Learn how to take care of the oral health of babies and young children (up to age 6).

What is oral health?

“Oral health” is the health of the teeth, gums, and other parts of the mouth.

Why is it important to take care of my child's oral health?

Your baby’s oral health is an important part of their overall health. And having good oral health early in life sets your child up for good oral health at later stages of life—they will be able to chew better, eat healthy foods, and avoid pain and tooth loss. Poor oral health during school age years may also lead to missing more school days and worse academic performance.

How should I brush my childʼs teeth?

Brushing is one of the main ways that you can keep your childʼs teeth healthy. And having healthy primary teeth (“baby teeth”) helps your child chew food and speak clearly.

Brushing your baby's teeth

For babies and children under 3, use a smear of fluoride toothpaste the size of a grain of rice and brush all sides of their teeth.

• Start to brush your childʼs teeth as soon as their first tooth begins to show. This usually happens at around age six months to 10 months.
• Brush after their first and last meal of the day.
• Use a baby toothbrush with soft bristles and a small head. Use a smear of fluoride toothpaste the size of a grain of rice and brush all sides of your childʼs teeth.
  • Be sure that the toothpaste contains fluoride, which helps prevent tooth decay (cavities).
  • Using fluoride toothpaste is important no matter where you live; it may be especially important in rural areas, where community water often does not contain fluoride.

Teaching your child (age 3 to 6) to brush their teeth

For children ages 3 to 6, put a pea-sized amount of toothpaste on the toothbrush.

• Use a child-sized toothbrush with soft bristles and fluoride toothpaste.
• Use a pea-sized amount of toothpaste.

• Find a position where your child is comfortable and where you can see your childʼs teeth while you brush.

  Example
  Sit on the floor with your babyʼs or young childʼs head in your lap, or stand behind your child in front of the mirror.

• Gently brush your childʼs teeth using small circles. Brush all sides of the teeth, including the fronts and backs.
• After brushing, have your child spit out the remaining toothpaste but not rinse. The small amount of toothpaste that stays in your childʼs mouth is good for the teeth.
• Young children like to do things by themselves. If your child brushes their own teeth, have an adult watch them to be sure they do it correctly. Dental professionals recommend adult supervision for children under age 7, or for children who canʼt brush their teeth well on their own.
• If youʼre having trouble brushing your childʼs teeth, use a timer, counting game, song, or a video to keep them engaged while brushing. You can also ask the staff at your childʼs dental office or clinic for help.

How soon should I start taking care of my baby’s oral health?

It’s never too soon! You should start even before your baby’s first tooth comes in.

• When your baby’s first tooth comes in (or no later than their first birthday), take them to the dentist.
• Clean your baby’s gums to remove sugars from liquids or food. Use a clean, damp washcloth to wipe the gums.
• Wiping out your baby’s mouth with a clean wet cloth after nursing or bottle feeding helps ensure good oral hygiene and a strong foundation for your baby’s oral health.

What’s the safest way to use a pacifier?

• Clean the pacifier with soap and water.
• Never place a pacifier in your mouth before giving it to your baby. Germs that cause tooth decay can pass from your mouth to your baby’s mouth.
• If the pacifier gets worn out or breaks, get a new one.
• Don’t dip the pacifier in sweet foods like sugar, honey, or syrup.
• Never put a pacifier on a string or ribbon around your baby’s neck. It could choke your baby.
• If your baby is still using a pacifier at 2 years of age, try to ween them from it to reduce possible problems with proper oral development.

How can I start good oral health habits for my child?

When you help your child create habits that encourage good oral health, it can affect their habits for life. You can do this by:

• Brushing your young child’s teeth.
• Providing them with a healthy diet.
• Taking them to the dentist early in life and regularly.

Can I put my baby to sleep with a bottle or sippy cup?

Don’t put your baby to bed with a bottle or sippy cup filled with breast milk, infant formula, fruit juice, or other liquid. These liquids contain sugar, which can cause tooth decay. The sugar in these liquids will stay in the mouth all night and feed the germs that cause cavities.

