How to Look After Your Infant’s Teeth: 0-3 Years

Keeping your children’s teeth healthy isn’t easy.

This is shown by the scary fact that 12% of 3 year olds have visible tooth decay.

To fight this epidemic, I will explain exactly how to keep your child’s teeth healthy from the ages of 0-3 years.

This will include: how to clean your child’s early teeth, how to instil good eating habits (hint: you may need to force it on them at first), and how to best use your dentist at this time.

I hope you find it useful, and who knows, your grown up kids might even thank you (second hint: they probably won’t) when they become adults who show can show off their teeth.

Anyway, lets get started:

Oral health before baby teeth (0-6 months)

Even before your baby’s first teeth, you need to take care of their oral hygiene.

Doing this is incredibly simple.

All it takes is twice daily cleaning of your baby’s mouth (after waking and before bed), and not giving them sugary drinks.

This is because mouths are superb breeding grounds for bacteria (warm and wet).

Add sugary milk residue, soft tender gum tissue, and a still-developing immune system to this mix, and you have one of the most ripe-for-infection zones that nature can offer.

Even before any teeth come out, there are certain oral health problems that babies are susceptible to.

These are: oral thrush and recurrent mouth ulcers (canker sores).

The risk of your baby developing both these problems can be reduced by cleaning their mouths regularly.

A (more important, I would argue) effect of cleaning your baby’s mouth out twice daily is the habituating effect that it has on both you and your baby.

The ritual of cleaning your baby’s mouth twice daily will get you (the parent) to automatically do this every day.

This will inevitably (read: with no thought or effort on your part) lead to you brushing their teeth twice daily when your child’s teeth eventually do come out.

For your baby, it will get them used to the feeling of having a clean mouth.

They will learn to enjoy this feeling and, conversely, dislike the feeling of having a mouth that is sticky with milk residue.

Your baby will then “remind” you (not so gently) to clean their mouths out.

At the end of the day, good oral hygiene is about habit and mindset, and the younger you start instilling these habits the more likely they are to stick.

 

How do I clean my baby’s gums?

You should clean your baby’s gums by gently massaging them with some damp gauze or a clean, damp cloth.

Ideally you should wrap your index finger in the gauze or cloth so you can clean each portion of the gum individually.

Using cold water when doing this is also an effective way of managing the pain of teething.

Two birds killed with one soft, damp stone.

You can also buy “baby brushes”, which have rubber bristles that you wear on your finger.

baby brush in use

A baby brush being worn on your finger

These brushes are used just as you would with the gauze or cloth.

Simply massage the gums gently and thoroughly, going over each portion of gum individually, as you would if teeth were present.

Both types of cleaning are equally as effective, so play around with them and see which type your baby takes to more (remember we want to get your baby to come to enjoy the ritual of cleaning)

Aim to do this twice a day, once in the just after waking and once before bed.

 

How to feed your baby in order to promote their oral health

Your baby’s drinking habits also hugely affects their oral health, perhaps more so than cleaning.

In particular, you need to closely monitor what your baby drinks, as well as when they drink and how they drink.

 

What your baby drinks

The best way to feed your baby to support their oral health is to feed them breast milk and water only.

Unfortunately feeding your infant baby formula, rather than breast milk, can significantly increase their chances of developing oral health problems.

This is simply because baby formula usually contains a lot more sugar than breast milk.

Now, breast milk is not sugar free.

In fact, on average, breast milk contains 7% sugar.

Baby formula on the other hand can contain up to 40% sugar.

Although this sugar comes in the form of lactose, which is in itself not harmful to teeth, when it remains in the mouth as a sticky residue your saliva will break it down into sucrose.

This is the type of sugar that feeds the harmful bacteria in your mouth.

We understand that not everyone can breast feed.

This means that if you are going to feed your child formula, make sure to look for a product that contains less than 10% sugar.

Low sugar baby formula

I recommend Holle Organic baby formula as it contains only 6% sugar

You should also feed your child some water after every feeding (regardless of method).

