Should a Child First Visit the Dentist?
visit a dentist for the first time within 6 months of the eruption
of the first primary tooth, and no later than age 12 months.
The goals of the visit are to assess risk for tooth decay, provide
anticipatory guidance, respond to questions parents may have
about oral health and development, initiate prevention practices,
and schedule the next visit.
During a child’s
early visits to the dentist, the dentist and dental hygienist
can also assess tooth and jaw development and check for problems.
By taking their child to the dentist early, parents learn how
to care for their child’s teeth. Children, in turn, learn the
importance of good oral health care and view visiting the dentist
as a positive experience.
an infant’s gums with a soft infant toothbrush and water after
feedings even before the teeth erupt.
• Begin cleaning
an infant’s teeth as soon as the first tooth erupts, usually
around age 6 to 10 months. Use a soft infant toothbrush that
is easy for the parent to hold and small enough to fit in the
infant’s mouth. Lift the lips to brush the front and back of
the teeth and at the gum line.
• Brush an
infant’s or child’s teeth two to three times a day, preferably
after eating. Brushing before bed is most important. Remember
not to give the infant or child anything to eat or drink (except
water) after brushing at night.
• To brush
an infant’s teeth, the infant should be seated in the parent’s
lap, with both facing in the same direction. To brush a child’s
teeth, the parent should stand or sit behind the child, with
both facing a mirror.
• For infants
and children under age 2, brush the teeth with plain water.
For infants and children at increased risk for tooth decay,
consult with a dentist or physician about brushing their teeth
with fluoridated toothpaste. (See Module 2, sections 2.1 and
• For children
ages 2 and above, brush the child’s teeth with no more than
a pea-sized amount (small smear) of fluoridated toothpaste.
Make sure the child spits out the toothpaste after brushing,
but do not have the child rinse with water. The small amount
of fluoridated toothpaste that remains in the mouth helps build
strong healthy teeth.
• Young children
will want to hold the toothbrush and participate in toothbrushing,
but they cannot clean their teeth well without parental help.
After children have fine motor skills (for example, the ability
to tie their shoelaces), typically by age 7 or 8, they can clean
their teeth well on their own but should be supervised.
and Eating Practices
• Do not put
the infant or child to sleep with a bottle or sippy cup or allow
frequent and prolonged bottle feedings or use of a sippy cup
containing beverages high in sugar (for example, fruit drinks,
soda, or fruit juice), milk, or formula during the day or at
• Do not use
a bottle to calm an infant or to put an infant to bed. Instead
of a bottle try:
o Giving the infant a favorite blanket or toy
o Offering the infant a clean pacifier
o Holding, patting, or rocking the infant
o Reading to the infant
o Softly talking or singing to the infant
• If an infant
is accustomed to being put to bed with a bottle, offer a bottle
filled with plain water. If the infant does not adapt initially
to the plain water, it may be necessary to fill the bottle with
a mixture of juice and water, reducing the amount of juice slightly
each night until only water is used.
• Hold the infant
or child while feeding. Never prop a bottle (that is, use pillows
or any other objects to hold a bottle in the infant’s mouth).
• Never add
cereal to a bottle. This causes sugary fluids to pool around
the teeth and can also cause choking if the infant is unable
to swallow the extra food. Instead, always feed infants and
children solid foods with a spoon or fork, or, if the infant
or child is coordinated enough, encourage self-feeding.
a small cup when the infant can sit up without support.
• As the infant
begins to eat more solid foods and drink from a cup, the infant
can be weaned from the bottle. Begin to wean the infant gradually,
at about 9 to 10 months. By 12 to 14 months, most infants can
drink from a cup.
• Do not dip
pacifiers in sweetened foods like sugar or honey.
• Serve age-appropriate
healthy snacks such as fruit, vegetables, grain products (especially
whole grain), and dairy products instead of foods high in sugar
such as candy, cookies, or cake.
• Offer snacks
at regular times between meals only. If a child snacks frequently,
brush the child’s teeth three times a day.
