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Teeth: Dental Care for Children

Toddler brushing teeth  

Your child’s first teeth are called primary teeth. Most of them, if not all, will be replaced by permanent teeth by the time your child reaches age 12. However, it is still important to keep your child’s baby teeth clean. Your child needs these teeth for proper eating, speaking and growth.

Dental care starts even before your baby’s first tooth grows in. Use the following dental care advice to protect your baby’s first set of teeth and help their future permanent teeth stay healthy.

Why is dental care important?

Dental care from an early age is important for preventing tooth decay. Often, the first sign of tooth decay is a toothache, which can cause a lot of pain in or around your child’s tooth.

What causes tooth decay?

A slimy substance called plaque constantly forms on the enamel that covers the teeth. The plaque contains bacteria, which break down the food and drink we eat every day and produce acid. This acid is entirely normal and healthy, but it must be washed away regularly with proper cleaning of the teeth and gums. If the acid stays too long in the mouth, it starts to eat away at the enamel, the hard shell of the tooth. This causes tooth decay.

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Tooth decay happens when the acid produced by bacteria in plaque is allowed to remain around the teeth and gums. If the acid is not washed away regularly, it eats away at the tooth enamel, causing cavities.

Children are most at risk for tooth decay when they fall asleep at night while breastfeeding or with a bottle of formula, juice or milk in their mouth. This can lead to early childhood caries (ECC), also known as nursing bottle syndrome. This is a serious form of tooth decay in babies and young children. It occurs when the acid that breaks down this food has all night to eat away at the tooth enamel.

Signs of tooth decay

The signs and symptoms of tooth decay may include:

  • a change in tooth colour
  • continuous, intense pain
  • bouts of throbbing pain
  • sharp pain lasting minutes (triggered by chewing or by hot or cold food)
  • occasional pain
  • sore or bleeding gums
  • fever
  • a white or red swelling inside the mouth, near the painful tooth.

How to keep your child’s gums and teeth clean

Good dental care is based on regular brushing and flossing. Some families have a particularly strong strain of mouth bacteria or higher levels of bacteria that can lead to more tooth decay. If tooth decay is a problem in your family, be extra careful when cleaning your child’s teeth.

When to start cleaning your child’s teeth and gums

  • Wipe a newborn baby’s gums with a soft, clean, damp cloth after feeding.
  • At age three months, begin cleaning your child’s mouth after every feeding. Lay your baby in a comfortable place and gently wipe their gums with a clean, damp washcloth.
  • As soon as your child’s teeth poke through the gums, you and your child should clean them with a toothbrush to keep them strong and healthy.
  • ​​​​If your child is under three years old, you will need to brush their teeth. Your child might find it fun to brush their own teeth and will be able to start. However, you should complete their toothbrushing until they are able to tie their own shoelaces or cut food with a knife and fork on their own.
  • If your child is aged between three and six, they can usually brush their own teeth with your help and supervision.

​​​​By the time your child is three years old, teach them “2 for 2”. This means brushing twice a day for two minutes each time, while you supervise them.

Download a poster that will summarize when you should start cleaning your child's teeth and gums.

Brushing your child's teeth

  • Use a small toothbrush with soft rounded bristles. Hold the toothbrush so that the bristles are angled to where the gums meet the teeth.
  • Use gentle circles to brush the teeth. Scrubbing or brushing too hard will hurt your child’s gums.
  • Cavities can form on the front, back and top of teeth, so clean every surface of every tooth.
  • If you are supervising your child, remind them to gently brush the front, back and top of their teeth in a circular motion and point the toothbrush to where the gums meet the teeth.

How often to brush your child’s teeth

  • All children should have their teeth brushed at least twice a day.
  • The best times to brush your child’s teeth are first thing in the morning after breakfast and right before bed. Brushing before bed is very important because your child produces less saliva (spit) at night to help keep their mouth clean.
  • Brush your child's teeth after every meal or snack. If you cannot do this, give your child a glass of water to wash away the sugars.

Using the right toothbrush

  • Use a toothbrush that is the right size for your child’s mouth. The bristles should be soft and rounded. You can start using a soft baby-size toothbrush as soon as your child’s first tooth appears.
  • Buy a new toothbrush at least every three or four months. A toothbrush with bent or worn bristles will do a poor job and may hurt your child’s gums.
  • It is safe for a child to use an electric toothbrush. In fact, children often enjoy using one. Ask your dentist about the types of electric toothbrush you can buy for your child.

Using the right amount of toothpaste

Fluoride is a mineral found in the soil, water and food. It is added to most brands of toothpaste and to the drinking water of many communities. When used in small amounts, it helps build strong teeth and prevents cavities from forming. Check with your town or city council to find out if your water has added fluoride.

  • If your child is under three and not at risk of tooth decay, you can clean their teeth with a toothbrush moistened with water. If they are at risk of tooth decay, use only a tiny amount of fluoride toothpaste (less than the size of a grain of rice). Ask your doctor or other health professional if your child is at risk.
  • Between the ages of three and six, your child can use a pea-sized amount of fluoride toothpaste.
  • ​Supervise your child while they are brushing their teeth and make sure they spit out the toothpaste when they are finished. Using or swallowing too much fluoride toothpaste can cause white specks to form on your child’s permanent teeth (dental fluorosis).

If your community does not add fluoride to the drinking water or if you get your water from a well system, tell your child's dentist. The dentist may recommend fluoride supplements to help prevent cavities from forming.

Flossing your child's teeth

Get your child to start flossing early. In most cases, it is a good idea to start when your child's back teeth touch each other. This usually occurs around age three. Flossing is important because a toothbrush cannot clean between teeth.