This washes the sugary residue of breast milk or formula off their gums.

This, combined with twice daily cleaning, should help eliminate any damage done to your baby’s gums by sugar.

 

How your baby drinks

Studies by the American Dental Association indicate that babies who are breastfed are less likely to develop teeth alignment issues such as over-bites or open bites compared to those who are bottle-fed.

The theory behind this is that regular pressure against the teat of a baby’s bottle can interfere with the growth of your child’s jaw.

Yet again, this means that breastfeeding is a superior option to bottle-feeding a child during the first six months of their life.

If you still want to bottle feed your child, make sure to use a bottle with as small and as soft a teat as possible so as to minimise interference with the development of their jaw.

You should also limit the amount of time your child has a bottle in their mouth.

Do this by only feeding them at regular intervals in the day.

Even at this young age, your baby can develop healthy or unhealthy habits and routines around feeding.

No baby is born with an innate fixation to their bottle, it is something that develops through habit.

You need to be find ways of soothing your baby that are not reliant on a bottle (or any other kind of pacifier for that matter).

It may seem hard at first, but it will be nowhere near as hard as trying to break such a reliance.

You must also ensure that your baby does not feed after their final mouth cleaning of the day.

This really is the golden rule of baby oral hygiene- sugary milk residue left in a baby’s mouth overnight is heaven for harmful bacteria

If you have to do this, rinse their mouth with water afterwards and then clean their gums again with a damp gauze or washcloth.

This is because the sugary residue of milk can stick to your baby’s gums and feed the harmful bacteria that cause gum disease.

If your baby regularly sleeps with this sugary residue on their gums than their chances of developing the beginnings of gum disease (gingivitis) will increase.

The most obvious sign of this in your baby is if their gums bleed when you clean them.

If this happens then you should book an appointment with a dentist immediately.

 

Managing oral health problems in babies

There are two very common oral health problems in babies…well three if you include teething, but that will be covered later.

Anyway, these two problems are: recurrent mouth ulcers and oral thrush.

Recurrent mouth ulcers

In babies, recurrent mouth ulcers are caused by cuts or burns to the mouth.

These become problematic if they take a long time to heal, as the pain they cause can lead to irrititability and an aversion to eating.

The pain caused by ulcers, and the length they take to heal is directly affected by the cleanliness of your baby’s mouth.

Simply put, poor oral hygiene will increase the pain that mouth ulcers cause to your child (as they are more likely to become infected) and will make them take longer to heal (again because of the likelihood of infection).

Therefore, there are two simple ways to drastically reduce your baby’s chances of getting mouth ulcers.

These are:

1) Look out for what your baby puts into their mouth (including fingers). Anything roughly textured, overly hard, or potentially sharp (such as fingernails…its almost always fingernails that cause mouth ulcers in babies) can cause the cut to the soft palette that leads to mouth ulcers.

2) Keep the good oral hygienes outlined here (proper cleaning and feeding) so chances of infection is kept to a minimum.

 

Oral thrush

Oral thrush is a fungal infection caused by the Candida fungus.

Candida naturally occurs in the body, but can multiply to unnatural levels in certain situations.

The most common contributing factors to thrush of any kind are: a compromised immune system and high sugar levels in the affected area.

Oral thrush in babies usually manifests itself as a white fur or film that covers your baby’s tongue or other parts of the inside of their mouth.

Baby with oral thrush

A baby with a severe case of oral thrush

It can cause irritation (read: crying), an aversion to feeding, and a propensity to put their hands in their mouth (even more so than usual!).

It does not cause any more serious or long term harm other than these factors, although it can spread to your breast if you are breastfeeding, and that can be incredibly uncomfortable and make feeding even harder.

Oral thrush can be treated quite easily using an anti-fungal cream applied to the affected areas. You can get these over the counter or on prescription (for more persistent cases).

Other swallowed medications also work but you will need to ask your GP if they are appropriate for your baby.