• Make sure the child drinks plenty of water throughout the
day, especially between meals and snacks.
• Don’t offer
food in return for good behavior. This teaches children that
foods are rewards and can lead to the development of unhealthy
What is Fluoride, and Who Needs
a mineral that enhances tooth and bone health when provided
in optimal amounts throughout life. Fluoride increases tooth
resistance to tooth decay, primarily through topical effects.
Fluoride occurs naturally in groundwater. It is also commonly
found in foods such as breads and beverages that are made using
fluoridated water and in many public fluoridated water supplies.
Tooth decay can be reduced by 50 to 70 percent with exposure
to the proper amounts of fluoride.
is one of the best examples of a public health preventive intervention
at the community level. All infants and children who drink fluoridated
water benefit from systemic ingestion by incorporating fluoride
into their developing teeth, as well as from important topical
effects. Unfortunately, many families live in communities without
fluoridated water, and many use multiple or alternative sources
of water (for example, bottled or processed water), complicating
the delivery of fluoride to infants and children.
is probably the most important method of preventing tooth decay.
Topical fluoride reaches the teeth directly, slowing down or
preventing the development of tooth decay. Topical fluoride
works best when it is ingested in very small amounts many times
a day through water, foods containing fluoride, and fluoridated
Almost all toothpaste
manufactured provides topical fluoride. Unless a dentist or
physician advises otherwise, fluoridated toothpaste should be
introduced at around age 2.
of topical fluoride is professionally applied fluoride (including
gels, foams, and varnish), which renews the high levels of fluoride
in the enamel. Topical fluoride may be especially effective
for children at high risk for tooth decay because they lack
fluoridated water, have a history of tooth decay, snack frequently
on foods high in sugar, or have a medical condition that makes
them susceptible to decay. Only a dentist, dental hygienist,
physician, or other qualified health professional should apply
Baby Bottle Tooth Decay
Tooth Decay (BBTD) is caused by prolonged contact with almost
any liquid other than water. This can happen from putting her
to bed with a bottle of formula, milk, juice, soft drinks, sugar
water, sugared drinks, etc. Allowing her to suck on a bottle
or breastfeed for longer than a mealtime, either when awake
or asleep, can also cause BBTD.
from a baby bottle builds up in the mouth, the natural or added
sugars found in the liquid are changed to acid by germs in the
mouth. This acid then starts to dissolve the teeth (mainly the
upper front teeth), causing them to decay.
Tooth Decay can lead to severe damage to your child's baby teeth
and can also cause dental problems that affect her permanent
But there are steps you can take to prevent Baby Bottle Tooth
Keep these pointers
in mind as you care for your child's teeth:
• Never put
your child to bed with a bottle. By 7 or 8 months of age, most
children no longer need feedings during the night. Children
who drink bottles while lying down also may be more prone to
getting ear infections.
• Only give
your baby a bottle during meals. Do not use the bottle as a
pacifier; do not allow your child to walk around with it or
to drink it for extended periods. These practices not only may
lead to BBTD, but children can suffer tooth injuries if they
fall while sucking on a bottle.
• Teach your
child to drink from a cup as soon as possible, usually by 1
year of age. Drinking from a cup does not cause the liquid to
collect around the teeth, and a cup cannot be taken to bed.
If you are concerned that a cup may be messier than a bottle,
especially when you are away from home, use one that has a snap-on
lid with a straw or a special valve to prevent spilling.
• Keep your
baby's mouth clean. This is an important part of preventing
tooth decay. After feedings, gently brush your baby's gums and
any baby teeth with a soft infant toothbrush.
• Use water
and a soft child-sized toothbrush for daily cleaning once your
child has 7 to 8 teeth.
By the time your toddler is 2 years of age, you should be brushing
his teeth once or twice a day, preferably after breakfast and
before bedtime. Once you are sure your child will spit, and
not swallow, toothpaste, you should begin using a fluoride toothpaste.
Use a pea-sized amount of toothpaste to limit the amount he
can accidently swallow.