Oral Care Chronicles: SLPs and Pediatric Dentistry in Feeding Disorders

 

Brianna Miluk: Hello, hello, and welcome to The Feeding Pod. This is your host, I'm Bri, Brianna Miluk, and I am a speech language pathologist and certified lactation counselor. I specialize in infant and medically complex feeding and primarily see patients in the home health setting, although I do have some that I see an outpatient or via tele practice.

I'm also an instructor at the university level and a PhD student studying communication and information sciences. I have a huge passion for evidence-based practice and supporting information literacy in speech, language, hearing, feeding, swallowing sciences, specifically as it pertains to social media and translational research.

This podcast is meant to share anything and everything related to being a pediatric feeding SLP feeding therapist with sprinkling in a little bit about working in academia, being a Ph. D. student, and how to access, appraise, and implement research into clinical practice. Some episodes may contain guests, and I'm already looking forward to some of those coming up, while others might just be me rambling about something that's been on my mind.

Regardless, my goal with this podcast is that you walk away not just with newfound knowledge, but with the inspiration to think critically and not be afraid of research. So, without further ado, let's get into today's episode.

Welcome back to the feeding pod. I'm really excited today because I have Dr. Taylor McFarland with us. And if you don't know who she is, well lucky you, you get to learn a little today because Taylor is amazing. She's awesome. She is themamadentist on Instagram, Tik Tok, all the things I will be sure to link everything so that you can follow her. But if you want to learn about oral health and pediatric dentistry and how to help your child and your family through this, you know, just really tough process, then Dr. Taylor McFarland is, is who you got to check out. So, Taylor, I'm so excited for us to talk today. 

Taylor McFarland: I'm excited to be here. 

Brianna Miluk: And yeah, I'm going to pass it to you. Why don't you give us like a little bit of an introduction about like, who you are, what you do. I mean, I kind of gave, you know, a little tiny snapshot, but give all of our listeners like a better understanding of what it is that you do.

Taylor McFarland: Sure. I mean, I'm still figuring that out, right? I am 37 turning 38 this year. I've been practicing pediatric dentistry for a decade now, which is wild to say I feel so old, right? But it is just a fantastic kind of time in my life. I've got three young kids. They're three, and seven. I work part time in private practice.

So, I have patient families that I've gotten to know over just significant lengths of time. My husband and I both are professionals. He is an ophthalmologist actually. So, we've moved around a little bit with his training and we were in Texas, North Carolina. Go Devils. I'm a Duke-y. Sorry guys. If there are any Tar Heels out here turning it off right now.

We've been all over, but settled in Virginia where both of our families live and we're just, yeah, living the dream and I'm kind of messing around, figuring out more flexibility, I think, in my schedule to be able to do education, excuse me, to be able to do educational content online and help families beyond just the little brick and mortar practice, and then have this time to kind of lean into my kids and their schedules and their schools.

They're all in different places and different schools and different things. And it's crazy, but I love it. And it's just been so fun. And I'm excited to see what more comes from just opportunities like this. So, thanks for having me. I love being here. Love reaching new audiences and just talking about teeth as dorky as it is.

Nobody really cares about teeth like, and it's not that they don't want to, it's just really on the back burner and it's separate from medicine. It's just this weird space that people enter into kind of by accident. Like, Oh crap, I probably need to get to the dentist. My kids three. And so, we'll talk today about all the important stuff and get people an early start if we can.

Brianna Miluk: Yes. Yeah. I'm, that's what I'm really excited about. Cause I agree. And I think that you know as a speech language pathologist, like sometimes we also overlook oral care and how important it is for the patients that we're working with. Like if we are working on feeding or swallowing, we need to think about oral care and we need to make sure that we are also helping to support families on oral care recommendations from an evidence-based lens. And so, having you come in here and talk, I think is going to be awesome because we're going to get you know, that lens of like, what does the ADA say? Like what, what should we be doing? What should we be recommending? So, okay. My first question for you though, before we kind of get into the nitty gritty of oral care and keys is like, how did you get into pediatric dentistry?

Like, how did you decide like, that's where you wanted to go? Because like you said, it's like, I feel like it's a, a field that's super needed, you know, like we need pediatric dentists, but it is often overlooked. Like people forget about teeth and kids and what you're supposed to do there. So. 

Taylor McFarland: Yes, for sure.

Brianna Miluk: How'd you get into it? 

Taylor McFarland: Yeah. I mean, so my mentor Martha Ann Keels, she went to Duke also UNC and I found her in undergrad. I was pre-med at Duke and then I went and shadowed in the hospital and I was like, wait, like this isn't the type of relationship building. I want to like really know these kiddos.

And to be fair, it wasn't like traditional pediatrician in the concierge practice where I could have probably fostered or facilitated that. But I stumbled in then with a friend to Martha Ann's practice and she was treating children of children she had treated. And I just loved the longevity of that.

I thought it was so, so cool, that relationship building and yeah, right. Happenstance. I could have found a pediatrician probably the same way, but I just fell in love with her, fell in love with the practice of dentistry. I love the autonomy. I knew I wanted to be- hoped to be anyway a mother and I wanted flexibility in my schedule. Dentistry- nobody works on Fridays. Right. So, you have a lot more schedule flexibility.

Brianna Miluk: So true. 

Taylor McFarland: So, I just loved kids. I loved her practice. She really inspired me really in so many ways on my career path and it's just. Yeah, it's really fun. It's really rewarding. You get to help families. You get to help kids. And it's a relatively new specialty. So, Martha and she was one of the first people to enter into a pediatric dental residency.

And so, it's not been around a super long time and you know, like a little bit older than us. A lot of the parents of the kids that we see have a lot of fear around the dentist and it's because general dentists don't always have, you know, I don't know, kid gloves, right? And so, there's some trauma that's happened from dentistry and that's really the overarching goal I would say of pediatric dentistry is to create people who are comfortable at the dentist lifelong. We want to create patients for forever. And we're all about reducing trauma, making stuff accessible, making it fun, making it enjoyable, not just for the kid, but for the family. 

Brianna Miluk: I love that because I feel like that is sort of like this generally- generational trend that was seen for a long time is like the caregivers like the parents didn't like the dentist and so they would kind of almost like believe that onto the kids a little bit like yeah you know the dentist isn't fun but we have to do it and it's like well that's not putting the kid in a position to like get ready for the dentist now.