In terms of reducing your baby’s chances of developing oral thrush, it really comes down to their sugar intake and how much sugar is consistently in their mouth.

As I said, the Candida fungus thrives off sugar. 

Therefore a sugary environment, and high blood sugar levels in general, will increase the chances of this fungal infection multiplying beyond control.

Therefore regular rinsing after feeding and cleaning of the mouth will minimise your baby’s chances of developing oral thrush.

That being said, genetic factors, such as how your baby’s immune system develops in their early months is still the biggest predictor of them developing oral thrush, so don’t beat yourself up if they get it. So long as you are following the steps I’ve outlined above you are doing everything you can to prevent it.

How to look after your child’s first teeth (6 months- 3 years)

Your child’s first tooth will most likely erupt between 4 to 8 months of age.

The first teeth that erupt are almost always the lower front teeth (lower incisors).

In most cases both lower front teeth will appear within days of each other.

Once your child’s first teeth come through in the front, more teeth should swiftly follow.

Milk teeth tend to erupt in a certain pattern as follows:

Your child’s age

Teeth that come out

5-7 months

Lower Central Incisors

7-9 months

Upper Central Incisors

10-12 months

Lower Lateral Canines

10-12 months

Upper Lateral Canines

13-16 months

Premolars (inside molars)

14-18 months

Canines (upper and lower)

2-3 years

Molars

Once any of your child’s teeth appear, their health needs to be nurtured.

This is achieved through brushing your child’s teeth twice daily as soon as they appear and by getting your child to enjoy food that is low in sugar.

 

Brushing early teeth

Your child’s teeth will come out before they are able to brush.

It is therefore up to you, the parent, to brush your child’s early teeth.

To brush your child’s early teeth properly, you simply need to follow three steps:

1) Brush each teeth individually, brushing each surface of the tooth for 5-7 seconds (roughly 20 seconds per tooth)
2) Brush all the way down to the gum line, to the point where the bottom bristles of the brush runs over the gum itself.

3) Make sure the bristles go in between the gaps that separate your baby’s teeth.

You can brush the gums lightly as well to clean them or continue to clean them with a damp gauze or cloth.

As the enamel of young teeth is thinner than that of an adult’s teeth, it is also important to brush your child’s teeth gently.

You can ensure gentle brushing through using a soft bristled toothbrush and by holding the brush with a light grip.

Speciality infant brushes, which are smaller than regular brushes, and have softer bristles than standard brushes, are definitely worth getting.

Baby tooth brush

Baby brushes are smaller so it is easier to get to hard to reach parts of your child’s new teeth

I would recommend using fluoridated toothpaste even at this early age, as regular use of fluoride can strengthen enamel.

Considering that a young child’s enamel is relatively soft, the strengthening effects of fluoride will improve their teeth’s resilience to cavities, wear and sensitivity.

That being said, you should use low fluoride toothpaste especially designed for young children.

This is for two reasons:

1) Too much exposure to fluoride toothpaste in the early years of one’s life can lead to a cosmetic condition called fluorosis. Fluorosis can cause tooth staining which can be hard to remove even by a dentist.

2) Fluoride toothpaste should not be swallowed. Very young children will not be able to spit toothpaste. Swallowing fluoride toothpaste will not cause any long-term harm, but it may cause an upset stomach.

Using low fluoride toothpaste eliminates both these problems as the amount of fluoride used in them is not enough to cause fluorosis, nor will it cause nausea when swallowing.

This makes low fluoride toothpastes better than just using a small amount of regular toothpaste—even swallowing a small amount of regular toothpaste can make your young child ill.

Since children under 18 months can struggle to spit, low fluoride toothpaste really is the best option for an infant.

 

Flossing your child’s teeth 

Not flossing and being surprised when gum disease occurs is like not brushing and being surprised when cavities occur.

Therefore, you should ideally be flossing your child’s teeth as soon as they have two adjacent teeth.

This will happen very soon after their first teeth comes out.

Starting to floss your child’s teeth at this young age will help instil the habit of flossing in your child—a habit that (in all honesty due to the tedium of doing it) is notoriously difficult to drum into in an older child.

