
  • Rinse each toothbrush and store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other.

Smear of toothpaste about the size of a grain of rice on toothbrush to use for children 1-2 years of age.Toddlers (Ages 1–2)

  • Make sure that each child has their own child-sized, soft-bristled toothbrush. Label the toothbrush with the child’s name.
  • Replace each child’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
  • Wear a new pair of gloves for brushing each child’s teeth.
  • When dispensing toothpaste from a tube, put a smear (grain of rice size) of fluoride toothpaste for each child on the rim of a disposable cup or on a clean piece of wax paper, and scoop the toothpaste from there onto the child’s toothbrush. (This prevents the toothbrush from touching the mouth of the tube.) Or, make sure that each child has their own labeled tube of fluoride toothpaste.
  • Help children brush their teeth.
  • After brushing, have children dribble or spit the remaining toothpaste into a disposable cup, but do not have them rinse. Then have children wipe their mouth with a napkin and place the napkin inside the disposable cup. Throw away the cups and napkins.
  • Do not allow children to play with toothbrushes.
  • Rinse each toothbrush and store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other.

Smear of toothpaste about the size of a pea on toothbrush to use for children 3-5 years of age.Young Children (Ages 3–5)

  • Make sure that each child has their own child-sized, soft-bristled toothbrush. Label the toothbrush with the child’s name.
  • Replace each child’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
  • Wear a new pair of gloves for brushing each child’s teeth.
  • When dispensing toothpaste from a tube, put a pea-size amount of fluoride toothpaste for each child on the rim of a disposable cup or on a clean piece of wax paper. Have each child scoop the toothpaste from there onto their toothbrush. (This prevents the toothbrush from touching the mouth of the tube.) Or make sure that each child has their own labeled tube of fluoride toothpaste.
  • Help children brush their teeth.
  • After brushing, have children spit the remaining toothpaste into a disposable cup, but do not have them rinse. Then have children wipe their mouth with a napkin and place the napkin inside the disposable cup. Throw away the cups and napkins.
  • Do not allow children to play with toothbrushes.
  • Rinse each toothbrush and store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other.

Content adapted from Checklist for Child Care Staff: Best Practices for Good Oral Health.

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,  Oral Health