Routine Care

Infants and Toddlers

Keep your baby safe by considering their oral health from the very start of your journey together. There are things you should know and simple steps you can take to ensure your baby's mouth stays clean and protected.

Care at home

Taking care of your child's mouth should begin at birth so they become comfortable with oral care being a part of their daily routine, and establish good habits from an early age.

Oral bacteria

Many parents don't realize that saliva contains unhealthy bacteria that can transfer to their baby's mouth. It's a bad idea to kiss a baby on the mouth or clean a baby's spoon or pacifier with your mouth. These habits can increase their risk of tooth decay or periodontal disease.

Breastfeeding

Breastfed babies can still get tooth decay. However, the risk of tooth decay is lower for babies that are exclusively breastfed than babies fed with formula.¹

If you plan on breastfeeding, talk to your physician about any medications you take before you start to ensure they will not affect your baby in any way.

Bottles and sippy cups

A common cause of tooth decay in infants is frequent exposure to drinks containing sugar, like fruit juice. In addition to unintended weight gain and other conditions like diabetes, prolonged exposure to sugary drinks can lead to a condition known as "baby bottle tooth decay."

• If you give your child a drink containing sugar, make sure you properly clean their mouth as soon as it is finished.
• Infants should finish their nap and nighttime bottles or cups before going to bed, and then you should clean their mouth. If you give your child a bottle or sippy cup in their crib or bed, only give them water. Even milk can cause tooth decay.

Preventing tooth decay before teeth erupt

• Within the first few days after birth, wipe your baby's gums gently after every feeding using a clean, damp washcloth or gauze. Don't forget to wipe the tongue as well. This will help reduce harmful bacteria in your baby's mouth that can lead to future tooth decay.
• Don't kiss your baby on the mouth. You could transmit bacteria to them.
• Don't let your child place their fingers in anyone's mouth. Children will usually put their fingers back into their mouths, increasing the chance of transmitting bacteria.
• Don't lick your baby's pacifier to moisten it, and don't dip it in sugar, honey, or other substances to make it taste better. Your saliva and sugary substances you have in your mouth transfer bacteria and provide an environment for it to grow. Always make sure the pacifier is clean and free of any soap residue.
• Don't share utensils with infants or clean their utensils with your mouth. Use a separate utensil if you need to check if food is too hot or cold.

When do teeth come in?

Unless your baby has congenitally missing teeth, your baby was born with all 20 baby (primary) teeth and some of the permanent teeth already forming below their gum line. Baby teeth usually start to erupt between 6-12 months. The bottom, front teeth are typically the first to appear. In rare cases, the primary lower central incisors may be present in the mouth at birth. These are called "natal teeth," and they may complicate nursing. Most children have their full set of primary teeth by the time they reach age three. Baby teeth will usually begin to fall out around age six when adult (permanent) teeth begin to push them out. This is also about the same time your child's first permanent molar teeth come in, bringing the number of visible teeth to 24.

Teething

Babies often begin teething between four and seven months. There can be a variety of symptoms when teething starts. Most of these symptoms are normal. Teething can cause concern, but taking your child to an emergency facility for teething issues is often unnecessary, inconvenient, and expensive.

Normal symptoms of teething include:

• Swollen, tender gums.
• Fussiness and crying.
• Changes in eating or sleeping patterns.
• A slightly raised temperature (less than 101℉).
• Wanting to chew on hard things.
• Drooling. Be sure to gently wipe the drool off with a damp cloth to avoid facial rashes.
• Cheek rubbing or ear pulling.
• Bringing their hands to their mouth.

What to do

• A couple of times a day, gently rub your baby's gums with a soft clean finger brush, a small cold metal spoon, or a moist clean washcloth or gauze pad. To prevent inflammation, take care not to avoid the gum tissues where the teeth are erupting.
• Chilled teething rings or other items appropriate for infants may also help soothe their gums. Look for teethers made of solid rubber. Your baby could chew through liquid-filled teething rings or plastic objects.
• Avoid using oral drug products containing benzocaine for children under the age of two. These products can be dangerous to infants and provide little to no relief for teething.
• Avoid homeopathic remedies such as 'teething tablets,' as they may contain an ingredient called belladonna. This ingredient is ineffective and may be dangerous to your baby.
• Contact a pediatric dentist to schedule your baby's first dental visit. When you do, alert the dentist that your baby has begun teething and ask for advice on how to make them more comfortable.
• While teething can be painful for a while, it doesn't usually make babies sick.

When teeth begin to appear

• Your baby's first teeth usually begin to erupt around six months. When they do, gently brush them with a small, soft toothbrush or fingertip brush with a small amount of fluoride toothpaste after meals and before bed to keep them free of food deposits and plaque. Continue to wipe the gums where teeth have not yet come through. Concentrate on the areas where the teeth are cutting through to make teething less painful for your child.

• There are toothpaste products designed specifically for infants. Use a very small amount (about the size of a grain of rice) to avoid having your baby ingest too much fluoride.
• Until your child can brush reliably and effectively on their own (around age six), you should brush their teeth for them. A good rule of thumb is to let your child begin to brush on their own around the time they start learning to write. Younger children don't realize it's important to brush every tooth and often lack the dexterity to do so.
• When your child has two adjacent teeth that touch, you should begin flossing between them daily. Floss picks are often easier to use on young children than string floss.

Fluoride

Fluoride is an important part of your child's oral hygiene. Toothpaste, rinses, and fluoride treatment at the dentist help make tooth enamel more resistant to tooth decay. An inadequate amount of fluoride may put infants and toddlers at a higher risk for tooth decay.