Oral health is important at every age. A healthy mouth helps you eat and speak, and healthy teeth can give you a winning smile. If you’re caring for young children, you can help them get an early start at protecting their teeth, gums, and mouth.

Newborn babies have a cute toothless smile. Even though you can’t see the baby’s teeth, they’re hiding just beneath the gums.

“You can start cleaning your baby’s mouth with a clean, soft cloth even before the first teeth come in,” says Dr. Tim Iafolla, a dental health expert at NIH. “That way your baby gets used to having his or her mouth cared for.”

Baby teeth may start to appear at about 6 months of age. As early as 6 years old, these teeth may begin falling out. Though baby teeth are temporary, they are important.

“Baby teeth are used for chewing food, of course, but they also guide growth of the jaw bones, and they make room for the permanent teeth when they come in,” Iafolla explains.

Once teeth start to emerge, tooth decay can become a problem. “Tooth decay can cause early loss of teeth, which can affect speech, nutrition, and appearance,” Iafolla says.

Pain from tooth decay might cause kids to miss school. If left unchecked, tooth decay can lead to a serious infection, or abscess, that may spread to other parts of the body.

Tooth decay is caused by sugar-loving bacteria that grow in the mouth. The bacteria use sugar to make acids. Over time, these acids can wear away your teeth’s hard enamel coating and create a hole, or cavity. Eating or drinking sugary things, or snacking often throughout the day, feeds the bacteria and creates more acid, which can lead to cavities.

The good news is that tooth decay can be prevented. Start by encouraging kids to eat healthy foods and brush their teeth twice a day. Consider flossing daily as well.

Regular visits to the dentist also help. Baby teeth can be painted with a thin coating that can prevent or reduce cavities, called a fluoride varnish. Fluoride varnish should be reapplied twice a year.

Once permanent teeth come in, dentists can paint the back teeth with protective coatings called dental sealants. Both dental sealants and fluoride varnish are preventive treatments that are usually covered by insurance.

“Sealants harden to form a protective shield against germs and food,” Iafolla says. “They last for years and can prevent 80% of cavities in the back teeth.”

“Helping your children develop healthy dental and nutritional habits early in childhood can set them up for a lifetime of good dental health,” Iafolla says.

Tooth Timeline for Kids

It’s never too early to create tooth-healthy habits.

• During pregnancy, brush your teeth twice a day, floss daily, and schedule a dental check-up before your due date.

• Before teeth appear, gently wipe your baby’s gums twice a day with a soft, clean cloth.

• When teeth emerge, clean them twice a day with a cloth or very soft toothbrush.

• At age 1, take your child to the dentist and schedule regular check-ups. Ask when it’s time to start using fluoride toothpaste or get fluoride treatments.

• Starting at age 2 or 3, brush your child’s teeth with a pea-sized drop of toothpaste. Help them brush twice a day until they have good brushing skills. Make sure they spit out toothpaste.

• Around age 7 or 8, kids can brush and floss their own teeth. Help them create a habit of brushing in the morning and before bed. Check from time to time to make sure they’re brushing all their teeth.

• At all ages, encourage healthy eating. Avoid sugary foods and drinks.

Some parents believe that primary (baby) teeth are less important than permanent teeth because primary teeth are going to “fall out anyway.” However, primary teeth are key to a child’s growth and development.