And so I have been really excited to see even in my area, like more pediatric specific dentist offices opening up, which I think is, is really important because like you said, there's like just a different lens you're looking through and a different approach that you're going to take with your expectations of how a child's going to come in, what you expect them to do and all the ins and outs of that as, as compared to the adult.

But it also really establishes like the dentist is an okay place to go to because I have found like I've seen, I've had friends and stuff that are like, I haven't been to the dentist in years because like, I just think back about how terrible it was. And so, they do put it on the back burner because they're like, it's just not.

It's, I mean, being in anybody's mouth is super invasive, like any type of oral, you know you're even just looking in the oral cavity for some kids is like, you're too close. This makes me uncomfortable. 

Taylor McFarland: Absolutely. And we're laying them back, you know, all the more. We all know anyone who's tried to change a diaper on most children, they, kids don't like laying back.

And so, there's so much building of trust and not just in that child, but the parent more than anything. And there are studies that show like the parental anxiety correlates to the child's anxiety and then future behavior. So, it's like, we really are, we realize as professionals, we're helping build the confidence and comfort level of those parents, if not first, before even that child.

Brianna Miluk: I think that also sort of leads into one of my first questions for you. So, we're talking about just like some of the more, more common questions in oral care in pediatrics and one of them is like the first trip to the dentist and I'm thinking a lot of the reasons this number has gotten a lot lower like, yes, because of tooth care, but also to build that trust and to build that report early on.

So, could you talk more about that? Like what is the recommended age? Because I'm pretty sure when I was growing up, it was like two years old or three. 

Taylor McFarland: Absolutely. Yeah. You know, it's wild because it was, I think 2003, it was 2001, 2003, the AAP. So, the American Academy of Pediatrics and then the American Academy of Pediatric Dentistry, they both established what's called the dental home guideline.

And that is that all children should have a dental home established by 12 months of age. So, one year. So, you'll see a lot of people on social media like me, they're like first visit by first birthday. And I can't tell you the number of people that comment like, wow, this is a scam. What are you doing? But you're exactly right.

It is building rapport. It is building that child's comfort. I can't tell you the difference between a child that we've seen from babyhood that has come to see us, see us and been able to establish kind of, oh, this is separate. It's distinct from the pediatrician. They're not giving me shot here and we get different prizes here, different people.

But yeah, building rapport, getting them comfortable with laying back with having someone looking in their mouth. And we're able to show to the parents early on key things that often are missed that a lot of parents don't realize, you know, brushing the back of the teeth, moving the tongue out of the way and how to do that.

Things that seem straightforward, but we don't get a manual with our kids and there's a lot that's really easy to miss or not understand until you're shown. And so, yeah, age one is the official recommendation that surprises a lot of people. I also encourage people to not feel guilty if that was not you.

So many kids still come at two and three. They're even misguided by pediatricians and their family dentists who still, even though it's a 20-year-old policy, aren't recommending themselves that children get in by age one. So even within our own profession, we are fighting to get our own fellow professionals to send children to us pediatric dentists by age one.

A lot of families don't realize there's a difference. And I think we're going to talk about this is like, how do you find a pediatric dentist? So, there's a locator on the AAPD webpage. I actually have it linked on my, themamadentist website, FAQ page too so that people can type in their zip code and find a true residency trained pediatric dentist.

So, we go to two or three additional years of training after dental school. So, four years of dental school and then two or three of training. You can get a master's or just a certificate. And that is a true residency trained pediatric dentist in the interim, like because pediatric dentistry is growing in popularity.

It's also growing as like a business and a lot of Companies are creating like offshoots and I won't say the names because I probably can't right? But you've seen them around like these clinics that are geared toward kids, but they're not actually ran by pediatric dentists or maybe they're owned by one, but they're not employing pediatric dentists.

And so, these are the questions for parents to be kind of judicious consumers and for providers recommending as well as like "Smiley Tooth" sounds kid friendly, but it may not be a pediatric dentist. And so, to make sure that the place you're going is listed on that website, that's a safe way to know. And then just ask them their credentials, ask the credentials of the provider treating the child. So, I'm seeing Dr. Smith. Okay. What is Dr. Smith's training? It should all be online. You should be able to find it pretty easily on the website if it's legit. 

Brianna Miluk: Yeah. Yeah. No, absolutely. I think that's really important. And I see that, you know, theme across the board in like other types of practices as well, like other types of disciplines where, you know, they, they're like, oh yeah, we take like birth through adult and it's like that is great, but like, I would really like someone who specializes in like, pediatrics, like my, my child's age range. Now, okay, this is just like a spinoff question that I have. 

Taylor McFarland: Sure. 

Brianna Miluk: So in pediatrics, obviously you know, I'm, I'm sure you're trained like from, you know, birth to like, usually pediatrics is considered like 21 years old, but do you find that like there is a certain age where more kids will transition to a more like standard dentistry, like even before they reach that age, or do you find that kids will typically hang out, like through, you know, 16, 17, 18, 19 plus years old?

Taylor McFarland: It really depends on the family and the kid. You know, we have some that like want to come back from college and still see us. We have some kids- so as a pediatric dental specialist, we manage kids with medically complex needs. Right. And so, some of them we want to see even into adulthood. At University of North Carolina, where I trained, we had a clinic in undergrad where we would do a pediatric dentistry rotation and we would go through there and it was adults still with medically complex histories that they were seeing into adulthood. You can't often do that in private practice. It's harder just by sheer patient numbers, but that's one of the big gaps in dental care and where there are so many right in the United States, but that is one where medically complex patients with more adult dental needs, like they need a root canal.

They don't want me doing their grownup tooth root canal. Right. And so, it's finding care for them. Most kiddos will, I'd say when they get their permanent teeth, all permanent teeth set, around age 12, like we're starting to encourage them to move up to the grown-up dentist.

One, if it's a busy area, there aren't enough pediatric dentists to go around. We want the kiddos who really need us, right, to build rapport, who are nervous to, to have us when they most need us, that really young age, like zero to 10 is kind of the prime time for pediatric dentistry. But you do have some kids with high anxiety, with other things going on that we keep, you know, on into 16, 17, 18. And our practice, our goal is to get them established with a general dental practice before they go to college so that they have somewhere they're set on recare so that they're kind of come back because you don't want to graduate them. 

