Dental care for babies

First teeth are temporary, and that is the reason they get neglected. It is a poor reason twice over. The habits formed around them are the ones that carry into adult life, and the teeth themselves can decay from the moment they appear — painfully, and often enough to need extraction under general anaesthetic, which is a common reason for young children in England to end up in hospital.

Almost all of it is preventable, and the measures are simple and start earlier than most people expect.

When the teeth arrive

Most babies cut their first tooth at around six months, usually the two lower front teeth, followed by the two upper front teeth. There are twenty first teeth altogether, and the last to arrive are the second molars, somewhere between two and three years of age. Teething covers the discomfort that goes with this, and what helps.

Brushing starts with the first tooth

Not at two, and not when the full set is through. As soon as the first tooth breaks the gum, it needs cleaning twice a day with a small soft brush and fluoride toothpaste, and one of those times should be last thing at night.

The amounts and strengths that current UK guidance sets out:

• Under three: a smear of toothpaste containing at least 1,000 parts per million of fluoride. An adult does the brushing.
• Three to six: a pea-sized amount of toothpaste containing more than 1,000 parts per million. An adult supervises.
• Children at higher risk of decay — a family history of it, early signs already showing, a condition or medicine that makes decay more likely — are advised 1,350 to 1,500 parts per million from the start, in a smear or pea-sized amount by age.

Children's toothpastes marketed by age or by cartoon character sometimes contain less fluoride than the guidance recommends, so the figure on the tube is worth checking rather than trusting the packaging. A single family toothpaste at around 1,450 parts per million, used in the right amount, suits a whole household and is often cheaper.

Spit out, do not rinse. Rinsing with water after brushing washes away the fluoride that was the point of the exercise. This applies at every age and is the single most commonly ignored piece of brushing advice.

Position matters more than technique with a baby. Sitting the child on a lap with their head supported, or standing behind an older toddler in front of a mirror, gives a view of what is being brushed. Every surface of every tooth needs the brush, and the backs of the lower front teeth and the biting surfaces of new molars are where plaque is most often left behind. Brushing is supervised until around the age of seven, because a younger child cannot yet do it thoroughly however willingly they try.

Fluoride beyond toothpaste

Fluoride varnish applied by a dentist or therapist is offered twice a year from the age of three, and more often than that for children at higher risk. It is quick, painless and free for children.

Fluoride drops and tablets are not part of current UK advice. Toothpaste, used properly, is the principal source, with varnish on top of it. Advice to ask for a fluoride prescription because the local water is not fluoridated comes from countries where water fluoridation is widespread, and does not apply here — only a minority of the UK population receives fluoridated water in any case. Fluoride and teeth covers this in more detail.

Drinks and the bottle

The thing that does most damage to first teeth is a sugary drink in prolonged contact with them, and a bottle is the ideal delivery mechanism.

• The only drinks for a bottle are plain milk and water. Not juice, not squash, not sweetened milk, not fizzy drinks, and nothing diluted enough to seem harmless.
• Nothing other than water once teeth are through and the baby is going to sleep. A bottle taken to bed leaves whatever is in it sitting against the teeth for hours while saliva flow, which normally washes sugar and acid away, drops right off.
• Moving from a bottle to a free-flow open cup from around six months, and away from bottles altogether from about a year, is recommended partly for the teeth and partly because a free-flow cup does not let a child hold liquid in the mouth.
• Fruit juice and smoothies count as sugary drinks for teeth however much vitamin C they contain, and are better given diluted, with a meal, and in a cup.

Plain milk and water are not a decay risk in the way free sugars are, and milk given at mealtimes is fine. The concern is any drink other than water being sipped slowly over long periods, or given at bedtime.

Food, dummies and medicine

No sugar is added to weaning food or drinks. Savoury foods and plain fruit and vegetables build the preference that makes everything else easier later, and a child who has not been given sweet puddings does not expect them.

Sweet things do less damage at a mealtime than between meals, because the frequency of acid attacks matters more than the total quantity of sugar. Rusks and teething biscuits are often sweetened; the label is worth reading.

A dummy should never be dipped in anything sweet — honey, jam, sugar, sweetened milk. Prolonged dummy use or thumb sucking beyond the early years can also affect how the front teeth sit, which is worth raising with a dentist rather than worrying about alone.

Medicines given frequently or long term should be sugar-free wherever a sugar-free version exists; a GP or pharmacist can say whether one does.

The first dental visit, and what early decay looks like

The first appointment belongs in the first year, as soon as teeth start appearing. It is largely about familiarity: a look in the mouth, a word about brushing and diet, and a child who learns early that a dental surgery is an unremarkable place. NHS dental care is free for children, and nothing about a first visit is unpleasant unless something has been left long enough to need treating.

Early decay is easy to miss because it does not look like a hole. The first sign is usually a chalky white line or band along the gum margin of the upper front teeth, which later turns yellow or brown and then breaks down. It is painless at the white stage and reversible at the white stage, which is precisely why those teeth are worth a proper look in good light every so often.

If a tooth is knocked out

A first tooth that is knocked out should not be put back in the socket. Replanting a baby tooth risks damaging the permanent tooth developing above it. The child should be seen by a dentist the same day for the mouth to be checked and the pain managed.

A knocked-out permanent tooth is the opposite case entirely and should be replaced in its socket immediately or kept in milk, with same-day dental attention. The distinction matters because the right action for one is the wrong action for the other.

See also cleaning teeth and gums, tooth decay and cavities and paying for dental care.