Childhood tooth decay is preventable. Good habits begin with the first tooth and lay the foundation for a lifetime of oral health.
When do teeth come through?
The first milk tooth usually appears at around six months, at the front of the lower jaw. By two and a half to three years all 20 milk teeth have come through. At around six, the first permanent molars appear behind the milk teeth; because they do not replace any milk tooth they are often mistaken for milk teeth and neglected. The change from milk to permanent teeth continues until 12 or 13.
These timings can vary by a few months from child to child; small differences are no cause for concern.
Care by age
0–6 months: before the teeth appear
After feeding you can wipe the gums with a clean, damp piece of gauze. This also gets the baby used to having their mouth cleaned.
6 months – 3 years
From the moment the first tooth appears, brush twice a day with a soft, small-headed baby brush. A smear of fluoride toothpaste the size of a grain of rice is enough.
3–6 years
Increase the toothpaste to a pea-sized amount. Teach your child to spit. Let them try brushing themselves, but always finish off afterwards.
6 years and over
Children have the dexterity to brush effectively on their own at around 7 or 8. Supervision is essential until then; pay particular attention to the new permanent molars at the back. Once the teeth start touching each other, floss comes into the picture too.
Baby bottle decay
The most common cause of early childhood decay is a baby being put to sleep with a bottle or at the breast without the teeth being cleaned afterwards. Milk, formula, fruit juice and a honeyed dummy stay on the teeth for hours during sleep. White or brown marks starting at the gum line of the upper front teeth are the first sign.
- Do not put your baby to sleep with a bottle; clean their teeth before sleep.
- Do not put anything sweet other than water in the bottle.
- Do not dip the dummy in honey, jam or molasses.
- Start the move from bottle to cup after the age of one.
The first dental visit
A first visit is recommended after the first tooth comes through and by the age of one at the latest. The aim is not treatment but getting acquainted, checking the teeth and jaw development and advising the family. A first visit when a child is not in pain goes pleasantly and prevents fear of the dentist developing.
Preventive procedures such as fissure sealants and fluoride are also planned at the visit. We describe these on our pediatric dentistry page.
Diet and habits
- Do not spread sugary snacks through the day; give sweets at the end of a meal.
- Between meals offer cheese, yoghurt, fruit and nuts (if age-appropriate).
- Give the fruit itself rather than juice, and water when they are thirsty.
- Thumb sucking and dummy use that continue after three can affect jaw development; ask your dentist.
Children do what they see, not what they are told. Brushing your teeth together with your child is the most effective teaching you can give.
Frequently asked questions
Is fluoride toothpaste safe for children?
Yes. Used in the amount appropriate for their age it is safe and is the most effective protection against decay. Use a rice-grain smear before the age of three and a pea-sized amount from 3 to 6, and make sure the child does not swallow it.
Is it normal for milk teeth to have gaps between them?
Yes, and in fact it is desirable. These gaps make room for the larger permanent teeth.
A permanent tooth has come up behind a milk tooth that has not fallen out. What should I do?
This is common with the lower front teeth. If the milk tooth is wobbly it usually falls out by itself and the tongue pushes the permanent tooth into place. If the milk tooth is not loose, or does not fall out within a few weeks, bring your child in for an examination.
This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.