Brianna Miluk: Also, that flexibility a little bit. Yeah. Cause you don't want them to go and be like, Oh, well I'm only going to go see my dentist which is it's going to be really hard schedule wise. So very cool. I love that you think about that ahead of time too. Like you're already thinking like, okay, well like our goal is always to like transition to general dentistry so that when the time comes you can have that flexibility. 

Taylor McFarland: Yeah, that's what we want.

Brianna Miluk: Cool. Okay, so another question that I have that I feel like comes up a lot is like choosing a toothpaste. So, like when to start using a toothpaste as well as like what are the things that we should be looking for in a toothpaste to make sure that it's like safe and effective for what we're trying to achieve.

Taylor McFarland: Well, as with everything, right, where there's profit and companies trying to make one it is kind of a gray area. And so, let's start with the official recommendation. So, in 2014, before that time, the American Academy of Pediatric Dentistry did not recommend fluoride toothpaste for kids aged two and under.

And so, most people, even most dentists, like general dentists, remember that. But in 2014, which doesn't seem like it was that long ago, but dear God, it's almost 10 years ago now, they changed to include fluoride toothpaste for kids as soon as the first tooth comes in. So, which is around six months of age through age two, and then at age three, you up it in the amount.

So, the size they want you to use when they're a little bitty is a grain of rice size. I tell parents, it's the white part of your pinky fingernail. It's not much at all. A jasmine. They're like, is it wild grain, long grain rice? Like what? Jasmine rice we'll say. 

Brianna Miluk: Which type of rice?! 

Taylor McFarland: I literally get that on Tik Tok like every other day. I'm like, you guys, are you trolling me or is this a real question? Jasmine rice.

Brianna Miluk: We'll give you a specific one, jasmine, okay. 

Taylor McFarland: White jasmine rice, that amount from the time they first get a tooth twice a day, morning, nighttime brushing until two. And then when they turn three, you switch to a pea sized amount. And then as an adult, there's a fun, fun fact for you and your listeners, the swoop of toothpaste you see on pictures, it's called a nurdle.

And your nurdle does not need to be like an inch long like you see on the product images. You never need more than that pea sized amount, save you a bazillion dollars on toothpaste. So, the companies hate that. But it's really confusing when you go out to buy a toothpaste because you see training toothpaste and you'll see on bottles that say two plus, and they're still in that 10 years ago time frame of if it has fluoride, it's not for kids under age two, and even though it says two plus on the package, you look on the directions on the back, and it'll say consult a provider under age two, I think they do the same thing with Tylenol and other stuff, and it's because it's like, it's more nuanced, like you want to be sure your child's not getting overexposed to fluoride.

This is why we want you to have a pediatric dental provider. Because say you have a child who is on formula, so they're formula fed, and you're constituting that water with the only clean water that you have, which is tap water, and that's fluoridated. Suddenly, your child might be getting more fluoride than someone else, and we may not want you to use fluoride toothpaste under age two.

We might be like, they're getting enough from their formula in that water, actually. So, it is nuanced, but by and large, the recommendation is fluoride zero to two in that grain of jasmine rice size amount. And you can use any fluoridated toothpaste, at least in the U. S. All toothpastes are the same amount, 1,100 parts per million, unless it's prescription of fluoride so grown up toothpaste, kids toothpaste, it's not so much to say go buy like You know, grown up toothpaste for your child, but rather if you're an adult that hates mint, there are so many fun toothpaste flavors out there. There are some great ones. I list a bunch of them in my little Amazon shop. Tanner's Tasty Paste is my go-to.

They have some really fun ones. Hello Brand, you can find in Target has some fun ones. And then an unflavored paste that a lot of our patient population is interested in when they struggle with flavors, some type of sensory aversion. Dr. Bob is one, a pediatric dentist invented and it is flavor free.

It's only sweet that I really like. So those three are my go-to-s when parents ask for toothpaste flavors. If you want a brick and mortar store, easy to find one. Hello. Or even just Crest Kids. One consideration I talk about online a lot is if a child is saying the toothpaste is spicy or that it burns, it's because it has an ingredient in it called SLS, sodium lauryl sulfate.

And that foaming agent is what makes it feel clean. So, we, as adults were like, it needs to have the foam, kids hate that because it burns and adults hate it too, when they realize that sometimes they're sensitive to that. And they might be getting frequent mouth ulcers. from it. So that's a hot tip.

Whenever I see a kid with frequent mouth ulcers, if we ruled out other things like celiac and vitamin deficiency, I'm like, are you using toothpaste that has SLS in it? And a lot of times stopping that can make those go away. So that's the main thing I encourage people is just use a kid flavored fun toothpaste.

Ideally, probably one SLS free if you can afford it. If you can find one of the fancy shmancy ones. Hello, is SLS free and that's a Target. So, you can find that there on Amazon. 

Brianna Miluk: Okay, so I have a side question on toothpaste. This is one that I've gotten a couple times from caregivers is, like, powder toothpaste versus, like, toothpaste from the tube.

Now, from what I've seen in powder toothpaste, there tends to be a lot of, like, appeal to nature with those. 

Taylor McFarland: Yes, it’s like yeah more natural. 

Brianna Miluk: Like, it's more natural, it's this, a lot of them don't have fluoride so I would love to just hear your, just a brief take on, on those. 

Taylor McFarland: Sure. I mean, I've, I'm in the land of Instagram, so I have heard much of the powder toothpaste of Esty. First I would say I would never buy a product that was putting into my child's mouth that was not from some type of like regulated place and even homeopathic things like vitamins and stuff like they're not regulated by the FDA and the FDA is not perfect sure by any means and we won't go off in the conspiracy theory land but generally I want something that is going to be quality controlled.

I know it's not made in like Joe Schmo's kitchen and there's no contaminants or allergens or just weird stuff. So, most of those powdered paste, if it's not from like a legit company, I wouldn't be buying enough Etsy. I wouldn't be making it myself. Like, I don't know, like nothing. People think that natural means it's benign or it's safe.

