Healthy teeth for children

Healthy teeth are an important part of your child’s overall health. Caring for them begins when the first tooth peeks through your baby’s gums.

When will my baby’s teeth appear?

The first primary (or “baby”) tooth usually comes at about 6 months, but it isn’t unusual for teeth to appear as early as 3 months or late as 12 months.

Every child is different, but most will have all 20 primary teeth by 3 years. Sometime around 5 or 6 years, your child will start to lose his primary teeth to make room for his permanent teeth.

Why are primary teeth important?

Primary teeth give shape to your child’s face, help guide permanent teeth into the right position in the mouth and are crucial for learning to eat and to speak. It’s important to care for them well.

Primary teeth have a thinner outer enamel (a thin, hard, white substance that covers the tooth) than permanent teeth. This makes them at risk for early childhood tooth decay, which can begin as soon as the first tooth appears. Decay is caused by bacteria and occurs more easily if teeth keep coming into contact with sweet liquids—such as formula, milk, juice, and even breast milk (which contains sugar)—and are not cleaned right away.

Early childhood tooth decay can affect your child’s health and cause pain, making it hard for her to sleep, eat or speak. It can also affect her ability to concentrate and learn. Children who develop dental decay at an early age are more likely to suffer from it throughout childhood.

Tips for good dental health from birth to age 4

From birth to 12 months	Wipe your baby’s gums with a soft, clean, damp cloth twice a day. As soon as the first teeth appear, clean them at least once a day (usually at bedtime) with a soft bristle toothbrush designed for babies. Lay your baby on a flat surface or with his head cradled in your lap to brush teeth. Avoid leaving your baby in bed with a bottle of formula or juice. After 6 months: Introduce a sippy cup for water and formula. Avoid juice. If you do offer it, limit juice to no more than 60 to 120 mL (2 to 4 oz) per day, in a cup rather than a bottle and only as part of a meal or snack. If a bottle is needed at nap time, offer water rather than milk or juice. If you breastfeed before nap time or, be sure to clean your child’s teeth before he goes to sleep. Never sweeten a soother. Don’t put a soother or bottle nipple in your own mouth for any reason. Bacteria (including those which cause tooth decay), viruses and yeast infections can be passed between you and your child this way.
From 1 to 3 years	Take your child for a first dental visit at 12 months. Check for signs of early childhood tooth decay once a month. Lift your child’s upper lip and look for chalky-white or brown spots on the teeth or along the gum line. If you see any, take your child to a dentist as soon as possible. Switch to a regular cup for all drinks between 12 and 15 months. Limit soother use to nap and bedtime.
From 3 to 4 years old	Teach your child “2 for 2,” which means brushing twice a day for 2 minutes each time. Encourage her to do some brushing with you completing the job, making sure that all tooth surfaces have been cleaned. Be a role model by brushing your teeth at the same time. Begin using no more than a pea-sized amount of fluoride toothpaste and teach her to spit rather than swallow. There’s no need to discourage thumb-sucking at this age. If your child continues to suck her thumb as permanent teeth begin to appear, talk to your doctor or dentist.
For all ages	Wash your hands before and after brushing teeth. Rinse toothbrushes thoroughly after brushing and ensure that each one can dry without touching others. Replace toothbrushes every few months, when the bristles become flattened with use. Between meals, quench a child’s thirst with water. Do not offer candy, dried fruit (including raisins) and sugared drinks or juices. Take your child for regular dental visits (every 6 months, unless otherwise suggested by your dentist).

How can I help my teething baby? When your child is getting her teeth, her gums may be swollen and tender.

Do:

Rub the gums with a clean finger.
Offer her something to chew on. A wet facecloth placed in the freezer for 30 minutes can be helpful, or a teething ring made of firm rubber.

Do not:

Use gel that can be rubbed on your child’s gums. Your child may swallow it.
Give her teething biscuits, which may contain sugar.
Ignore a fever. Getting new teeth does not make babies sick or give them a fever. If your baby is younger than 6 months call a doctor. Older children can be treated at home, as long as they get enough liquids and seem well otherwise.

What is fluoride?

Fluoride is a natural compound that protects teeth from cavities. Many communities in Canada add fluoride to the local water supply. It’s also in toothpastes and mouthwashes.

Children who start using products with fluoride from an early age have fewer cavities than those who don’t.

How does fluoride work?

Fluoride helps prevent cavities and decay by coming in direct contact with the tooth enamel (the outside of the tooth).

But, if you consume fluoride from sources such as drinking water, it gets absorbed in your bloodstream. Then it becomes part of the enamel on the inside of the tooth.

If too much fluoride gets into the inside of the tooth, it can cause a condition called fluorosis.

What is fluorosis?

Fluorosis means a person has had too much fluoride. People with fluorosis have white spots or blotches on their teeth. These spots can stain or become dark.

Fluorosis usually happens during a child’s first few years when the teeth are forming. Most cases are mild.

Fluorosis is not a health problem, but it can be avoided.

How much fluoride does my child need?

The right amount of fluoride will prevent cavities, but not cause fluorosis.

The best way to prevent cavities is to add fluoride to drinking water. It acts by coming into contact with the teeth.
The right amount is about 0.7 parts per million (ppm) in drinking water, which is enough to prevent cavities but not too much so as to cause obvious fluorosis. You can check with your local municipality to find out how much fluoride is in water that comes from your taps.
Natural sources of water may also have fluoride. If your water comes from wells or springs, you can have it tested. If it contains 0.7 ppm of fluoride or less, it is safe.
If the level of fluoride in your water supply is 0.3 ppm or less, ask your dentist or doctor whether a supplement is needed.
If the amount of fluoride in the water is more than 0.7 ppm, there is more chance that a child will develop fluorosis. Children younger than three years of age should not drink water with fluoride levels of much more than 0.7 ppm. Do not use water with fluoride levels much above 0.7 ppm to mix infant formulas.

What about fluoride from toothpaste?

Because fluoride works by coming into contact with the outside of the tooth, you should brush your children’s teeth as soon as they appear.

What about supplements?

Fluoride is also available as drops or lozenges, but most children don’t need extra fluoride.

If there is a reason to give your child fluoride supplements, your dentist or doctor will recommend them. If you use drops, dilute them with water (follow instructions on package) and squirt them on the teeth. Tell your child not to swallow the drops.

Reviewed by:
CPS Public Education Advisory Committee

Last updated: April 2008