How to floss your child’s teeth

  1. Take a piece of floss about as long as your child's arm.
  2. Wrap it around your middle fingers, leaving a two inch gap between your hands.
  3. With your index fingers, slide the floss between the teeth and wrap it into a ‘C’ shape.
  4. Wipe the tooth from the gum to the tip at least two or three times.
  5. Use a new part of the floss for each tooth.

Floss both sides of each tooth and remember the backs of the last molars.

Your child will need help with flossing for a while. By the age of 10 or 11, they will be able to floss on their own.


Other ways to prevent tooth decay

Prevent early childhood caries

Do not let your child fall asleep:

  • on the breast while breastfeeding
  • while sucking a bottle of formula, milk, juice or any other liquid besides plain, unsweetened water
  • while using a sippy, spout or straw cup.

Clean your baby's teeth after you breast or bottle feed them. If your baby tends to fall asleep after the last breast or bottle feeding, gently clean their teeth and gums just before the last feeding.

  • Do not let your child walk around with a training cup or bottle full of sweetened water, juice or milk.
  • Do not dip a pacifier in honey or any other sweetener. Give your child a plain pacifier instead.

Download a poster that summarizes why it is important only to offer your child water to drink between meals.

Do not let liquid pool in your child’s mouth

Acid-producing bacteria break down simple sugars such as table sugar, lactose (in milk) and fructose (in fruit). Liquids that pool in your child's mouth for hours can coat the teeth in sugars that will promote tooth decay.

By the time your child is aged 12 to 15 months, they should use a regular cup for all drinks. This not only reduces the risk of tooth decay but also helps them with feeding and co-ordination.

Download a poster that summarizes when your child should start using a sippy cup and a regular cup, and when they should be fully weaned from a bottle.

Have a healthy diet

Introduce a balanced diet of healthy foods as soon as your child starts eating solids. This will help your child develop a taste for healthy eating early on and set the stage for good eating habits in the long run.

Snacking throughout the day may cause tooth decay because the teeth are constantly covered in sugars. Make sure you feed your child healthy snacks and only give sweets as a treat.

Allow your child to eat only at set meal and snack times. After they eat, brush your child's teeth or have them wash down the food with water. This is especially important if they have eaten sticky treats, such as raisins or chewy candies.

Brush teeth after medicines

Some liquid medicines have high sugar content. Clean your child's teeth after a dose of medicine the same way you would after a snack.

Decrease juices

Even 100% juice can coat your child’s teeth in enamel-damaging sugar. The taste of juice can lead to cravings for sweet food and drinks that can last a lifetime. Juice may also fill your child’s stomach and prevent them from drinking milk, which has more nutrients. For all these reasons, keep juice and other sugary drinks to a minimum.

Visiting the dentist

According to the Canadian Dental Association, your child should first visit the dentist within six months of their first tooth emerging or by the time they are 12 months old, whichever comes first. Starting early will get your child used to visiting the dentist. If your family dentist does not treat children, find a pediatric dentist in your area.

After your child's first visit, the dentist will tell you when your child needs to return. Your child should see a dentist regularly (normally every six months).

If you do not like going to the dentist, there is a strong possibility your child will copy your behaviour and attitude. Have a positive attitude when taking your child to the dentist and tell your child what happens there. Before each visit, try reading your child a fun book or two about going to the dentist.

When to see a doctor or dentist

Make an appointment with your child’s dentist if your child has:

  • bouts of throbbing pain
  • sharp pain triggered by chewing hot or cold foods
  • pain triggered by meals, especially sweet foods.

If your child has a cavity and it is not treated, severe pain and infection can occur. This infection can spread to your child’s face or other areas of their body, making them very sick. A serious infection can also damage the permanent teeth that are developing in the bone just below the baby teeth.

Call a doctor or dentist right away if your child has:

  • intense and continuous pain in the mouth
  • fever
  • swelling of the face.

How you can help your child with a toothache

If your child is complaining of pain in their mouth, you can help ease the pain before you see a dentist or doctor.

You can either use:

  • liquid acetaminophen (liquid Tylenol, Tempra or other brands)
  • ibuprofen (liquid Children’s Advil or Children’s Motrin).

Never give your child ASA (acetylsalicylic acid, or Aspirin​).

Key points

  • Tooth decay happens when bacteria on the teeth produce acid while breaking down food and drink. This acid is normal, but it can damage tooth enamel if it is not washed away regularly.
  • Start cleaning your child's teeth early. Wipe with a damp cloth after every feeding, starting when they your child is around three months old. When the first tooth appears, you can start using a baby toothbrush.
  • To prevent early childhood caries, do not let your child fall asleep on the breast or with a bottle of juice, milk or other sweetened liquid in their mouth. Other ways to reduce cavities include limiting eating to snacks and mealtimes and keeping juice and other sugary drinks to a minimum.
  • Brush your child's teeth at least twice a day and preferably after every meal. Brushing before bedtime is very important.
  • If your child is not at risk of tooth decay, start using a pea-sized amount of fluoride toothpaste when they turn three. Until they are age six, supervise them while they are brushing and make sure they spit out the toothpaste.
  • Flossing is important. You can start flossing your child's teeth from around age three.
  • Take your child to their first dentist appointment within six months of the eruption of their first tooth or by 12 months of age. Try to have a positive attitude when taking your child to the dentist.

Michael J. Casas, DDS, MSc, FRCD(C)
Sonia Chung, DDS, MSc, FRCD(C)
Edward Barrett,DDS, MSc, FRCD(C)​