And it's not like these essential oils. They've got studies coming out about lavender and like hormone stuff. And so, yeah. So, I'm very hesitant about the natural world as people putting something off as like safer or better for you. When we have very little knowledge about whether or not something is, but people are out there, like it's natural.

I made it. Buy it for $23. So, I'm all for someone who is hesitant about fluoride, but I would buy a paste that is fluoride free from a legitimate company. And so, like Rise Well, I think is a pretty good one. A lot of people like that one has a cake flavor. It doesn't have fluoride and that's okay.

Like if that's a personal family's choice, they don't want to use for it. You don't have to, but I just want you to be safe. Use something from a legit place. Not like Etsy. The powders are newer. I don't know one from a legitimate place. I'm not sure if Rise Well has one. They tend to be more like these weird areas.

The thing about powders is they're often putting stuff in it as abrasives to like clean. Okay. Kids don't have a lot of stain like we do, like we're here drinking our tea and coffee, right? Like we need stain removal and that you get that from abrasives. But there are like a whole chart from the ADA about abrasive levels in certain toothpaste.

And you can get things that are really abrasive, causing a little like micro scratches in your tooth that can make you more prone to bacteria buildup, more prone even to cavity formation. So, you don't know what they're using it as an abrasive. A lot of times it's like bentonite clay. And it's just things that aren't standardized again, not studied by the people who are doing the dental stuff you want studied.

So, I would just stay away from things that aren't from a legit company. The powder I'm kind of sketch about, but again, if that's what you got to do, because your child is averse to a paste, a texture. I would almost rather you use just like fluoride, water, and a plain toothbrush because your toothbrush is what's truly doing the cleaning.

The toothpaste isn't like soap. It's not antibacterial really, like fluoride is considered antibacterial a little bit. But it's more that it's strengthened the enamel by forming fluorapatite, making the little crystals more acid resistant. It's not so much as like killing bugs. So really it's just your toothbrush. Brush with just a toothbrush that's going to clean off the plaque. 

Brianna Miluk: That really goes into my next question, which is like selecting the toothbrush. So, when we're selecting the toothbrush, you know, there's all these different like tools and things that are marketed to families, right? Of like the, there's a finger brush, there's a three-sided brush, there's a, this one with the little rubbery things in it versus like a soft bristle toothbrush. So, when you are helping families selecting a toothbrush, now we are talking specifically about pediatrics as well. So, a little different. You know, what are some of your thoughts about selecting a toothbrush? 

Taylor McFarland: Yeah. I mean, the most important thing for people to understand is that anything that's not a nylon bristle toothbrush or like bamboo or whatever, but like an abrasive type of bristle versus these little basting brush type bristles like the silicone brushes. Those silicone brushes are trainers, so it's to like desensitize them to clean and cleanse their tongue or their gums. You're using it before teeth come in, but once teeth come in, you need that mechanical cleansing from a firmer bristle.

So typically, nylon or like a bamboo, whatever type bristled toothbrush. And then from there, it doesn't really matter what kind, whatever fits in your child's mouth, whatever is soft from, again, a reputable company, you don't want something where the bristles are going to fall out and they're going to like inhale them or swallow them.

We've all seen the, like the horrifying grill brush stories and the bristles. And I think of that with toothbrushes, because there are some brushes that you're like, where are these coming from? And they're not very well made. And so again, good product, reputable company, Oral B. They have a zero to three Winnie the Pooh series.

That's what we give out in our office. They're really cute. It's a soft flat head. It's easy to access all the teeth. If you have a kid that's biting down or you've got to be really quick, right? And efficient. Those triple sided toothbrushes are great. There's two that I like the snot sucker people Frida Baby.

They make one you can get on I think it's a Target. And then there's another one that's from a more specialized company. It's a slightly bigger brush, so for an older child, but it's called surround by Specialized Care Co. And that's my favorite. My go to is a little more expensive, but it's great.

Really firm bristles in that triangle shape that cleans all sides of the tooth. At the same time, you can couple that with like a mouth prop to help them stay open. I'm an affiliate for one called the brushing buddy. That's like a little dinosaur teether. And it has a tail on it. You can put between their teeth.

I love that thing. I use it in the office for like the baby exams to like hold them open so I can show the parents and then they get to take it home. And so those tools I think are my three go to just like a nylon regular old toothbrush, a triple sided toothbrush if they're biting or they've got molars or they're any kind of difficulty with brushing with who doesn't have difficulty brushing their two-year-old. I mean, let's be real. And then the little brushing buddy, like a mouth prop. Those three things. 

Brianna Miluk: This is a side note for any feeding therapists listening but notice she did not say a foam brush. Those dang foam brushes. 

Taylor McFarland: They don't clean. 

Brianna Miluk: They don't clean. We gotta stop. Don't. Do not use the toothette. 

Taylor McFarland: Yes.

Brianna Miluk: Foam brush to brush teeth and do oral care. That's my, that's my little side soap box. Okay. Final question in terms of like the products we're using. So, mouthwash, should we be using mouthwash? How do we use mouthwash? Like do we need to use mouthwash for kids? What's that like? 

Taylor McFarland: For kids and adults, right? It's like, is this really necessary? 

Brianna Miluk: Yeah.

Taylor McFarland: I think for most people, unless your dentist specifically says you need it for a reason, like added anti cavity benefit, bad breath, you know, sodium chloride or whatever the ingredient is. I can't remember the name. It's not that I think that's bleach, but whatever, but not bleach ingredient is that's going to be helping with bad breath.

You don't usually need a mouth rinse or if you do, it's for a specific period, like someone with periodontal disease or a child that might have really severe gingivitis. Maybe they put them on a specific mouth rinse for like two weeks, but it's not usually something you need daily. And at least with like an anti-cavity fluoride rinse.

That tends to be something that the added benefit is that stronger fluoride exposure at a different time of day. It's not going to be with like tooth brushing. The one time I recommend mouthwash is actually when it's a child that can't tolerate paste or foaminess. And I say, well, dip the toothbrush in that and at least get a little added fluoride concentration, use that as sort of like a toothpaste substitute.

And that's just me. And like one of my little tricks, it's not an official recommendation or whatever of the AAPD, but that is something that can help get a little flavor, if you want a little flavor, for a kiddo in a little extra fluoride, if they're not tolerant of traditional toothpaste, but most kids do not need mouth rinse unless the dentist specifically has a reason for it.

