Massachusetts Makes Brushing Kids' Teeth the Rule

Jan. 27, 2010— -- While parents try all manner of incentives to get their children to brush, Massachusetts is trying to help them with new regulations on day care centers that have more teeth to them.

As of the start of the year, day care centers in Massachusetts must help children brush their teeth after meals or risk losing their licenses.

After the story was reported by ABC affiliate WCVB in Boston, the message board filled with comments. Some supported the measure because of the good oral hygiene habits it might help kids develop. Others said the state was imposing an undue burden on day care centers.

The new rule was put in place by the Massachusetts Department of Early Education & Care. While the toothbrush regulations themselves are new, department spokeswoman Constantia Papanikolaou told ABCNews.com, "We always have regulated child care."

The new rules, she said, were made based on the latest research on children's development and best practices for children's dental care.

Massachusetts regulations say, "Educators must assist children in brushing their teeth whenever they are in care for more than four hours or whenever they consume a meal while in care."

(Read the full regulations here.)

Papanikolaou clarified that the children need to brush their teeth at least once in day care, but not after both meals if they eat breakfast and lunch there.

"It's not 'after every meal or after every snack', it's 'incorporate this into your program once a day,'" she said. "It's a learned skill; it's improved by practice, so that is the underlying intention here."

A presentation on the department's Web site said the Massachusetts rules were not the nation's first; the federal Head Start program had mandated dental day care for kids without any problems.

Good Idea Or Overreach?

"The program was mandated in January, but the Family Tree Child Care Center in Pepperell, Mass., kicked off the program in November," said Kim Casey, the center's director. She said the center had a dentist come in to give the children a demonstration.

"He showed them everything from the how to brush your teeth to what to eat to promote healthy oral hygiene. He helped make the kids feel comfortable," she said.

The time needed to brush everyone's teeth did present a problem, said Casey.

"We had to cut back on one of our activities by 15 minutes to allow enough time for teeth brushing. But it's been working out really well. The kids love it…they see it as part of daily routine," she said. "We help kids as young as 15 months brush their teeth. For some toddlers and two-year-olds, as soon as they're done [eating] lunch, they ask to brush their teeth."

To some, the regulations may seem overreaching. The American Dental Association recommends brushing twice a day and flossing once, not after every meal, but the day care guidelines take better steps toward an ideal, dentists say, and reflect the extra care kids' teeth need.

"I think it is a very good idea," said Dr. Man Wai Ng, chief of the department of dentistry at Children's Hospital in Boston. "It increases the opportunities for children to receive tooth brushing and oral health care if they are in a child care center during the daytime."

Ng said having the day care center brush children's teeth can help parents out by supporting their efforts outside the home. It can be especially helpful if the children eat breakfast at day care, since the center then ensures they brush after their first meal in the morning.

Also, dentists say, the children may not be getting adequate brushing encouragement at home.

If they are brushing in day care, "Some of those behaviors can then go home for the parents to end up implementing in the home environment," said Ng.

Children also tend to consume more tooth-eroding sugars than adults.

"The kids seem to consume more carbohydrates," said Dr. Peter Blanchard, president of the DentaQuest Oral Health Center in Boston, and former chief of dentistry at Harvard Pilgrim Health Care, a nonprofit insurer in New England.

"The interventions that are necessary are to improve the diet and to have kids eat less sugary foods or carbohydrates," he said.

Cavities are an incredibly common phenomenon in children in general and in Massachusetts.

"Here is Massachusetts, 25 percent of kindergarten children have cavities," said Blanchard.

Fixing a Common Problem

So tooth brushing can prevent a health problem in addition to helping children develop a good habit for the future.

"These habits become routine after a while, so if kids are made aware they have to brush their teeth after meals, that becomes pretty much routine," said Blanchard. "It's a wonderful initiative; it certainly will have an effect on reducing cavities in children. It certainly is another duty for the daycare providers, but I think it is a very worthwhile pursuit."

And while most adults may not brush after every meal, "Ideally, you should," said Blanchard.

Parents in Massachusetts can opt out of their daycare's tooth brushing policy, but Casey said parents of children at her center have been in favor of the initiative.

"We've received positive feedback from parents...they think it's a good idea," she said.

And the new regulation seems to be working for the kids too.

"At first I was little nervous about this change, it was a bit of an adjustment to rearrange the schedule...but it was well worth the time," said Casey. "What helped is that children enjoy doing it. This is part of their own learning. "

The ABC News Medical Unit's Alessandra Sozio contributed reporting.