Caring for your child's teeth

As soon as your child's first tooth erupts, begin twice-daily brushing using a smear of fluoride toothpaste. After age 3, use a pea-sized amount of fluoride toothpaste once your child masters spitting. Near age 7, children should be able to brush their own teeth twice a day with supervision (to make sure they're doing a thorough job). Most importantly, after nighttime brushing make sure your child has only water so there is nothing on their teeth while they are sleeping. Each child is different, so ask the dentist for advice in determining whether your child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching your child to brush, place the toothbrush at a 45-degree angle; start along the gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by cleaning the tongue with a tongue cleaner to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth, to get to areas a toothbrush can't reach. Flossing should begin as soon as any two teeth touch. Floss your child's teeth until he/she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth, until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don't forget the backs of the last four teeth.

Healthy diet, healthy teeth

Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Healthy eating habits result in healthy teeth. Children should eat a variety of foods from the five major food groups. Most kid's snacks can lead to cavity formation, and the more frequently your child snacks, the greater the chance for tooth decay. The length of time the food remains in your child's mouth, without brushing, also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which causes longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt and low-fat cheese, which are healthier and better for children's teeth.

Preventing cavities

Good oral hygiene removes bacteria and the leftover food particles that combine to create cavities. For infants, you may initially use a washcloth to wipe the plaque from teeth and gums. Switch to a soft toothbrush once the front two lower teeth have halfway erupted. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby bottle tooth decay" for more information.

For all children, teeth should be brushed at least twice a day. Limit the number of snacks containing sugar that you give your children.

The American Academy of Pediatric Dentistry recommends visits to the pediatric dentist every six months, beginning with the appearance of your child's first tooth, or his first birthday. Routine visits lead to a lifetime of good dental health.

The dentist may also recommend protective sealants or home fluoride treatments for your child. Sealants applied to your child's molars help prevent decay on hard-to-clean surfaces.

Sealants prevent decay

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (molars), where four out of five cavities in children occur. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.


Fluoride has been shown to be beneficial and effective against cavities; however, not enough or too much can be harmful. Little or no fluoride will not strengthen the teeth enough to resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, a chalky white to brown discoloration of permanent teeth. Many children often get more fluoride than their parents realize. Make sure you're aware of your child's potential sources of fluoride to prevent dental fluorosis.

Some sources of fluoride include:

  • Too much fluoridated toothpaste at an early age;
  • The inappropriate use of fluoride supplements; and
  • Hidden sources of fluoride in the child's diet.

Most 2- and 3-year-olds may not be able to spit out fluoride-containing toothpaste when brushing. As a result, these kids may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate fluoride supplements may also contribute to fluorosis. Do not give fluoride drops and tablets, or fluoride-fortified vitamins to infants younger than 6 months of age. Give fluoride supplements to your child only after all the sources of ingested fluoride have been accounted for, and upon the recommendation of your pediatrician or dentist.

High levels of fluoride are also in certain foods, particularly powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, including decaffeinated teas, white grape juices and juice drinks manufactured in fluoridated cities.

Decrease the risk of fluorosis in your children's teeth:

  • Use baby tooth cleanser on the toothbrush of the very young child.
  • Place only a pea-sized drop of children's toothpaste on the brush when brushing.
  • Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child's physician or pediatric dentist.
  • Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
  • Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child. Local water utilities have this information.


Recreational activities and organized sports can lead to injuries. A properly fitted mouthguard, or mouth protector, can help protect your child's smile and should be used during any activity that could result in a blow to the face or mouth. Mouthguards are an important piece of athletic gear that helps prevent broken teeth and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask the dentist about custom and store-bought mouth protectors.

Reducing cavities with xylitol

Xylitol is a natural sugar alcohol that helps prevent cavities. The American Academy of Pediatric Dentistry recognizes the benefits of xylitol on the oral health of infants, children, adolescents and people with special health care needs.

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. In one study, mothers with high cavity rates used xylitol gum two to three times per day, starting three months after delivery and until the child was 2 years old. This resulted in a 70% reduction in their children's cavities by the time they were 5 years old.

Xylitol provides additional protection that enhances existing prevention methods, with low decay rates continuing even years after trials have been completed.

Xylitol occurs naturally in sources including fruits, berries, mushrooms, lettuce, hardwoods and corncobs. One cup of raspberries contains less than one gram of xylitol. Studies suggest that xylitol produces positive results when taken in three to seven doses totaling four to 20 grams per day. Higher amounts did not result in greater reduction and could lead to diminishing results. Similarly, taking xylitol less than three times per day showed no effect.

To find gum or other products containing xylitol, visit your local health food store or search the internet. Be sure the product contains 100% xylitol.