Healthy teeth start long before the first tooth appears, and the habits children learn in their first years usually stay with them for life. Tooth decay is still one of the most common chronic conditions of childhood in the United States, yet it is largely preventable. This guide explains what parents can do at each age, from wiping a newborn’s gums to sealants and mouthguards for teens.
Why Baby Teeth Matter
Children have 20 primary teeth. They start forming before birth, and the first one usually breaks through around six months of age; most children have all 20 by about age three. Baby teeth hold space for the permanent teeth, help children chew and speak clearly, and support the shape of the face. A decayed baby tooth can hurt, become infected and affect the permanent tooth underneath.
According to the CDC, about 1 in 5 children aged 5 to 11 has at least one untreated decayed tooth, and about 1 in 7 adolescents aged 12 to 19. Children from low-income families are about twice as likely to have untreated cavities.
Dental Care by Age
| Age | What to do |
|---|---|
| Birth to first tooth | Wipe the gums with a clean, damp cloth or gauze after feedings. |
| First tooth to age 3 | Brush twice a day with a soft child-size brush and a smear of fluoride toothpaste the size of a grain of rice. First dental visit by the first birthday. |
| Ages 3 to 6 | Use a pea-sized amount of fluoride toothpaste. Teach the child to spit, not swallow. Start flossing where teeth touch. |
| Ages 6 to 8 | Children brush on their own, but parents still check or finish the job. First permanent molars arrive around age 6: ask about sealants. |
| Ages 9 to 12 | Independent brushing and flossing. Second permanent molars around age 12: sealants again. |
| Teens | Mouthguards for sports, care around braces, limit sugary and acidic drinks. |
From Birth to the First Tooth
Bacteria and sugars collect on the gums even before teeth appear. Wiping the gums after feedings removes milk residue and gets the baby used to having the mouth cleaned. Teething usually starts around six months and can cause drooling, chewing on everything and fussiness. A clean, chilled (not frozen) teething ring or gentle gum massage helps. The FDA advises against teething gels with benzocaine for children under two, and against amber teething necklaces because of choking and strangulation risk.
Preventing Baby Bottle Tooth Decay
Putting a baby to bed with a bottle of milk, formula or juice lets sugars bathe the teeth for hours. The result, known as early childhood caries or baby bottle tooth decay, usually starts on the upper front teeth as white spots and can progress to brown, broken teeth that may need to be treated under anesthesia.
- Do not put a baby to sleep with a bottle; if needed, offer only water.
- The American Academy of Pediatrics (AAP) recommends no fruit juice before age one and limits it afterwards.
- Move from bottle to cup around the first birthday.
- Avoid sharing spoons or cleaning a pacifier in your mouth, which passes cavity-causing bacteria to the child.
The First Dental Visit
The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend the first dental visit when the first tooth appears and no later than the first birthday. A pediatric dentist has two to three years of extra training in children’s dental care. The first visit is short: the dentist checks teeth and gums, assesses the risk of cavities, and shows parents how to clean the teeth and what to watch for. After that, most children see the dentist about every six months.
Brushing and Flossing
- Brush twice a day for two minutes, once in the morning and always before bed.
- Use fluoride toothpaste: a rice-grain smear under age three, a pea-sized amount from three to six, as recommended by the ADA and AAP.
- Angle the brush toward the gum line and clean the outer, inner and chewing surfaces.
- Floss once a day as soon as two teeth touch.
- Replace the toothbrush every three to four months or when the bristles fray.
- Most children lack the hand skills to brush well alone until about age seven or eight, so parents should help or check.
Songs, timers and letting the child brush a parent’s teeth make the routine easier. Children who dislike the feel of a toothbrush may do better with an extra-soft brush, a mild-tasting toothpaste and a predictable order of steps.
Fluoride and Sealants
Fluoride
Fluoride strengthens enamel and makes it more resistant to the acids that bacteria produce from sugar. Children get it from toothpaste, from community water in many areas, and from fluoride varnish, which pediatricians and dentists paint on the teeth several times a year starting when the first tooth appears. Ask your water utility or dentist whether your tap water is fluoridated; if not, the dentist may suggest other options.
Sealants
Sealants are thin protective coatings painted onto the chewing surfaces of the back teeth, where most cavities in children form. They are applied quickly and without drilling. According to the CDC, sealants protect against about 80% of cavities for two years and continue to protect against about 50% for up to four years. Children aged 6 to 11 without sealants have almost three times as many first-molar cavities as children with them. Many schools offer free sealant programs.
Food, Drinks and Sports
How often children eat sugar matters as much as how much. Sipping juice or soda all day or grazing on sticky snacks keeps the teeth under constant acid attack. Water and plain milk are the best drinks; sweets are better at mealtimes than between meals. For contact sports such as football, hockey, basketball and soccer, a mouthguard protects against broken and knocked-out teeth. If a permanent tooth is knocked out, hold it by the crown, put it back in place or in milk, and see a dentist immediately.
Frequently Asked Questions
When should my child first see a dentist?
When the first tooth appears and no later than the first birthday, according to the AAPD and ADA.
How much toothpaste should a young child use?
A smear the size of a grain of rice for children under three and a pea-sized amount for children aged three to six, always with fluoride.
Are dental sealants worth it?
Yes. The CDC reports that sealants prevent about 80% of cavities in back teeth for two years. They are usually placed on the permanent molars around ages 6 and 12.
Is it a problem if a baby tooth has a cavity?
Yes. Decay in baby teeth can cause pain and infection, affect eating and speech, and damage the permanent tooth growing underneath, so it should be treated.