Kids, once they're around age six, that's when they're best able to fully spit out mouthwash. And so, if that's something you want your child to do, we generally recommend at least waiting until age six, you can do what I call the Dixie cup test where you fill it. However much, you know, the act rinse has a little, like, dispenser in a level.

You pour that in the Dixie cup, mark it with a sharpie, have them swish, have them spit it back in the cup. Did it get back up to the sharpie level? If it did, they're spitting most of it out and you're safe to try starting mouthwash. 

Brianna Miluk: Awesome. I love that. I love that little test to kind of check us out. And I have kind of the same thing as what I've done in practice, based on other recommendations, like if they can't tolerate toothpaste, then if anything we can just dip and get a little bit of fluoride support in their oral cavity. And then also, like, I've had kids that are more medically complex, that we really need to kill all the germs in their mouth that we'll use like an antiseptic, like mouthwash, to actually kill all the bacteria in there. But same thing, we're kind of just dipping and then brushing to make sure that we're getting it all out. 

Taylor McFarland: Yep. But that would be a good indication. And when we talked about periodontal disease, something like that, or a kid with dysphagia, like you really want to be sure you're killing these bad germs. And yeah, the good reason to do one that's more strong.

Brianna Miluk: Okay. So next question I want you to kind of just, and you can just. Give us, give these to us quickly, you know, it's like, what are your top three strategies for improving a toothbrushing experience with kids? Like, what are your go to-s when someone's like, I'm struggling to get my kid to brush their teeth, you know, I'm like holding them down while someone else is brushing. It's very traumatic for them. Like, what are your top three tips to kind of get there? 

Taylor McFarland: Sure. I mean, I think it's so much of it comes down to it's so much more than just tooth brushing. A lot of times. It's just like that kind of, I don't know, figuring out how to make that time something that isn't stressful.

And you see similar kind of trends with taking medicine, that if a child has had a negative experience with it, with tooth brushing, they've been held down and forced to do it. And you're now kind of backtracking, like how do we rebuild this experience? I kind of call it toothbrushing boot camp in a way that if you haven't started a certain way, you're now trying to step back and get it a certain way.

And that's sort of a different question than like just starting generally, right? So, I'll start first with like, let's talk about backtracking and like, how do you kind of stop and reassess? And a lot of it is for us, I think, as the caregiver to be a little more chill. about it, like to give yourself two weeks and be like, okay, it's not going to be perfect for this two-week period.

And I'm going to just try to work it out and make this more positive. And one of the best things you can do with kids is be a little bit silly and to give them a sense of autonomy and purpose. So those are the two things I do with my own kids when they start to be resistant at all to some type of task.

I'm like, well, do you want to do the red toothbrush or the blue toothbrush? Do you want to stand on your stepping stool or lay on the floor and let mommy brush your teeth? Do you want to like, just give them choices so they feel they have this autonomy and then make it fun? Like I will tell the story. I will make up stories about the sugar bugs in their mouth.

I'm like, that one has red tennis shoes on. He's running really fast. Oh my gosh. He just jumped to the back and they're like on the edge of their seat as I'm like, telling them about brushing their teeth and it's distracting them. And then you can have fun toothpaste, like just make it more entertaining and fun.

But I think to start with, when there's already an aversion to it, you kind of have to put your foot down. Not I'm like, this is happening. I'm holding you down, but very calmly. And, and this is what I've had to do with one of mine with medicine when we got derailed kind of and it became really difficult is we'd sort of like, let them off the hook.

I'm like, okay, we're not going to do it. And then if they fuss enough, okay, we won't. And then the next night, no, no, we have to do it. We're going to hold you down. I'm going to make you do it. And to just be really calm and say, we're going to brush your teeth. And you give yourself that two-week period and know it might be an hour, an hour and a half, two hours of you calmly sitting at the door by the bathroom with your child, like we're going to brush your teeth.

I'm so excited to go read books with you. We're going to brush your teeth first. Do you want to do it first or me? And like staying that chill, whichever parent can stay the most chill and the most torturous two hours of your life of rebuilding toothbrushing. That's what it takes. And it's really hard sometimes.

And just to know that you're not a bad parent, like so many parents get to that point and it is, it's just like, okay, we're committing two weeks. I'm going to let myself have a special bottle of wine and keeping it positive, atraumatic, and just waiting them out. And eventually they'll do it. And you don't have to brush the full two minutes that first time.

Like they just let you in there and brush a little bit. You're like, awesome. Let's go read a book. Good job. And then you repeat and you repeat and just staying consistent, predictable. And that leads into how do you start the process, right? How do you make it good from the beginning, early introduction? So, you're stimulating their mouth with those little finger brushes before they ever get teeth.

You incorporate it like from two weeks onward into their bath time routine. You just include oral care. You wipe their tongue with a wet washcloth. That makes it all the more likely in the long run they're going to be much more comfortable with toothbrushing and you keep it fun, make it entertaining, that kind of thing too.

Brianna Miluk: Yeah, I love that. I know some of the things that I'll tell families that I'm working with is like, do not be afraid to pull out distractions. Like- 

Taylor McFarland: Yes, the tablet. 

Brianna Miluk: If there's a toothbrushing video that's fun for them to watch or a song. Like, I know you have a toothbrush. Yes. Like. You know, if you have to pull that out and that brings their anxiety about what's happening down, then great.

I also like using songs and stuff because it's almost like a means to an end. Like, Hey, we are going to brush your teeth and we're going to brush your teeth until the alphabet song is done. And I'm going to sing the alphabet song so they know like, okay, by the time I get there, or Hey, like you have, you know, 8 teeth and we're going to do three seconds on each tooth. And so here we go. One, two, three, stop. Oh, we already have one tooth done. All right. Tooth number two. And like being able to, like you said, just like make it more fun. Give them the idea that like, this is going to end, you know, because if you go into something that you don't like and you don't know when it's over, I always felt like running sprints and like sports in high school and if they were like, okay, we're going to go run sprints. And I'm like, okay, but like, how many are we? 

Taylor McFarland: Yes. No, that's so true. That's such an important point. 

Brianna Miluk: Like 20 sprints today or like 40? Cause I gotta pace myself and prep myself differently. 

Taylor McFarland: Yeah. 