I get it, brushing your baby’s teeth is enough of an effort; you don’t want to floss them as well.

This is understandable, but I really do stress that starting early with flossing is the easiest way to do it.

This is because the first teeth that come out are the front teeth. These are the easiest to floss, and as there is initially only one adjacent gap to floss, you can do this quickly.

This will allow you to easily practice flossing someone else’s teeth so once you get to having to floss a whole (small) mouth of teeth, the task does not seem so daunting.

The biggest challenge when flossing your baby’s teeth is getting them to open their mouth for long enough to take the floss.

Unlike brushing, where the brush keeps your baby’s mouth open, you have to ensure that your child keeps their mouth open without obstructing it with something.

To get around this problem, I recommend using a floss pick to floss your child’s teeth.

Dental floss pick

This is a dental floss pick

This is a plastic holder to which floss is tightly attached.

The plastic holder goes into your child’s mouth, keeping it open in the same way that a brush does.

This makes flossing your child’s tooth little more effort than brushing them.

I won’t lie, flossing back teeth is harder than front teeth, but if you start flossing early you should be well practiced enough when the molars come in to make light work of it.

 

How to manage teething

The erupting of new teeth inevitably comes with teething pain.

Teething is pain and swelling that occurs in the gums soon before teeth erupt.

As teething happens just before teeth erupt, a young child can experience teething pain in different areas of their mouth from four months to three years of age.

It all depends on which teeth are coming through at that particular time.

Different children react in different ways, and with different intensity to teething pain, but its most common symptoms are irritability, excessive drooling, sleeplessness (due to pain) and an aversion to feeding.

The best way to manage teething pain really depends on which teeth are coming out.

For front teeth coming through (usually occurring from 6-12 months) the favourite damp gauze/cloth trick can be very soothing.

For more acute teething pain, you can try putting the damp cloth or gauze in the freezer for a few minutes before you apply it to your child’s gums.

As your child gets older, they are likely to experience teething in the back of their mouths as their premolars and molars erupt.

This is often more painful, as the teeth that are coming out are bigger and come out more slowly.

More importantly for you, applying pressure to this part of an older child’s gums can result in being bitten…

At this age teething toys may be more appropriate so children can manage their own teething pain by applying the soothing pressure themselves.

They can apply the pressure with their fingers (make sure they are clean), cold hard food, ice cubes, or a teething toy

If your child is going to use a teething toy, just make sure they only use it when they are actually in pain.

Habitually sucking on toys, dummies and fingers can interfere with the alignment of teeth, causing an overbite (buck teeth) that can remain during adulthood.

So be careful to make sure that the teething toy does not become a permanent attachment.

In terms of painkillers, this is best used when applying cold pressure is not enough, or when you are unable to do so (such as at night).

The only painkiller I would recommend for teething is ibuprofen.

This is because a lot of the discomfort caused by teething is due to the inflammation of the surrounding area. This is why nausea and a fever can also accompany teething.

As Ibuprofen is an anti-inflammatory, it can fight all aspects of teething discomfort, and is therefore more effective for teething than other painkillers

 

Ibuprofen dosage chart by weight

A useful table showing recommended ibuprofen dosages by the weight of your child

It is easiest to give your infant ibuprofen in the form of sugar free syrup.

However it is vitally important that you use only ibuprofen products that are designed for young children, and that you do not exceed the recommended dose.

In most cases, this will mean not giving your child a dose of ibuprofen more than once every eight hours.

Giving your child ibuprofen before bed is recommended to help ease irritability and restlessness at night.

You should note that even in small doses suitable for an infant, ibuprofen can cause stomach pain.

The best way to mitigate the chances of this happening is to give them food with the ibuprofen.

Paracetamol (in the form of Calpol— remember that lovely taste) can be given to supplement ibuprofen in severe cases of teething pain. However it should not be used as the main painkiller to soothe teething pain.

