A Practical Guide on Children's Teeth
The British Society of Paediatric Dentistry (BSPD)
Caring for your baby’s teeth is one of many important responsibilities as you become a parent. The British Society of Paediatric Dentistry (BSPD), the organisation dedicated to improving children's oral health in the UK, has assembled the basic advice and information you might need about oral health in one concise leaflet. We hope we can help you get your child off to the best possible start and achieve healthy teeth.
Caring for your baby’s teeth
Milk teeth (also known as baby teeth, primary teeth or deciduous teeth)
Your baby will have 20 baby teeth which usually come through from the age of about six months, but this can vary greatly. Occasionally teeth can be present at birth (natal teeth) or shortly after birth (neonatal teeth). These are seen in less than 1% of babies and shouldn’t be a cause for concern.
You should ask for a referral to a paediatric specialist who will advise if treatment is required. Milk teeth have an important role to play as they hold space for the second teeth to descend into. Because the enamel is thin, milk teeth are more likely to be affected by decay and erosion if exposed to too much sugar or acidic drinks.
Your baby’s lower front teeth will usually come through first, followed by the upper front teeth. For some babies, teething is a straightforward process, others may suffer from discomfort and become restless or wakeful at night.
Signs of discomfort might be chewing on fingers or toys and increased drooling. Many parents confuse minor illnesses with teething. If your child seems to be in significant discomfort, it is always best to seek medical advice to rule out illness, such as an ear infection.
There is no good evidence to tell us how to manage teething, but many parents find that offering their child chilled (not frozen) teething rings and extra comfort will help. By the time your child is three years old, he or she should have all 20 milk teeth, although there can be a few months of variation.
When to start cleaning a baby’s teeth
As soon as your child’s teeth start to come through, introduce them to the idea of brushing. Use a small soft toothbrush to clean the teeth so your child gets used to it. Brush regularly as part of your child’s morning and night-time routine, using a flat smear of fluoride toothpaste (with at least 1000ppm fluoride) until they are 3 years of age. After this time, you can use a small pea-sized amount.
As your child gets older you can encourage them to do their own brushing but you should continue to supervise until they are 7 years of age. It is advisable to keep toothpaste out of the reach of young children. A manual toothbrush used correctly is as effective as an electric brush. The last thing to touch a child’s teeth before bed should be fluoride toothpaste.
When to visit a dental practice for the first time
As soon as your child gets their first teeth, and certainly by their first birthday, take them to the dentist so they become familiar with the experience. Their first visit might be to accompany you or someone else in the family for a routine appointment. If you are worried about going to the dentist, you might also like to ask your partner or a grandparent to attend.
You must be positive about your forthcoming visit so your child does not become unduly anxious. Don’t worry if your child doesn’t want to open their mouth on the first visit to the dentist.
The important thing is they get used to being in a dental practice while you have time to ask the dental team for advice on caring for your child’s teeth. Your child should see a dentist regularly. Until their 18th birthday, the time between appointments should never be more than 12 months.
Dummies & thumb-sucking
Sucking is a natural reflex in a young child; a dummy may help soothe a restless child. Some children automatically suck their thumb or finger for comfort. This is entirely natural. However, you should never give your child a dummy with a drink or something sweet in it, and we recommend that in the long term, as adult teeth come through, the dummy and thumb-sucking are discouraged. Talk to your dental team if you need some advice on managing this.
Why is fluoride recommended?
Over time, we have become increasingly aware of the critical role of fluoride in strengthening tooth enamel. Fluoride occurs naturally in some water supplies, but in other parts of the country, it is added to prevent dental decay. Research has shown that there is substantially less dental decay in children’s teeth in areas where the drinking water is fluoridated.
Fluoride can also be found in toothpaste and other oral health products. When brushing with fluoride toothpaste, please do not rinse your child’s mouth after brushing, as you will wash away the fluoride and lose its protective effect. “Spit - don’t rinse” is the mantra! Fluoride varnish is an effective way to protect your child’s teeth and should also be discussed with your dental team.