Brianna Miluk: Depending on what we're doing. And so, you know, being able to kind of do that. 

Taylor McFarland: Yes. 

Brianna Miluk: May give that means whenever it's like, we're brushing your teeth. It's like, well, what does that mean? 

Taylor McFarland: Absolutely. We count, we count all the time in pediatric dentistry in the office of like, we're giving an aesthetic, we're doing this, like, we're going to count to 10, we're going to count to 15 and we're going to do whatever or younger child, you know, we're going to say the colors of the rainbow or like whatever you want to do.

Brianna Miluk: Yes, yes or I'm like, okay, we're going to do a whole hand. 

Taylor McFarland: Yes. Exactly. 

Brianna Miluk: Got the whole hand. So even if they can't count, it's like, I'm counting, but we're just going for the whole hand. 

Taylor McFarland: It's perfect. No. And when I put my little like course together, I was trying to make just different resources for parents who are struggling with tooth brushing. I made a little sugar bug song, but I didn't put this one on my YouTube because I put my own kids in it. And I'm like one of those, I don't put my kids on there. So, they're on my little course, but it's the, we're going on a bear hunt, but we're going on a sugar bug hunt. And then they know, they know the back and forth, like we're going to find a sugar bug. And they know by the last time we do it that they're all done. I mean, it just gives them predictability that's what you have. 

Brianna Miluk: Yeah, and that's so important when you're in a situation where you feel like you have a loss of control. So, like giving that means to an end, giving that autonomy, giving those pieces can really make a difference. But I think regardless of all these strategies, like Taylor just said, you have to give yourself like a two-week period. 

Taylor McFarland: Yes. 

Brianna Miluk: Like you could be throwing all these out and be like, why is it not working? It's like, well, because we need to do that strategy consistently over and over again. So, they know that's what you mean.

And the other thing I'll always tell families is like, if you say three seconds per tooth, do not sneak in four seconds. You say three seconds, it is three seconds. Like, you have to do what you mean because the second you slip something in, trust is gone. 

Taylor McFarland: Exactly. No, you do what you say and no more. 

Brianna Miluk: Yes, like do exactly as you say and leave it. Like, you're like, oh, they're doing pretty good. Let me get another tooth while I'm in there. No, do not do that. Like, if you want to try for two teeth next time, then say, this time I'm going to do two teeth. And then go for the two teeth, because if you don't tell them, and you just go in there, you're probably going to take a couple steps back. So, baby steps forward, but don't, don't go faster than you think they need, so. 

Taylor McFarland: I agree, I agree. 

Brianna Miluk: Okay, what are your best tips for preventing cavities? And now we know that like, sometimes there's this, like, idea that, like, cavities and baby teeth don't matter. Like, oh, it doesn't really matter. But it does, first of all. Secondly, what are some of your, your strategies? Or, like, you know, what do you educate families on the most for preventing cavities early on? 

Taylor McFarland: Sure. I mean, I think the biggest thing for a lot of that, a lot of people don't understand is that cavities are a bacterial disease. So, cavities are caused by buildup of bacteria and that's in plaque and in tartar.

Tartar is just hardened plaque that's been there a little while. And so those bacteria, they digest carbohydrates and that can be carbs from like crackers or chips that are broken down or sugars. Like we all think of sugar and juice, right? But people don't realize that fermented carbs, like pretzels and whatever, veggie straws, all the things kids love.

Those can also feed cavity causing bacteria too. And then what they do is they digest those carbs. They produce acid as a waste product. That acid sits on the teeth long enough, eats away the mineral of the tooth, and ultimately you get these holes in the teeth, those cavities. And the earliest signs of them are like little white lines along the gum line that parents think is plaque, but it's actually the early start of a cavity. And that's where oftentimes parents will be like, Oh, shoot, I, I want to go get them to the dentist to see what this is. And that's often when we'll see kiddos for the first time, if they weren't aware of the age one, we see them around one and a half or two, or unfortunately, it's even later when it's actually a big brown cavity and the pediatrician or the parent didn't even notice it until then.

Cause a lot of people, even professionals are under the belief that cavities don't happen in young kids, but they absolutely do. I have seen kids barely a year old with cavities. And so really the main two things you're trying to balance and it's multifactorial, right? So many of these chronic diseases and cavities are considered tooth decay is considered the number one chronic disease of childhood.

So more so even than asthma and it is just controlling the factors that we can right? Some kids they have poor saliva. It is more acidic. It's not really good at neutralizing things naturally. They may have dry mouth because of medications they're on. Like there's things we can't really control, but the ones we can are hygiene.

So, brushing well, developing early on a good routine and being sure we're thorough. And that's where it's helpful. When you bring your child to the dentist for the first time, we're showing you how to lift their lip and move their tongue and clean every surface. Because a lot of times kids will develop cavities along the gum line, along the back molars or the top and bottom lip, because they're not lifting the lip all the way up to gum line and cleaning right there in that spot. So, it's good hygiene, thorough hygiene, effective hygiene. Fluoride helps, right? It's one tool, but it's not a necessary tool. If you don't want to use it, you don't have to. You can have a cavity free kid with no fluoride. You can also have a kid with tons of cavities, even though you're using fluoride.

So, the other big factor is diet and it's not just what they're exposed to because I am not one of those folks that's like, get rid of all candy. Like I had, we were just joking before this started, I have a desk drawer full of sweet tart ropes. I love candy. And my kids eat goldfish crackers and they have candy, but it's how do you mitigate these risks when you know it's a higher risk food?

So, say they like goldfish crackers. Well, I don't let my kids have goldfish crackers at a time when they can't be, when they're not able to clean their teeth off after. So, I want to be able, like, I don't put it in their school lunch because I'm more worried that they can't brush their teeth and they can't chew a piece of gum.

But when they're home after school, I'm like, Hey, you just finished your crackers. Chew this piece of gum, chewing gum for an older child, like five plus when you're not worried about them choking on it is a great tactic for cleaning the teeth when you don't have a toothbrush around. So, I'll use that for my, you know, kindergarten plus kiddos, but those are the main two and it seems really basic, right?