Information About Primary Teeth

• Primary teeth are important. Primary teeth are key to young children’s health and development in five ways. These include:
  • Maintaining good health. The health of primary teeth affects children’s overall health and well-being. Tooth decay in primary teeth can lead to abscessed teeth. Infections from abscessed teeth can spread to other areas in the head and neck and lead to fever, pain, severe swelling, and, in rare cases, death. Using antibiotics to treat dental infections may work temporarily. However, infections will always come back if tooth decay is not treated.
  • Maintaining good nutrition. To grow and be strong, children need to eat healthy foods. Children with tooth decay in their primary teeth are less likely to eat crunchy foods, such as fresh fruits and vegetables that promote good nutrition and a healthy body. These children are also at risk for developing nutritional deficiencies and becoming malnourished.
  • Helping with the development of speech. Losing teeth early due to tooth decay can interfere with the development of a young child’s speech. Young children with missing teeth have difficulty making “th,” “la,” and other sounds. This can make it hard for others to understand the child. In some cases, the child may need speech therapy to change speech patterns he or she developed because of missing teeth.
  • Maintaining space for permanent teeth. Primary teeth hold space for permanent teeth developing underneath them in the jaw. This picture of an X-ray shows permanent teeth developing below primary teeth. If primary teeth are lost too early, other teeth move into the space and block the incoming permanent teeth. This can cause crowding.
  • Promoting self-confidence. Young children can be quick to call attention to other children that have decayed, chipped, or discolored teeth. Children with visible tooth decay often do not smile, cover their mouth with their hands when they speak, or minimize interaction with others. A healthy smile gives children the self-confidence they need to have positive social experiences.
• Tooth decay in primary teeth matters.
  • Children with pain from tooth decay do not do as well in school and have more behavior problems than children with no pain.
  • Tooth decay can also spread from one tooth to another. Children with severe tooth decay may need to receive treatment in a hospital operating room.
• Brushing primary teeth with fluoride toothpaste every day promotes good oral health. As soon as the first tooth appears, parents should begin brushing a baby’s tooth with a smear (rice-sized amount) of fluoride toothpaste twice a day. Making this a daily habit lowers the amount of bacteria in the mouth, helps prevent tooth decay, and starts a lifetime of good oral health habits.
• Having a dental visit by age 1 promotes good oral health. The American Academy of Pediatric Dentistry recommends that a child have his or her first dental visit by age 1. A young child’s dental visit is simple and quick. The oral health professional looks in the child’s mouth, identifies potential problems, and explains what changes to expect in the child’s mouth as he or she develops and grows. The oral health professional also shows parents how to take care of their child’s teeth and may apply fluoride varnish to the child’s teeth.

Teething happens when a baby’s primary teeth push through the gums into the baby’s mouth. For some babies, teething is uncomfortable.

Most babies begin teething around age 6 months, but teething can start any time between ages 3 and 12 months. As the primary teeth come into the mouth, babies may feel pain from the tooth pushing through the gum. Babies who are teething may become cranky, drool more, have red and swollen spots on their gums, and chew on things more frequently.

Tips for Parents to Ease Baby’s Teething Pain

• Clean it. Many strategies for comforting a teething baby include putting something in the baby’s mouth. Everything that goes in the mouth should be cleaned first to keep the baby healthy. Read the package for directions on how to clean the item. Some items are dishwasher safe, and some are not.
• Massage it. Gently rub the baby’s gums with a clean finger for about two minutes. Many babies find the pressure soothing. For babies who already have some teeth, be careful the baby doesn’t bite you!
• Cool it. Cold helps ease the pain of sore gums. Give the baby a cool clean wet washcloth, spoon, pacifier, or teething ring to chew on. Teething rings can be put in the refrigerator but not the freezer. Chewing frozen teething rings can make a baby’s cheeks or chin become bumpy and turn reddish-purple. Note: To prevent injuries to the mouth, do not let a baby walk while holding a spoon.
• Don’t use it. Over-the-counter teething gels and liquids on babies’ gums are not recommended because they offer little to no benefit for treating oral pain. They all contain benzocaine, which if used incorrectly can cause serious health problems, including blood disorders and death. If nothing works to ease a baby’s teething pain, ask the baby’s doctor or dentist for directions on what pain medications can be used and how to use them safely.

It is important to remember that once a tooth comes into the mouth, the tooth is at risk for developing tooth decay. Encourage parents to brush their child’s teeth using an infant-sized toothbrush with soft bristles with a rice-size amount of fluoride in the morning and before bedtime.

Most babies have a natural need to suck, and most find it calming. This type of sucking is also called “nonnutritive sucking” because the baby is not being fed. Giving a baby a pacifier can satisfy a baby’s need to suck.

If a child continues to use a pacifier after 18 months, it can affect the way their teeth bite together and cause problems, such as an overbite. It can also affect the growth of jaws and bones that support the child’s teeth.

