Oral Health Recommendations for Mothers and Primary Caregivers with Young Children

Tooth decay (dental cavities) is one of the most common chronic diseases of childhood in the United States. Untreated tooth decay can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Compared with children who have good oral health, those who have poor oral health often miss more school and receive lower grades. Good oral health supports life-long health and achievements in education, employment, and social relationships.

The good news is that tooth decay is preventable. The best protection against tooth decay is good oral home care, regular access to professional care, a healthy diet of low sugar food and beverages, use of fluorides, and dental sealants. Mothers and primary caregivers play a critical role in good oral health practices and the prevention of tooth decay in young children. Your child should see a dentist when their first tooth erupts, or at age 1, whichever comes first.

When liquids or food that contain sugar are left in a baby’s or a young child’s mouth for a long time, the sugar breaks down into acid that can remove minerals from the teeth, causing cavities to form. Common high sugar food or drink sources are sugar-sweetened beverages, fruit-based and milk-based sweetened drinks, 100% fruit juices, pureed baby food pouches, cakes, cookies, sweetened cereals, sweet desserts, candy, honey, and syrups. Breast milk and formula also contain sugar.

Why are baby teeth important?

Baby teeth are needed for chewing food and for permanent tooth development. They provide a nice smile and promote a good self-image for children. They are needed to speak clearly. If baby teeth are lost too early, permanent teeth can come in crowded and out of alignment.

The parent or primary caregiver should brush the child’s teeth with a soft toothbrush and a tiny smear of fluoridated toothpaste twice daily, once in the morning and then before bedtime. Children should not have access to toothpaste after toothbrushing time. The parent or caregiver should also wipe the child’s mouth with a wet cloth after feedings or meals. In particular, be sure to wipe plaque from their upper front teeth.

Children should be eating healthy, age-appropriate foods and should not be given sugary drinks, such as fruit juices. Meals and snacks should include no-sugar-added yogurts, fruits, vegetables, nuts (if not allergic), sources of protein, and cheeses. Avoid sugary and sticky foods, including candy, cookies, cakes, fruit roll-ups, raisins, fruit leathers, or dried fruits. Foods high in carbohydrates, such as crackers, chips, and dried fruit tend to get stuck on the teeth and lead to tooth decay.

Children should be given only water to drink between meals. Juice should only be allowed at mealtime, and infants should not consume more than 4 ounces of 100% juice daily. Juice is not necessary for a balanced diet and whole fruit should be prioritized.

Infants should NOT be put to sleep with a bottle, sippy cup, or no-spill cup with formula, milk, or juice products. Nighttime, on-demand breastfeeding should be curtailed as much as possible. Children should be weaned from the bottle, and the pacifier after one year. Pacifiers should never be dipped in sweetened foods such as honey, syrup, or sugar.

Limit food and utensil sharing between mothers or primary caregivers and infants or children to reduce the transmission of bacteria that can cause dental caries. Do not clean a dropped pacifier or toy with saliva, which can transmit bacteria from the caregiver to the child.

The bottom front baby teeth (central incisors) are often the first teeth to come into the mouth, usually between 6 to 8 months of age. Generally, four teeth erupt for every six months of life after the development of the first teeth into the mouth. Theupper jaw center teeth (central incisors) often erupt after the lower central incisors and a total of 30 primary teeth should have come into the mouth by 3 years of age.

The teeth eruptive process can be a source of stress and pain for children, and it can, be alleviated by biting on cold teething rings or other soft teething aids. Teeth must always be brushed and properly cared for, even at such a young age, because primary teeth have permanent teeth successors.

The parent or caregiver should brush the child’s teeth with a soft toothbrush and a tiny smear of fluoridated toothpaste for children under the age of 3 years and a pea-sized amount of toothpaste for children between 3 and 5 years old. Children should not have access to toothpaste after toothbrushing time. The toothbrushing routine should be repeated twice a day. Start using dental floss daily when teeth are in contact, particularly between the back teeth. Tooth brushing together with parents and older siblings can be incorporated as a fun family activity.

Children should be eating healthy, age-appropriate foods and should not be given sugary drinks or fruit juices.Meals and snacks should include no-sugar-added yogurts, fruits, vegetables, nuts (if not allergic), sources of protein, and cheeses. Avoid sugary and sticky foods, including candy, cookies, cakes, fruit roll-ups, raisins, fruit leathers, or dried fruits. Foods high in carbohydrates, such as crackers, chips, and dried fruit tend to get stuck in the biting surfaces of teeth and lead to cavities. Limit these snacks.

Children should be given only fluoridated water to drink between meals. Juice should only be allowed at mealtime; infants should not consume more than 4 ounces of 100% juice daily. Juice is not necessary for a balanced diet and whole fruit should be prioritized.

Children should be discouraged from thumb sucking, finger biting, or nail chewing.