Keep in mind that some bottled water does not contain fluoride, and some tap water filters remove fluoride. If you regularly give your child bottled water or non-fluoridated tap water, they may be missing out on the benefits of fluoride. If you are unsure if your tap water has fluoride, contact your local or state health department or water supplier.

Discuss your child's fluoride needs with your dentist or pediatrician. They may recommend a fluoride supplement if you live in an area where the water is not fluoridated or if you give your baby filtered water that removes fluoride.

Baby-proof your home

Babies and toddlers like to explore and put things in their mouths. These can lead to accidental injuries to the face or mouth. As your child begins to move around, make sure your home is as safe as it can be.

• Temporarily move furniture out of the way, or place cushioning edges around hard corners. This helps prevent facial impacts.
• Make sure any furniture like tables, bookcases, or TVs are firmly anchored to prevent them from falling on your child.
• Changing tables should have secured rails and guards.
• Install child-proof gates at the tops and bottoms of stairs or in areas that you don't want your child to wander.
• Avoid giving your toddler hard candy or other substances, as they can cause a tooth to chip without you even realizing it. They can also be a choking hazard.

If your child does have an impact to the face

• If a fall or accident has moved a tooth or caused a chipped tooth or cracked tooth, have them evaluated by a dentist or pediatrician as soon as possible. Keep a close eye on your child until you can get them to a dentist. A tooth or pieces of it that have moved out of place or broken can become dislodged and swallowed or inhaled.

Care at the dentist

It is important to help your child become comfortable with visits to the dentist. This is a great way to help ensure a lifetime of good oral health habits.

• It is a good idea to contact a dentist within the first few months of birth to get their advice on when to schedule your baby's first visit. Your dentist may also provide oral hygiene suggestions when you call.
• Most dental experts suggest that your baby's first visit should be no later than six months after teeth begin to appear and before their first birthday.

To make visits positive:

• Consider a morning appointment when children are well-rested.
• Keep your anxiety or concerns to yourself. Children often sense your emotions, which can make them anxious as well.

During this visit, you can expect the dentist to:

• Examine your child's mouth for proper growth and development.
• Look for oral injuries, cavities, or other problems.
• Let you know if your child is at risk of developing tooth decay.
• Discuss fluoride varnish or other preventive treatment options.
• Gently clean your child's teeth and provide you with tips for daily care.
• Discuss teething, pacifier use, or finger and thumbsucking habits.
• Schedule the next visit.

Other considerations

Thumbsucking and pacifiers

Many infants and toddlers place fingers, pacifiers, or other objects in their mouths for comfort, a sense of security, and to help soothe teething. While these habits are a normal part of growth and development, they should be monitored. If these habits are excessive or continue beyond their toddler years, they can impact your child's oral health and development. Negative effects can include:

• Abnormal jawbone development and position.
• Delayed speech development or abnormal speech.
• Crooked, crowded, or rotated teeth that can promote tooth decay and periodontal disease.
• Difficulty chewing.
• Misaligned teeth, which may ultimately require orthodontic treatment.

Getting your child to stop a sucking habit can be challenging. It is typically best achieved through a system of reminders and rewards. Positive approaches can motivate and educate your child, so they stop the habit on their own. Negative reinforcement, such as using unpleasant-tasting substances on fingers and pacifiers, is generally considered to be less effective.

Your child may continue their sucking habits despite your best efforts. In these cases, it may be necessary to place a dental appliance such as a palatal crib on your child's teeth. This will help provide a gentle reminder not to place fingers, thumbs, or other objects into their mouth.

Tongue thrusting

Babies and toddlers often poke out their tongues when nursing or feeding. This is an entirely normal reflex known as tongue thrusting.² However, if your child continues to poke out their tongue as they become older, it could be an early warning sign of dental problems. For example, prolonged tongue thrusting can lead to poor teeth alignment or a lisp. The thrusting puts forward pressure on your child's front teeth that can cause them to tip outward. Flared teeth are more likely to be injured and can cause unnecessary orthodontic issues.

If you notice your toddler's tongue remains forward in their mouth or pushes out when swallowing, talk to your child's dentist or pediatrician. Other signs to look for include breathing only through the mouth, frequent oral sores, or lips that are constantly chapped or cracked from licking. Enlarged tonsils may also cause your child to hold their tongue forward to breathe.

Thrush

Thrush is a rare fungal infection in the mouth called oral candidiasis. It can occur at any age but is most often seen in babies and toddlers, especially those with weakened immune systems. The fungus can also cause diaper rash and vaginal infections. An infant who breastfeeds can pass the infection to their mother.³

It's important to check your baby's mouth frequently for signs of thrush. It is typically easy to treat.

Symptoms of oral thrush include:

• White raised areas on the tongue, inner cheeks, the roof of the mouth, gums, tonsils, or in the back of the throat.
• Large painless red marks in the center of the tongue.
• Gum irritation or inflammation.
• Cracking or redness at the corners of your baby's mouth.
• Loss of taste or a lack of desire to eat.
• Fussiness, crying, or a change in sleep patterns.

If you notice any of these symptoms, contact your pediatrician or pediatric dentist immediately. Additional tests may be required to rule out other possible conditions. To treat thrush, the doctor or dentist will most likely prescribe an antifungal medication that is usually taken for ten days or more.

In addition to medical treatment, there are some things you can try at home that may help ease symptoms of thrush. Talk to your child's doctor or dentist before taking any of these steps:

• Ensure your child maintains healthy oral hygiene with regular brushing and flossing.
• While they may not like the taste, have them rinse their mouth with about 1/8 teaspoon of salt in warm water a few times a day.
• Ask your dentist or pharmacist for the name of a pediatric oral gel or rinse that may be helpful, and follow their advice on how to use it.