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Good Oral Health Starts Early: AAP Policy Explained

By: David Krol, MD, MPH, FAAP & Kaitlin Whelan, MD, FAAP

Tooth decay (dental caries) 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.

In the clinical report, "Maintaining and Improving the Oral Health of Young Children," the American Academy of Pediatrics explains key risk factors for tooth decay, and ways to keep your child's teeth healthy. Here is what you need to know.

Can babies get tooth decay & cavities?

Everyone, even babies, can get tooth decay. Children living in poverty, in an ethnic or racial minority groups, or with special health care needs are at more risk for dental decay. 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 cavities (pits) on the teeth. This is a sign that the tooth is decaying.

How water helps prevent tooth decay

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.

When to start using 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.

  • Assist or supervise kids during toothbrushing until they master the task, usually at around 10 years of age.

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 in children

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.

Fluoride varnish: 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.

Finding a dental home for your child

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 their 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 Section on Oral Health (Copyright © 2022)
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.
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