 

When to first take your child to the dentist 

As soon as your child’s first tooth erupts, it is time to take them to the dentist.

This is so your dentist can identify and treat any early issues that may affect your child’s teeth.

A dentist will also advise you on how to specifically look after your child’s teeth

This kind of tailored oral hygiene, recommended by a professional, will always be superior to generic care, regardless of your diligence.

During the first few years of your child’s life, you should try to take them for a dental check up every six months.

This frequency is required to monitor oral health through the rapid development of your child’s teeth.

Such regular trips to the dentist will also help instil this ritual as a habit, leading to responsible self-care of teeth in the future.

 

Introducing your child to food

As new teeth come out, they need to be put to use.

Generally, you will want to start giving your child solid food between 6-12 months.

The food that you give to your child at this age can hugely impact the health and development of their teeth.

In particular you need to watch your child’s sugar intake, and the textures of food that they eat.

 

Sugar intake 

Remember the scary statistic that 12% of 3 year olds have visible tooth decay?

Well the main culprit of this is children consuming too much sugar.

We all know that eating sugar is bad for your teeth.

But these negative effects are effects are even more profound for young children.

This goes back to children having softer enamel than adults. This makes teeth more vulnerable to plaque acid damage.

Consumption of sugar causes plaque bacteria to produce acid, it therefore needs to be very carefully monitored in young children.

Ideally your child should have no more than 20 grams of sugar a day between the ages of 6 months and 3 years old.

This includes sugars from food and drinks.

20 grams of sugar can accumulate very quickly, particularly when you consider that 100ml of milk contains 5 grams of sugar.

You therefore need to find low sugar foods that your child would be able to eat and enjoy.

Although low-sugar foods may not have that much appeal to children at first, the enjoyment of food is something that can be acquired.

This is a phenomenon that is apparent in adults—we always enjoy foods that we have grown up with because we are used to how they taste.

If you your child to taste and swallow a specific food item on 10 separate occasions, it is likely that they will start to enjoy (or at least tolerate) it.

This is particularly effective if you limit the amount of alternatives your child has to these foods.

The acquisition of taste for the food on offer is likely a survival instinct—we either enjoy what we are given or we starve.

Similarly your young child has to learn that the low sugar food is their only option.

If this is made clear they will learn to enjoy it and this enjoyment should continue through to adulthood.

I’ll also give you some less obvious foods that you should avoid giving young children:

 1) Most fruits- they tend to range from 15% to 40% sugar. Try not to feed your child more than one portion of food each day. Vitamins should come from vegetables. One of the better fruits to give to your child is berries, as they are low in sugar compared to other fruit (strawberries have on average only 5% sugar). That being said berries are very acidic so should still be given in low quantities.

2) Sweet “orange” vegetables- such as butternut, sweet potato and Unfortunately children love sugar so these are often the easiest vegetables to get little ones to enjoy… its a great source of vitamins but make sure its not the only vegetable that your child has.

3) Crisps- usually contain more sugar than you expect (particularly the nicer flavours) and stick to the teeth, bathing them in sugar. The sharp edges can also damage the softer tissues in you child’s mouth

4) White bread– this sticks to the teeth and saliva alone can break the simple carbohydrates down into sugar.

 

What your child drinks is also vastly important.

As milk contains sugar, you should start to introduce water as the main drink of your child’s diet.

A good ratio at around 18 months is having your child drink the same amount of water as they do milk.

Try to increase the ratio of water to milk as your child gets older.

Fruit juice and other sweet drinks need to be introduced with caution as they are too easily drunk to excess and can contain up to 50% sugar.

Diluting juice with water, and only allowing it as an occasional treat can teach your child to drink juice in moderation without drastically increasing their sugar intake.

 

Getting kids to eat the right textures of food

I get many questions from parents about whether they can feed young children overly hard, crunchy or chewy foods without doing damage to their teeth.

Quite simply, your child should be getting a good mixture of textures of food.

Moderation is key however, they should be getting used to having different textures in their mouth.