But sometimes it's just as simple as, you know, you can think of a kiddo that drinks eight ounces of milk in a day, right? And one sips on it all day long and one drinks it with lunch. Well, the one that sips on it all day long is way more likely to develop cavities because they get that frequent exposure of the natural sugars in the milk. And we think about that overnight. A lot of parents don't realize that even milk, even nursing overnight can place a child higher risk for cavities because our mouths are really dry overnight. We're not cleaning their teeth afterward because Lord knows I didn't wake up my baby, brush her teeth after I nursed her.

And so, it's just trying to wipe the teeth off, you know, be kind of cognizant of how often they are nursing, what age they are, if they have teeth and just doing other things to kind of mitigate risks where you can. But those are the big two hygiene and diet, not what they're eating so much, but how often trying to make it less frequent, like little meals, but more clumps together.

Brianna Miluk: Yeah, that makes sense. I mean, that's kind of the, you know, I feel like the overall recommendation everyone knows about, like, you know, put it, what you're putting in your kid's cup. Like if it's, there are cups that they're sipping on all day long, whenever they're thirsty, like it should just be water. You know, if they're going to have milk or they're going to have juice, like it's okay to have that, but like.

They sit, they drink it, and then you're gonna do oral care or you're not just sipping on it all day long. So awesome. Okay. So, let's kind of finish up a little bit talking about oral care for children that have pharyngeal dysphagia. So, this is something that comes up when we're thinking about more medically complex kids and as feeding therapists, this is one that we are often educating parents on is like, we need to provide oral care.

So, if we're thinking about first, just like oral care with pharyngeal dysphagia. So, in there's a Logeman's article on the pillars of aspiration pneumonia, you know, we think about these three pillars. And one of the biggest ones is oral care and oral hygiene because the bacteria in the mouth that's being swallowed or aspirated is ultimately what is more likely to cause an infection than just water than just saliva as is.

And so, thinking about oral care. So, if we're doing oral care with a child who is more medically complex, a child who can't spit. You know, a child who has more difficulty managing secretions, you know, what might this look like? So, like in my brain, I'm already thinking like, okay, you might have to suction along with it, or you might have to wipe your mouth out after. So, I'd love to hear you kind of talk about some of the strategies you recommend for families in these types of situations. 

Taylor McFarland: I mean, I think just like with eating, one of the most important things is position. A lot of people think like they need to like lay the child back into their like, Kind of, I don't know, armpit area is where a lot of families, especially a child who is in a chair they've got them positioned in that way to brush, but man, that's going to make their saliva go backward.

So, like leaning them at least 90 degrees, if not slightly forward can help. And sometimes if you've got someone helping you to kind of hold their forehead, so they're not like totally falling over, but they're leaning slightly forward so that those secretions aren't going back is going to help suction for sure.

I mean, that's the main thing. That's what we do in the dental office as well. And just having like, you know, towels and things to capture those secretions, especially and using a toothpaste that's less foamy, that helps a lot. So, you want to look for that SLS, like we talked about earlier, probably something that's SLS free, or if even too much toothpaste, even the ones that don't have SLS, they still have some type of foaming agent.

So, either using a very small amount, like not that standardized pea size or dipping it in mouthwash, like we talked about, but. Yeah, you definitely want to use a true toothbrush. I know we talked about like those little two sets and those, they just don't scrub the teeth. And I get it because there are adults too, like people who struggle with depression.

And like some of my platform is kind of engaging people in that space of like, I know it's hard. And sometimes you just got to meet people where they are. Right. And maybe the goal is not to use that, but that's what they're doing right now. Okay. But have a treatment goal of getting to a true bristled toothbrush, right?

For sure, because that's what's truly going to clean the teeth. The danger of these bacteria is not so much that they are present, but they're maturing, right? That's the danger with plaque bacteria. It's not that plaque bacteria are there. They're in our mouth. Like our mouths are full of bacteria.

Disgusting, like billions of nasty things, but it's when they mature, it's when they clump together, they form these biofilms and they get old and nasty and they're producing just gnarly stuff. That is the stuff that we want to break down, break up those groups of bacteria for cavity preventive purposes.

And then for dysphagia, like, you know, SVE prophylaxis, that kind of stuff too. And infectious endocarditis, like Same goals is break up this black bacteria. You don't want it maturing. So, you want to be sure you're being effective, getting all the areas so you don't leave one area too mature and then cleansing as best you can, you know, as quickly as you can and effectively. So, a triple sided toothbrush can be really helpful in these cases too. 

Brianna Miluk: That's super helpful. So, I have kind of like a side off question for this because this is one that I get a lot from people that are like, okay, I'm working with a child newly diagnosed with pharyngeal dysphagia. You know, they're on thickened liquids for it or whatever, you know, X, Y, Z, and they want to implement oral care so that they can start to like wean off thickener or do some water trials.

But this isn't a child who has had a lot of lung compromise. You know, they haven't really had respiratory infections. But they can't spit and they don't have a suction machine. So, what sort of is your recommendation in that type of situation? Like, are you still going to, I mean, we still want to do oral care, but like, how are you making sure that like what you've just brushed away is at least *talking at the same time unintelligibly*? So, like one of the things I do is like, if we really are concerned about it, I will ask them to get a suction machine. 

Taylor McFarland: Yeah, that's what I would say is like in a perfect world, right? We get a suction machine. Like that is the goal is you want to get it out of there and be sure you're getting it out of there.

But we have kids in the office, they're scared of the suction, right? And so, what we do is have them spit, but they can't spit. So, then you're wiping them with a gauze. You've got like a washcloth ready. I would have something to be like cleansing that toothbrush in with almost like each couple of teeth that I'm cleaning.

So, I would like scrub them off with that triple sided toothbrush is nice because it kind of traps that plaque in it because it's that triangle shape. And so maybe do the triple sided toothbrush and then clean the toothbrush. Use the triple sided toothbrush, cleaning the toothbrush. And this is a case I probably wouldn't use if they don't have suction, a lot of toothpaste, if any.

And just so you're not creating one, the sweetness, that flavor of the toothpaste causes them to increase salivary flow. So, you may not want to use anything at all while you're just starting to introduce it, you're just cleaning off those bacteria. That's the most important thing. You can get fluoride, you know, other ways if we need to, after you can even take a q tip and like wipe on some white mouthwash at the end, something like that.

