Skip Ribbon Commands
Skip to main content
Healthy Living
Text Size

Good Oral Health Starts Early

​​Tooth decay (dental caries or cavities) is one of the most common chronic childhood diseases in the United States. The good news is there are ways to prevent it.

Even the tiniest teeth can decay. There are habits you can start now to keep your baby's teeth healthy. And when that first tooth shows up, there are ways your pediatrician can keep it healthy, too. Here is what you need to know.

Who can get tooth decay?

Everyone, even babies, can get tooth decay. Some things put children are at more risk, such as living in poverty, being in an ethnic or racial minority group, or having special health care needs. There are other reasons a child could be high risk.

  • The child's mother or main caregiver had tooth decay in the past 12 months or does not have a regular source of dental care.
  • There are white spots on the child's teeth. These spots are a sign that the tooth is losing calcium and minerals that keep it strong.
  • There are tan, brown or black spots or you see holes (pits) on the teeth. This is a sign that the tooth is decaying.

How water helps

Fortunately, your family's tap water probably has fluoride added to it. Fluoride is a safe and useful cavity-fighting ingredient that has been added to drinking water since 1945.

Fluoride is a natural mineral that can slow down or stop cavities from forming. When you drink water every day, the fluoride makes it hard for bacteria in your mouth to make acid. Fluoride also rebuilds tooth enamel (the outer layer of the tooth) and it even makes teeth stronger.

Check with your local water utility agency to find out if your water has fluoride. The health benefits work when the drinking water has 0.7 mg/L of fluoride. If your community water supply does not have fluoride or you live on a private well, ask your doctor if you should get a prescription for fluoride drops or chewable tablets for your child.

Fluoride toothpaste

As soon as your baby's first tooth erupts, it's time to start using fluoride toothpaste. Here's how to do it:

  • Use a tiny smear --- the size of a grain of rice --- until age 3. Clean the teeth at least twice a day. It's best to clean them right after breakfast and before bedtime.
  • Use a pea-sized amount of fluoride toothpaste when your child is 3 years old. Teach your child to spit without rinsing.
  • It is best if you put the toothpaste on the toothbrush until your child is about age 6.
  • As your child gets older let her use her own toothbrush. Until children are 7 or 8 years old, you will need to help them brush twice a day for at least 2 minutes. Try brushing their teeth first and then letting them finish.

A toothbrush should be the last thing to touch your child's teeth every night....

Do not put your baby to bed with a bottle at night or at naptime. It is also not a good idea to let your baby use a bottle filled with a sweet drink or dip your baby's pacifier in anything sweet like sugar or honey. If you do put your baby to bed with a bottle, fill it only with water. You can give your baby about 4-8 ounces of water per day starting at around 6 months. (Remember, the American Academy of Pediatrics (AAP) recommends breastfeeding as the sole source of nutrition for your baby for about 6 months.)

Special steps stop tooth decay

When your baby is 6 months, your pediatrician will start to do oral health checkups and apply fluoride varnish. Pediatricians are trained to apply fluoride varnish because many young children do not see or have access to a dentist until they are older. All infants and children should have fluoride varnish every 6 months until age 5. Children might need it every 3 months if they have a higher risk of dental decay.

Varnish is used to help prevent or slow down tooth decay. It is painted on the top and sides of each tooth and hardens quickly. The process is safe and does not hurt.

It's in your plan

Fluoride varnish is a "preventive care service" for children. This means that all public and private health insurance plans should cover fluoride varnish. No part of the cost should be shared by patients or families.


Oral health starts early. Be ready to discuss your family's plan for a "dental home." All children need access to a dentist for regular care. See your child's dentist by his first birthday or within six months of their first tooth. At this first visit, your dentist can easily check your child's teeth and determine the frequency of future dental checkups.

More information

Last Updated
American Academy of Pediatrics (Copyright © 2020)
The information contained on this Web site 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.
Follow Us