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Healthy teeth for children

Healthy teeth are an important part of your child’s overall health. Helping your child develop good oral health begins at birth.

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. At 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 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 puts them at risk for early childhood tooth decay, which can begin even before the first tooth appears. Decay is caused by bacteria and happens 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 regularly.

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 oral 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.
  • After 6 months:
    • Introduce a sippy cup.
    • Avoid juice. If you do offer it, limit juice to no more than 125 to 175 mL (4 to 6 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 naptime, 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 2 years
  • Take your child for a first dental visit at 12 months.
  • Brush your child’s teeth daily (using non-fluoridated toothpaste).
  • 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. Your dentist may suggest you start using a small amount (the size of a grain of rice) of fluoridated toothpaste.
  • 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.
  • Start using fluoride toothpaste, the amount of a green pea, and teach her to spit rather than swallow.  Supervise your child while he/she is brushing teeth.
  • 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.
  • 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 mineral that is found in soil, water and in various foods. It is necessary for tooth mineralization (a process that helps to harden and protect the teeth). Many communities in Canada add fluoride to the local water supply to help prevent tooth decay. It can also be found in many types of toothpaste, mouthwash and varnishes (polish applied to the teeth by a dentist).

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) and promoting mineralization.

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?

Too much fluoride in the early years can damage teeth as they are forming, and can lead to a condition called fluorosis. Fluorosis causes white spots or blotches on teeth.  But white spots on teeth can also be a sign of early cavities. Your dentist will have to look at your child’s teeth to know for sure. 

In more severe cases of fluorosis, these spots can stain or become dark. The teeth can become brittle, chipped or “pitted”.

Cases of fluorosis are quite rare, and most cases are mild.

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.
  • 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 your drinking water supply.
  • 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.

What about fluoride from toothpaste?

Start brushing your children's teeth with a pea-sized amount of fluoridated toothpaste by the time they are 3 years old. If your child is under 3 years of age and you think she may be at risk for early childhood tooth decay, talk to your dentist to find out if it is a good idea to start using a small amount (the size of a grain of rice) of fluoridated toothpaste.

What about supplements?

Fluoride is 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 the following CPS committees:
Community Paediatrics Committee
Nutrition and Gastroenterology Committee
Public Education Advisory Committee

Last Updated: March 2013