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American Academy of Pediatrics

A Guide to Children's Dental Health

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The road to a bright smile begins long before the first tooth appears. Parents play a big part in helping their children develop healthy teeth. Early monitoring by your child’s doctor and dentist is important. (See “What is a pediatric dentist?”)

Steps to good dental health include

  • Regular care by a dentist trained to treat young children

  • Getting enough fluoride

  • Regular brushing and flossing

  • Eating right

Read on for information from the American Academy of Pediatrics (AAP) about why fluoride is important, when to start cleaning your child’s teeth, if pacifier use or thumb-sucking hurts teeth, how to prevent tooth decay, pediatric dentists, and regular dental checkups.

Why is fluoride important?

Fluoride is a natural substance that can be added to drinking water and toothpaste. It strengthens tooth enamel (the hard outer ­coating on teeth). Fluoride also helps repair early damage to teeth.

Children should drink water with fluoride in it when available. If not available, talk with your child's doctor or pediatric dentist to see if you child needs fluoride tablets or drops. Your child may also have fluoride varnish applied to his teeth by his doctor or pediatric dentist.

When should I start cleaning my child’s teeth?

Daily tooth cleaning should start as soon as your baby’s first tooth appears. Wipe the teeth with a piece of gauze or a damp cloth at least twice daily, after meals. Switch to a soft toothbrush with a fluoride toothpaste once your child has a tooth.

A smear (grain of rice) of fluoride toothpaste should be used for children younger than 3 years. For children 3 and older, a pea-sized amount of fluoride toothpaste should be used. Because children tend to swallow toothpaste, using too much fluoride toothpaste while brushing may result in fluorosis (spotting of the teeth).

Also, check the teeth for early signs of tooth decay. Tooth decay appears as white, yellow, or brown spots or lines on the teeth. Any 2 teeth that are touching each other should be flossed to prevent a cavity from forming between the teeth. An ideal baby bite should have gaps between the front teeth.

Does pacifier use or thumb-sucking hurt teeth?

If a child sucks strongly on a pacifier, his thumb, or his fingers, this habit may affect the shape of his mouth or how his teeth are lining up. If he stops using a pacifier by 3 years of age, his bite will most likely correct itself. If he stops sucking on a pacifier, his thumb, or his fingers before his permanent front teeth come in, there’s a chance his bite will correct itself. If he continues his sucking habit after his adult teeth have come in, orthodontic care may be needed to realign his teeth.

How can I prevent tooth decay in my baby or child?

Parents, especially if they have a history of cavities, can pass germs that cause cavities and gum disease if they share food or drinks with their children. This is why it is important for parents to keep the following tips in mind:

  • Do not share your food or drinks with your children.

  • Do not lick your children's spoons, forks, or pacifiers.

  • Do make sure to keep your gums and teeth healthy and schedule regular dental checkups. Pregnant women should make sure their gums and teeth are healthy too.

Other ways parents can help prevent tooth decay in their babies and children include:

  • If you put your child to bed with a bottle, fill it only with water.

  • If your child drinks from a bottle or sippy cup, make sure to fill it only with water when it’s not mealtime.

  • If your child wants a snack, offer a healthy one like fruits or vegetables. (To help your child avoid choking, make sure anything you give your child is soft, easy to swallow, and cut into small pieces no larger than one-half an inch.)

  • Avoid sweet or sticky snacks, such as raisins, gummy candies and vitamins, or Fruit Roll-Ups or cookies. There is sugar in foods like crackers and chips too. They should only be eaten at mealtime.

  • If your child is thirsty, give her water or milk. If your child drinks milk at bedtime, make sure to clean her teeth afterward. Don’t let your child sip drinks that have sugar and acid, such as juices, sports drinks, flavored drinks, lemonade, soft drinks (soda, pop), or flavored teas.

What is a pediatric dentist?

During regular well-child visits, your child’s pediatrician will check your child’s teeth and gums to make sure they are healthy. If your child has dental problems, your child’s pediatrician will refer her to a pediatric dentist or a general dentist trained to treat young children.

A pediatric dentist specializes in the care of children’s teeth, but some general dentists also treat children. Pediatricians refer children younger than 1 year to a dental professional if the child

  • Chips or injures a tooth or has an injury to the face or mouth.

  • Has teeth that show any signs of discoloration. This could be a sign of tooth decay or trauma.

  • Complains of tooth pain or is sensitive to hot or cold foods or liquids. This could also be a sign of decay.

  • Has any abnormal lesion (growth) inside the mouth.

  • Has an unusual bite (the teeth do not fit together right).

Find a pediatric dentist in your area on the American Academy of Pediatric Dentistry Web site at

When should my child begin regular dental checkups?

The AAP recommends that all infants receive oral health risk assessments by 6 months of age. Infants at higher risk of early dental caries should be referred to a dentist as early as 6 months of age, and no later than 6 months after the first tooth erupts or 12 months of age (whichever comes first) to establish their dental home. Every child should have a dental home established by 12 months of age.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

© 2004 American Academy of Pediatrics, Updated 01/2016. All rights reserved.

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