7 Baby Tooth Care Tips

It's easy to consider baby teeth expendable. After all, they're temporary by design. But until your child has a full adult set of choppers at about 12 years old, those tiny teeth play a big role: They're not only essential for chewing and thus for good nutrition, but they also affect lifelong oral health. "Baby teeth set the foundation for a child's permanent teeth," says Beverly Largent, DMD, president of the American Academy of Pediatric Dentistry.

Unfortunately, that foundation is shaky for many kids. According to research from the Centers for Disease Control and Prevention, tooth decay in 2- to 5-year-olds increased between 1988 and 2004 -- while it decreased for everyone older. One reason for more cavities in little kids, dental experts say, may be nonstop drinking (think the ever-present juice bottle or sippy cup) and nibbling. The starch in food turns into simple sugars that nourish decay-causing bacteria, which then secrete the acid that erodes enamel. For grazing kids, the tooth-destruction scenario repeats over and over, wreaking havoc early on.

When a baby tooth teeming with bacteria falls out, it doesn't leave a clean slate -- instead, bacterial organisms immediately start chomping away at the new permanent tooth. So keep those little pearly whites pristine, and you can save your child from dental distress now and in the future. Just follow our experts' key tips for caring for baby teeth.

Tooth decay is an infectious disease, the most common one among children, which means it's passed from person to person. A newborn's mouth is essentially sterile until someone else -- the primary caregiver, usually Mom -- introduces bacteria. Typical scenario: "The binky drops, so Mommy cleans it in her mouth," says David Krol, MD, member of the American Academy of Pediatrics' (AAP) dentistry and oral health section.

Brush and floss regularly to purge your own mouth of bacteria, and don't share utensils. "I treated a family for bad breath -- it turned out they shared cups and spoons," says Martha Ann Keels, DDS, chair of the AAP's dentistry and oral health section.

Using a clean washcloth, gauze, or a finger brush, gently wipe off your baby's gums with a fluoride-free gum cleanser -- ideally, after each feeding but at least once every morning and night. This not only keeps breast milk and formula from pooling inside the mouth, but it also establishes the teeth-cleaning habit. "Routines are very important for children, and setting them can make a big difference in maintenance later in life," Dr. Krol says.

Plus, most babies enjoy a good gum massage, which gets your baby used to having something poked around in her mouth. "The more you're in there at an early age, the easier toothbrushing will be," Dr. Keels says. "If you don't start till age 2, you'll get a fight."

"As soon as teeth come in, they need to be brushed," Dr. Keels says. "Brushing stirs up those bacterial colonies so they can't stick to the tooth." Start flossing when your baby has two teeth side by side.

Twice a day, hold your child in your lap, and brush around each tooth with a small circular motion. Lift her lip to make sure you hit the gum line, where plaque (the colorless film formed by bacteria) accumulates. "Run the brush under really hot water to soften the bristles," Dr. Largent suggests. "Don't add regular toothpaste. And don't use products with fluoride until she's old enough to spit well, typically around age 3." (At that time, introduce a smear of toothpaste about the size of her pinky fingernail.) Unfluoridated baby toothpaste, however, is safe. Brush gently so you don't scratch the gums or harm the enamel.

If you're dealing with a tight-lipped tot, consider this trick: "I got my son to open up by asking him to roar like a lion," says Liz Campbell, of Carlisle, Pennsylvania.

Toddlers and preschoolers who constantly carry a cup filled with juice or other sugary drinks are just as vulnerable to cavities as babies put to bed with a bottle of sweet stuff. "No matter what the delivery system, every time a child takes a drink, the bacteria get more sugar and make more acid," Dr. Krol says. On-the-go bottles and sippy cups should hold nothing but water.

You don't have to convince a juice guzzler to go cold turkey. "Don't take away what your child loves -- just serve it with meals instead," Dr. Largent says.

Tooth decay usually starts on the backs of the front teeth, which parents can't see. By the time a child is 3, that could progress to devastating disease.

But what if your 1-year-old is still all gums? Don't see the dentist until some teeth come in. "At my practice, we have an eight-tooth rule -- four on top, four on the bottom," Dr. Keels says. For some babies the rule applies at 12 months; for others, around 18 months.

Ideally, of course, you'll hear "Look, Mom, no cavities." Dr. Krol says, "It's best to make that first visit a positive one, with no decay. One that requires drilling and filling is not a good start."

Tap water, toothpaste, and supplemental drops all can be sources of fluoride, which strengthens and hardens teeth to better resist onslaughts of acid. But too much can be bad. When permanent teeth grow under a flood of fluoride, they develop a condition called fluorosis, which means they become mottled and speckled -- forever.

"No infant under 6 months, breastfeeding or not, should receive fluoride supplements," Dr. Krol says. "After that age, the only children who should get supplements are those living in an area where the water supply used for cooking and drinking doesn't have adequate fluoride." If your household water is fluoridated and your baby drinks reconstituted formula, the American Dental Association (ADA) suggests mixing it with fluoride-free bottled water for babies under 12 months.

Continue to wield control of the toothbrush until your child masters the fine-motor skills needed to do the job right and tackle every side of every tooth -- about when she can write in cursive, around age 7 or 8. "Let your child earn it," says Mary Hayes, DDS, an ADA spokesperson. "You brush first, and if she cooperates, she can take a turn."

Whatever you do, don't give up on dental hygiene any more than you would on healthy eating and sleep habits. "My son always resisted my attempts to brush his teeth," says Dawn Raab, of Euclid, Ohio. "As a baby, he bit my fingers to stop me from cleaning his gums. After we started using a toothbrush, he screamed when I picked it up." Now 16 months, David can't wait for toothbrushing time. What made the difference? "He got a bright-red toothbrush shaped like a fire truck," Raab says.

Originally published in the November 2008 issue of American Baby magazine.

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