When baby teeth become loose, which could happen as early as 5 years of age, children should be encouraged to “wiggle” the teeth to help them come out. The lower front teeth (central incisors) are usually the first teeth to fall out, at around age 5 to 7 years.

The first permanent molars, which begin development at birth, most frequently come into the mouth around age 5 to 6 years. Extra care must be taken with toothbrushing to properly clean these new permanent teeth and the surrounding soft tissue, which is often inflamed following tooth eruption. This process can be a source of pain for children, and it can be alleviated with age/weight adjusted dose of Motrin or Tylenol.

Fluoride’s mechanism of action suggests it would be best to have a high fluoride level in surface enamel and plaque before an acid challenge. It makes more sense to brush before breakfast and before going to sleep. Caregivers should brush the child’s teeth until they are confident that the child is brushing effectively (usually around age 7 or 8) and not swallowing toothpaste. A child who can tie their shoes has the dexterity to brush and floss effectively. Lift the child’s lip to inspect the teeth and gums after the child brushes. Parents or caregiver should closely monitor toothbrushing habits through age 8 years. Similarly, dental floss should be used by the parents or caregivers when the child’s adjacent teeth touch each other. Gently work the dental floss between teeth to avoid injuring the gums.

Children should be eating healthy, age-appropriate foods and should not be given sugary drinks or fruit juices.Meals and snacks should include no-sugar-added yogurts, fruits, vegetables, nuts (if not allergic), sources of protein, and cheeses. Avoid sugary and sticky foods, including candy, cookies, cakes, fruit roll-ups, raisins, fruit leathers, or dried fruits. Foods high in carbohydrates, such as crackers, chips, and dried fruit tend to get stuck on teeth and may lead to tooth decay.

Children should be given only water to drink between meals. Juice should only be allowed at mealtime; infants should not consume more than 4 ounces of 100% juice daily. Juice is not necessary for a balanced diet and whole fruit should be prioritized.

Children should be discouraged from thumb sucking, finger biting, or nail chewing.

When teeth become loose, which could happen as early as 5 years of age, children should be encouraged to “wiggle” the teeth to exfoliate or fall out. The primary lower jaw incisor teeth are often the first teeth to fall out of the mouth between 5 and 7 years of age. The upper jaw incisor teeth are often the next teeth to fall out.

The first permanent molars (FPMs), which begin development at birth, most frequently come into the oral cavity between 5 and 6 years old. Extra care must be taken in toothbrushing regimens to properly clean these new permanent teeth and the surrounding soft tissue, which is often inflamed following a tooth eruption. This process can be a source of pain for children, and it can, therefore, be alleviated with Motrin or Tylenol. Dental sealants, a thin protective plastic coating, are generally recommended for FPMs as a caries prevention technique.

Fluoride’s mechanism of action suggests it would be best to have a high fluoride level in surface enamel and plaque before an acid challenge. It makes more sense to brush before breakfast and before going to sleep. Similarly, flossing techniques should be implemented before nightly toothbrushing. Mouthwash should only be considered as an additional oral hygiene technique, as opposed to a replacement for regular toothbrush and flossing care.

Children should be eating healthy, age-appropriate foods and should not be given sugary drinks or fruit juices.Meals and snacks should include no-sugar-added yogurts, fruits, vegetables, nuts (if not allergic), sources of protein, and cheeses. Avoid sugary and sticky foods, including candy, cookies, cakes, fruit roll-ups, raisins, and fruit leathers or dried fruits. Foods high in carbohydrates, such as crackers, chips, and dried fruit, tend to get stuck on teeth and lead to cavities. Limit these snacks.

Older children and pre-teens should drink only water between meals. Otherwise, drinks low in sugar, such as plain milk or 100% juice, should be consumed very infrequently, as neither is necessary for a balanced diet.

Older children and preteens should not have to be reminded to brush their teeth or floss. Regardless, parents or primary caregivers should emphasize the importance of a routine because children aged 9 to 12 years may tend to stay up late and fall asleep in front of the television without properly attending to their oral hygiene. Consequently, they may wake up too late for school to follow throughwith their morning oral hygiene regimen. The trap of this cycle should be discouraged.

Most primary (baby) teeth should have fallen out naturally, and the successor permanent teeth should come into the mouth during the preteen years. The second permanent molars frequently emerge at about age 12. Extra care must be taken in toothbrushing regimens to properly clean these new permanent teeth and the surrounding soft tissue, which is often inflamed following a tooth eruption.

The preteen years also present a crucial window for growth and alignment of the permanent teeth, as well as possible evaluation by an orthodontist.

The human papillomavirus (HPV) vaccine is recommended for all children aged 11 or 12 years. It is important that the two doses of the HPV vaccine be administered 6 to 12 months apart to prevent HPV infection.