Ultimately the consistency of food that your child eats should reflect how many teeth they have.

As more teeth erupt, you can introduce them to more solid food.

That being said you should be regularly pushing your child to the edge of what they feel comfortable biting into.

This is to expand what they are happy to eat (as taste is acquired) and because eating crunchy and fibrous foods can help clean and strengthen teeth.

Chewy, sticky foods, especially those that contain sugar, should be avoided.

Foods with these consistencies can be hard to remove from your child’s teeth through rinsing with water, and therefore can feed harmful bacteria for hours after consuming.

 

Baby bottle tooth decay (“Bottle Mouth”)

For the 12% of children under 3 who have tooth decay, I’m willing to bet that a large number of them have been allowed to develop the habit of regularly having a bottle in their mouth.

The phenomenon of “baby bottle tooth decay” or “bottle mouth” is damage caused to a young child’s teeth and gums caused by constantly having their mouth filled with sugar.

Bottle mouth tooth decay in child

Example of decay caused by “bottle mouth”

How do parents allow this to happen?

Simple, you allow your child to carry a bottle filled with milk or juice with them at all times (including when they are sleeping).

This is, hands down, the worst thing you can do for developing teeth.

Having your child constantly have a sippy cup filled with juice is like having them constantly having a lollypop in their mouths.

Please don’t do it.

The easiest way to avoid this is by never letting your child develop this habit in the first place.

This is done through:

1) Giving your child water as their main drink
2) Only giving your infant access to have a cup or bottle at certain times (meals or to specific requests of thirst)
3) Having your child drink exclusively from a regular cup as early as possible (this is often achievable from 12 months old)

4) Only allowing water to be drunk after teeth are cleaned at night

If you instil these habits from the off, you do not need to worry about your child forming an attachment to their bottle.

If you child does form an attachment to their bottle, than at least make sure the bottle contains water.

Even if this is met by protest from your sugar craving little one, you just need to be firm about this one.

Do not compromise.

 

Can my child suck their thumb or a dummy

 Infants age tend to have oral fixations.

They just love sticking things in their mouth.

This can be as a source of comfort, to reduce teething pain, or simply to explore the world around them through taste and texture.

Some sucking of fingers and other objects (so long as they are not large enough to swallow) is fine.

However thumb sucking that is clearly habitual should be discouraged as it can alter your child’s teeth alignment.

This can lead to cosmetic issues such as an overbite or crossbite, as well as breathing issues such as an open bite (mouth breathing). This can require orthodontic treatment to correct.

Constant use of a dummy can cause this as well.

As with regular use of cups and bottles it is easier to never start these habits than to break them.

And of course you should never, ever put your child’s dummy in something sweet before they suck on it (please).

This has the double effect of bathing your child’s teeth in sugar and making dummy sucking even more habit forming.

 

To summarise

Now I’ve taken you through how to best look after your child’s oral health from 0-3 years old.

At this point they will have gone from having no teeth to all 20 of their milk teeth, hopefully free from cavities and any gum inflammation.

Let’s go over again how we make this happen:

1) Before your baby’s teeth erupt, clean their gums every morning and night with a damp gauze or cloth. This will instil the ritual of teeth cleaning as a habit in both you and your child.

2) Try to breastfeed your child until their first teeth develop at 6 months, if you use formula go for a low sugar product.

3) Never let your child fall asleep without having their gums cleaned first

4) If you use a bottle make sure the teat is as small and soft as possible

5) As soon as teeth erupt you need to brush them for roughly 20 seconds each using gentle brushing on every surface of the tooth

6) Floss your child’s teeth as early as possible, use a floss pick to make this easier

7) Take your child to the dentist as soon as their first teeth appear, then take them for check ups every 6 months.

8) Don’t let your child get in the habit of eating high sugar food, force them to eat low sugar food until they enjoy (or at least tolerate it)

9) Give water as your child’s main drink after 12 months

10) Do not let your child carry around a bottle habitually and have them switch to drinking from a regular cup as early as possible