Brianna Miluk: Yeah, that's super helpful. That's very consistent with what I've heard from other providers and what I've recommended to families as well. It's like, more than anything, we just, we need this oral care done. And so like, if we can't get a suction or they're very scared of the suction or whatever, like we might get there eventually.

But especially if I'm doing like that risk to benefit, right. Of like, you know, this kid really hasn't had any respiratory infection. They've overall been very, you know, healthy. It's going to be a little bit different of an approach where it's like, okay, maybe we'll just wipe with gauze after put, like you said, do a little bit of that fluoride toothpaste or use more of like an antiseptic, like mouthwash in between. Before just like full on suctioning their mouth that could be just that is enough to reduce that risk of infection. 

Taylor McFarland: Yes, for sure. 

Brianna Miluk: Okay. Rapid fire questions. I have a couple questions for you. So, all right, first of all so rapid fire is basically like answer in a word or just a few words. So, I'm going to have three questions for you. So, my first one is because you're a pediatric dentist, what is your favorite candy? 

Taylor McFarland: Sweet Tart Ropes. 

Brianna Miluk: Is it? 

Taylor McFarland: Yes, I love them. 

Brianna Miluk: It's what is in her drawer right now, y'all. 

Taylor McFarland: It is, lots of them. 

Brianna Miluk: Sweet Tart Ropes, okay, okay. This is a question I like to ask pretty much all my guests because I'm constantly looking for more things to read, but what is either your current favorite book, because I know favorite books can change, so currently what's your favorite read, or what is your favorite children's book? You can give one or-

Taylor McFarland: Oh, that's a good one. So right now, what I'm really loving is The In-between. It's a Tik Tok-er. I can't think of her last name or I'm gonna say it wrong cause I only read it. Right. Like I used to say her Hermione instead of Hermione. That's how I'm gonna say her name. Her name is Hadley Vlahos yeah. Don't judge me. Hermione. I saw the movies and I was like, wait, who? 

Brianna Miluk: You're like that's how you say it?  

Taylor McFarland: but she is a nurse. And it is about end of life care and just like the stories of her patients and their lives. And it's just really, really cool. Yeah. She's awesome. 

Brianna Miluk: Very cool. I like that. That reminds me of a book that I read recently this year called Every Patient Tells a Story. And it's about a doctor who tells stories of multiple patients where he talks about how like. So important that we listen to the story and not just like look at labs. 

Taylor McFarland: Yes. 

Brianna Miluk: Or look at those like the story actually could get you to like majority of the diagnoses. 

Taylor McFarland: Yes.

Brianna Miluk: If you just listen, which I think is super cool.

Taylor McFarland: I love it. I love books like that. 

Brianna Miluk: Yeah. Okay. My last question is, did you do any traveling this summer? And if you did, where's the favorite place you visited? 

Taylor McFarland: Well, I don't travel much. At least not very fun with small children, but we went to Great Wolf Lodge. They opened a new one up outside of Baltimore in Perryville. It was very clean and nice, but we all still came home with the plague. So, we were very sick, we were coughing for like two weeks. I was like, we have to get better before school starts. So highly recommend, but it is still. Kind of gross. I'm a germophobe, so. 

Brianna Miluk: I mean. 

Taylor McFarland: If you go places like that.

Brianna Miluk: If you go anywhere with kids, it's like, you know, they're like licking the like, I know. I'm like, why are you lick legal? And you're like, why? Yeah. Like, why did we chew? We don't do that at home, so why are we licking the door handle here? Not just, you know, so I a part of it, but, okay, cool. I've actually never been to a Great Wolf Lodge, but I hear it's fun. Although I don't have kids and I feel like a lot of people with kids, like 

Taylor McFarland: I would never go without children. There's no reason. 

Brianna Miluk: Yeah. But like all my friends that have kids say that like, it's so fun. So. 

Taylor McFarland: It's fun. It is.

Brianna Miluk: Keep it in mind for, for future. 

Taylor McFarland: Yes. 

Brianna Miluk: Okay. So, to close out for today, where can people find you? I will make sure to put all of this in the show notes, but. 

Taylor McFarland: Okay. 

Brianna Miluk: For any listeners right now, where can they find you?

Taylor McFarland: So, I am on Instagram, TikTok, and YouTube, but my primary shift this fall, especially, is to YouTube. So, as I have grown, it has become just a monstrosity to manage like comments and answer questions. And that is what I enjoy. So, I made YouTube a little membership that people can go and join. I give priority to answering questions and answering stuff.

They're doing lives there, but you can always find my stuff, videos. I'm creating free content always on TikTok and Insta, but if you really want to find me, YouTube is where to go. 

Brianna Miluk: Awesome. Thank you. I will be sure to link that one in first so that people can can head over there. I am also loving YouTube more and more as a platform. It is. I got to like find time to actually like get used to a new platform. 

Taylor McFarland: It's different for sure. 

Brianna Miluk: Yeah, but I have enjoyed it more and more. And for anyone listening to the podcast episode, I do post, I cross post my, the video version of my podcast on YouTube. You can check it out there. I just love that YouTube searchable. Like you can search a concept and find something, which is so cool. So that is something that I feel like Instagram and TikTok are not very good. I know you can search hashtags, but like, I hate using hashtags. I get like, I forget it. And like. 

Taylor McFarland: Yes. 

Brianna Miluk: So, but anyway, well, Taylor, thank you so much. I appreciate you immensely. I think this is going to help really get out more of this information to providers and families on, you know, some of these recommendations that like actually have been around for a while and like we need to start pushing for these changes. 

Taylor McFarland: Yes. Yes. I hope so. I hope more and more kids will get there by their first birthday. That'll help their families as well. 

Brianna Miluk: Awesome. Thank you so much. 

Taylor McFarland: Thanks for having me. Good to see you.

Brianna Miluk: Thanks for tuning in to The Feeding Pod this week. If you enjoyed today's episode, please don't hesitate to share this podcast with your friends and colleagues and leave us a five-star review wherever you're listening from. If you're interested in learning more about pediatric feeding and swallowing, be sure to follow Bri, me, on Instagram @PediatricFeedingSLP or check out my website where you can get access to more courses and information www.pediatricfeedingslp.Com. Again, thanks for being here and listening to my ramblings, and I hope you'll keep listening. Until next time, cheers.