Tips for Parents About Pacifier Use

If parents choose to give their baby a pacifier, here is how they can do it safely:

• Wait until breastfeeding is going well (usually after about three to four weeks). If a pacifier is given to a baby before then, nipple confusion may occur and make breastfeeding hard to establish. After a pacifier is introduced, it should never be used to delay or replace regular feedings.
• Let a baby decide whether to use a pacifier. If a baby shows no interest in using a pacifier, do not force it.
• Offer a pacifier at naptime and bedtime. If a baby uses a pacifier, the best times to offer it are at naptime and bedtime. Using a pacifier at these times may help lower a baby’s risk for sudden infant death syndrome (SIDS).
• Don’t coat pacifiers. Sucking on a pacifier coated with anything, especially sugar, honey, or jam, increases a baby’s risk for tooth decay.
• Attach pacifiers with clips that have short ribbons to keep from falling. Never tie a pacifier to a baby’s wrist or neck or to a baby’s crib. The string can get tangled around the baby’s neck and make the baby choke.
• Clean pacifiers and replace them regularly. Wash a pacifier that has fallen on the ground or floor with soap and warm water before giving it back to a baby. Parents who clean pacifiers with their mouths pass bacteria that cause tooth decay to the baby. Carrying extra pacifiers is a good idea.
• Check pacifiers for wear and tear. Over time, pacifiers can break down. Look at the rubber every now and then to see if it is discolored, cracked, or torn. If it is, replace it.
• Do not share pacifiers. Each baby should have their own pacifier(s). Letting babies share a pacifier can pass bacteria that cause tooth decay and increase a baby’s risk for tooth decay.

Tips to Help Parents Wean Their Child from a Pacifier

If a child shows no interest in self-weaning from the pacifier by 18 months, parents need to help. Here are some ideas to share with parents:

• Take it away gradually. Limit pacifier use to certain times (such as naptime or bedtime) or to certain places (such as in bed). In most cases, when a child uses a pacifier in bed, it falls out of the child’s mouth during sleep. Parents can gradually increase the amount of time the child is not using a pacifier until the child completely stops using it.
• Throw it away. Encourage the child to throw their pacifier away. If the child asks for a pacifier, parents can remind them that the child threw it away, the child is a big kid, and big kids don’t use pacifiers.
• Trade it. Encourage the child to put pacifiers under the pillow for the “pacifier fairy” (or another positive cultural character) who will trade them for a gift, like a toy or something soothing. If the child keeps asking for a pacifier, remind the child that all the pacifiers were given to the pacifier fairy (or some other character), who gave the child a gift.
• Poke holes in it. This alters the pacifier so it is no longer satisfying to suck on. It’s best to use a clean pin to poke two to three holes in the tip.

Choose drinks that will help keep your child healthy. Many drinks have natural or added sugar. Children who are often given sugary drinks are more likely to have tooth decay (cavities). You might not even know you are giving your child drinks with sugar! Water or milk are the best drinks for your child.

Tips for choosing healthy drinks for your child:

• Breast milk is best. Breastfeed your child for 6 months or longer.
• Give your child plain water with fluoride. Water from the tap (faucet) is safe and cheap.
• Give your child milk at scheduled meal and snack times.
• It is best not to put your child to bed with a bottle or sippy cup. If you do, the bottle or sippy cup should contain only water, nothing else.
• Give your child cut-up or whole fruit instead of fruit juice.
• If you give your child juice, wait until he is 6 months old. Offer your child no more than 4 to 6 ounces of 100-percent fruit juice each day. Serve juice in a cup.
• If your child drinks from a sippy cup, it should contain only water or milk, nothing else. By age 12 to 14 months, most children can drink from a cup.

Do you know how much sugar is in each drink?

Teaspoons of sugar in each 4-ounce drink.

What is baby bottle tooth decay?

When an infant or small child develops several cavities, usually on the top front teeth, it is called baby bottle tooth decay. These cavities may look like dark pits, holes or broken teeth and may cause toothaches and make it hard for the child to eat.

What causes baby bottle tooth decay?