Toothpaste containing no less than 1000ppm (parts per million) of fluoride is recommended as soon as the first teeth come through. Once your child has reached their 3rd birthday, toothpaste can be used between 1000ppm and 1500ppm. If you doubt which toothpaste is best for your child, discuss it with your dental team.
Early food and drink
The early weeks of your baby’s life are straightforward, with milk being the sole food, either from the breast or bottle. Breast milk or infant formula milk meets all your babies nutritional needs for the first six months of their life.
Around the age of 6 months, you can encourage your child to drink from a free-flowing or open-top cup so that bottle use does not continue past their first birthday.
Food and drink for little toddlers
Try and keep drinks and food to mealtimes and avoid giving your child any food or drink with the exception of water in the hour before bed. Aim to limit food and drink that contain sugar, including those which are said to be healthy, such as dried fruit, which is sticky and clings to teeth and can be damaging to teeth if frequently consumed between meals.
Water should be made regularly available to your child from around the age of 6 months. Your child is less likely to get decay if their teeth are given a rest from food and drinks other than water between meal times.
What not to do
Never leave your baby or toddler with a feeding bottle or trainer cup in their mouth for long periods of time, such as when they go to bed, and never dip a bottle or pacifier in sweet or fruit-based drinks.
Please do not put drinks other than milk in your baby’s bottle or add anything to milk, such as sugar or honey, as this can damage your child’s teeth. It’s also recommended that parents shouldn’t “clean” their babies’ dummies or bottles by putting them in their own mouths. You could pass on bacteria to your child, which would otherwise not be present in their mouths.
Growing up: Caring for children’s teeth (6+ years)
Permanent teeth (also known as second teeth or adult teeth)
Children’s permanent teeth start to erupt at the age of around six years, and most of your child’s permanent teeth should have come through by the age of 12-14 years. The exception is wisdom teeth which are likely to emerge from the age of 17-21 years. Adults usually have 32 teeth, including wisdom teeth, if they are present.
Food and drink
It will be harder for you to control what your child eats and drinks as they get older, but hopefully, they have gotten used to healthy eating. We recommend that you encourage them to limit sweetened foods or drinks to mealtimes only and remember that some products marketed as being ‘healthy’, including sports drinks, contain high amounts of sugar.
Moving to adulthood
As your child grows up, it is important that they begin to take responsibility for their own oral health, as you will not be there to monitor their choices at all times. By educating your child and supporting them to make healthy choices, you can have more confidence that they will be able to maintain their oral health.
When you are both comfortable, you might consider encouraging them to choose to go into the dentist’s surgery unaccompanied. However, you should also be there in case the dentist wants to involve you in any treatment decisions.
Maintaining oral health
If your child plays contact sports, ensure they have a professionally made mouthguard to optimise protection against dental trauma. Discourage sports drinks which usually have a lot of sugar and are also acidic. This means they can cause dental decay as well as acid wear to the teeth, reducing them in size and strength. From early teens, you can also ask your dental team to show your child how to clean their teeth.
Take your baby to a dentist as soon as they get their first teeth and certainly before their first birthday.
Once your baby is old enough to drink anything other than milk, the best drink is water.
After the age of one, introduce a golden hour before bed when your child has nothing to eat or drink with the exception of water. Their teeth should be brushed just before they go to bed, so the last thing in their mouth is fluoride toothpaste.
Wherever possible, ask for sugar-free medication for your child.
Encourage your child to brush their teeth at least twice a day with fluoride toothpaste.
Your child should see a dentist regularly. Until their 18th birthday, the time between appointments should never be more than 12 months.
It’s likely that most of your child’s dental care can be provided in general dental practice. However, if you have concerns you should ask your dentist for a referral to a Specialist in Paediatric Dentistry. A second opinion can sometimes be a good idea if you are worried about your child’s teeth.
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