It happens when liquids that contain sugar are left in a baby’s mouth for long or frequent periods of time. Even breast milk and formula contain sugar.

How can you protect your child’s teeth?

Your child should not —

• go to bed with a bottle filled with milk, formula, juice or sweetened drink
• sleep at night at the breast
• drink from a bottle throughout the day
• use a pacifier if it is dipped in honey, syrup or anything sweet, such as Jello™ water, soda pop, fruit juice, Kool-Aid™, sugar water, milk or formula

Your child should —

• start drinking from a cup at 6 months of age and be weaned from his or her bottle by 1 year of age
• go to bed without a bottle. If your child must have a bottle to sleep, fill it with plain water. You may need to mix the drink in the bottle with water, a little more water each night, until your child is drinking plain water.
• have his or her teeth cleaned after each feeding with a clean washcloth, gauze pad or a soft infant toothbrush. It is very important to clean your baby’s teeth before bedtime!

Are baby teeth important?

Baby teeth are important for chewing food and speaking properly. They also give your child a nice appearance and help to promote a good self image. If they are lost too early, the permanent teeth can come in crowded or out of line. Be sure your child visits a dentist before 2 years of age. These early efforts will be the key to your child’s future dental health!

A regular bedtime routine helps your child know what to expect at the end of the day. Brushing your child’s teeth with fluoride toothpaste as soon as the first tooth appears in the mouth is an important part of the routine.

Why is setting up a bedtime routine important?

• Brushing your child’s teeth with fluoride toothpaste before bed removes bacteria from their teeth and prevents tooth decay (cavities). It also helps to set a toothbrushing routine that lasts a lifetime.
• Spending 15 minutes reading to your child every day can improve their language development. It can also help strengthen the bond between you and your child.
• Sleep is important for your child’s health and well-being.

A bedtime routine for your child can include these simple steps:

1. Tell your child it’s time to get ready for bed. Letting your child know it’s bedtime begins the process for preparing them to relax and sleep.
2. Brush your child’s teeth. For children under age 3, use a rice-size amount of fluoride toothpaste to brush teeth. For children ages 3 to 6, use a pea-size amount of fluoride toothpaste. After brushing, don’t give your child anything to eat or drink before bed.
3. Read a book with your child. After brushing, read a book aloud to your child in a comfortable spot. As your child gets older, let them pick out a book or two to read.
4. Put your child to bed. After reading, put your child to sleep in their own bed.

Be consistent and patient. It may take time for your child to get used to the bedtime routine. Once the routine is set, bedtime will be calmer, quieter, and more fun for you and your child.

Tooth decay can be prevented or managed if children have early dental visits and if parents or other caregivers take good care of their child’s teeth between dental visits. Goals of dental visits are preventing tooth decay and finding and treating oral problems early.

Importance of the Dental Visit

Some parents believe that because primary (baby) teeth are going to “fall out anyway” they do not need to take care of them. However, primary teeth are important to a child’s growth and development. The American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Dental Association all recommend that children have their first dental visit by age 1. A state’s Medicaid and Children’s Health Insurance Program (CHIP) dental fees and payment policies must line up with the state’s pediatric dental periodicity schedule.

The age 1 dental visit is a foundation for building a lifetime of good oral health. By beginning visits early, children learn that dental visits are usually not associated with pain or fear of the oral health professional. The visit is also an important opportunity to learn if a child is at high risk for developing tooth decay. During the visit, the oral health professional can talk to parents about steps to reduce their child’s risk for decay.

What Happens During the Dental Visit

A child’s first dental visit is usually short. The goal is to make the visit as pleasant as possible. Some oral health professionals ask the parent to sit in the dental chair and hold their child in their lap during the visit. Other oral health professionals use the knee-to-knee position to look into the child’s mouth (see the photo above). During the visit, the oral health professional:

• Describes what they will do during the visit and asks the parents if they have any questions. Parents should be encouraged to ask questions about their child’s oral health and their own oral health.
• Checks the child’s mouth and teeth. Using a small mirror, the oral health professional checks the child’s lips, cheeks, gums, and roof of the mouth for any problems and the teeth for signs of tooth decay.
• Checks the child’s bite and their jaw’s growth. The child’s teeth and jaw will be checked to make sure that they are developing in the right way. The oral health professional may also describe what to expect for the child’s oral development during the next few months.
• Provides preventive care. The oral health professional may provide care to prevent tooth decay. This care may include cleaning the child’s teeth with a toothbrush and applying fluoride varnish. Fluoride varnish is a liquid that is painted onto children’s teeth to prevent tooth decay and to repair early stages of tooth decay. This can be done up to four times a year depending on the child’s risk for developing tooth decay.
• Informs parents about healthy oral hygiene habits. Because home care is a vital part of good oral health, parents may be shown how to brush their child’s teeth and how much fluoride toothpaste to use. The oral health professional may also teach parents how and when to start flossing the child’s teeth. Other topics that may be discussed with parents include the timing of the next dental visit and setting goals to promote their child’s oral health. For example, a goal may be brushing their child’s teeth with fluoride toothpaste twice a day instead of once a day.
• Talks about foods, drinks, and habits that can cause oral problems. The oral health professional may ask questions about feeding practices and the use of sippy cups. Answers to these questions help determine if the child is at high or low risk for developing tooth decay. Parents may also be asked about their child’s thumb sucking, use of pacifiers, and other habits that may cause oral problems.
• Offers tips on how to prevent oral injuries. Injuries to the head, face, and mouth are common in young children, especially when they are learning to walk and climb. The oral health professional may offer tips on how to prevent oral injuries and what to do if an injury occurs.

Even if a child is fearful or cannot cooperate during the dental visit, the visit is still helpful. The child may enjoy riding up and down in the dental chair or seeing how dental tools work, such as the air, water, and suction hoses, and mouth mirror. Often, the oral health professional can get a quick look into the child’s mouth to see if there are any problems.

Set your kids up for a lifetime of good oral health with these strategies for infants and children.

Babies

You can’t see your infant’s teeth, but they’re there, hiding just beneath the gums. Take care of them right from the start with these 4 strategies.

For children younger than 2, consult your dentist or doctor before you use fluoride toothpaste.

Children

Cavities are still one of the most common chronic diseases for kids from age 6 to 19. Protect your child’s teeth by having them:

If your child is younger than 6, watch them brush. Make sure they use a pea-sized amount of toothpaste and always spit it out rather than swallow. Help your child brush until they have good brushing skills.

Good Oral Health Is Important for Pregnant Women

When you’re pregnant, you may be more prone to gum disease and cavities, which can affect your baby’s health. Follow these 3 steps to protect your teeth:

If you have nausea, rinse your mouth with 1 teaspoon of baking soda in a glass of water after you get sick. This helps wash stomach acid away and keep your tooth enamel safe.

Taking good care of your baby’s mouth and teeth is important. A baby’s first tooth usually comes in at around age 6 to 10 months. Healthy primary (baby) teeth help children chew food and speak clearly.

Tips for keeping your baby’s mouth and teeth healthy:

• Cleaning your baby’s gums and teeth
  • Clean your baby’s gums even before you can see the first tooth. Use a clean, damp washcloth to wipe the gums. Do this twice a day, especially after night feeding.
  • After your baby’s first tooth comes in, use a baby toothbrush with soft bristles and a small head. Put a smear (size of a grain of rice) of fluoride toothpaste on the toothbrush, and brush all sides of your baby’s teeth.
  • Brush your baby’s teeth in the morning and before bedtime.
• Using bottles and sippy cups
  • Do not put your baby to bed with a bottle or sippy cup filled with breast milk, infant formula, fruit juice, or other liquids besides water. Liquids that contain sugar can cause tooth decay.
• Using pacifiers
  • Clean the pacifier with soap and water.
  • Never clean a pacifier in your mouth before giving it to your baby. Germs that cause tooth decay can pass from your mouth to your baby’s mouth.
  • If the pacifier gets worn out or breaks, get a new one.
  • Do not dip the pacifier in sweet foods like sugar, honey, or syrup.
  • Never put a pacifier on a string or ribbon around your baby’s neck. It could choke your baby.