Basic Dental Care

Infants and Children

A child's dental care really starts with his or her mother's healthy pregnancy, because baby teeth begin to form before birth. If you are pregnant, make sure to eat a balanced, nutritious diet and get an adequate amount of vitamins and minerals. It's important for pregnant women to have a complete dental exam and have any cavities or gum disease treated.

Teething

Your child's first teeth ( primary teeth ) usually begin to break through the gums (erupt) at about 6 months of age, although the timing varies among children. All of the 20 primary teeth should come in between the ages of 6 months and 3 years. Your child will lose his or her primary teeth between the ages of 6 and 11. For more information, see the topic Teething.

Your child's first permanent teeth ( molars ) usually erupt behind the primary teeth at about age 6. The last permanent teeth usually erupt between the ages of 12 and 21.

Starting to visit a dentist

By the time your child is 6 months of age, your doctor should assess the likelihood of your child having future dental problems. This may include a dental exam of the mother and her dental history, as the condition of her teeth can often predict her child's teeth. If the doctor thinks your child will have dental problems, be sure your child sees a dentist by his or her first birthday or 6 months after the first primary teeth appear , whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.

Experts recommend that your child's visits to a dentist start within 6 months after the first teeth appear or at 12 months of age, whichever comes first. Babies with dental problems caused by injury, disease, or a developmental problem should be seen by a children's (pediatric) dentist right away. If these dental problems are not limited to the surfaces of the teeth, your baby should also be seen by a children's doctor (pediatrician) or your family doctor.

Caring for your child's teeth and gums

It's best to start good oral health habits before permanent teeth come in.

• Use a soft cloth to clean your baby's gums. Start a few days after birth, and do this until the first teeth come in.
• Parents and caregivers often share spoons, forks, and other utensils with babies. The saliva you may leave on the utensil contains bacteria that can cause tooth decay. Sometimes, kissing can also transfer bacteria. You can help prevent early childhood tooth decay in your child by making sure that your family practices good dental health habits. Keeping your own teeth and gums healthy reduces the risk of transferring tooth decay bacteria to your child.
• Do not put your infant or small child to bed with a bottle of milk, formula, juice, or other product that contains sugar. The sugar and acids in these liquids can cause tooth decay (bottle mouth). Do not prop the bottle up in your baby's mouth. Remove the bottle as soon as your baby is done feeding or is asleep. Breastfeeding your infant to sleep is safe, however. Encourage your baby to begin drinking from a cup at about 4 to 6 months of age.
• Teach your child to drink from an open cup as soon as possible. Try to do this by age 12 to 15 months. Drinking from a cup is less likely to cause liquid to collect around the teeth. If your child must have a bottle or sippy cup for long periods, fill it with water only.
• Discuss your child's fluoride needs with your dentist. If your child needs extra fluoride, your dentist may recommend a supplement or a gel or varnish that he or she would apply to your child's teeth. Use supplements only as directed. And keep them out of reach of your child. Too much fluoride can be toxic and can stain a child's teeth.
• Give your child nutritious foods to maintain healthy gums, develop strong teeth, and avoid tooth decay. These include whole grains, vegetables, and fruits. Try to avoid foods that are high in sugar and processed carbohydrates, such as pastries, pasta, and white bread.
• Do not give your child mouthwashes that contain alcohol. If your child age 6 or older has cavities, ask the dentist if your child should try mouthwash that contains fluoride. But watch to make sure your child does not swallow it.
• Keep your child away from cigarette smoke (secondhand smoke). Tobacco smoke may contribute to the development of tooth decay, gum disease, and other health issues.^{footnote 1} As your child grows, teach him or her about the dangers of smoking and secondhand smoke.
• Children play hard, sometimes hard enough to knock out or break a tooth. Learn how to prevent injuries to teeth and what to do in a dental emergency. For more information, see the topic Mouth and Dental Injuries.
• If your child sucks his or her fingers or thumb, help your child to stop. If the child can't stop, see your dentist. For more information, see the topic Thumb-Sucking.

Brushing and flossing

• Start cleaning your child's teeth with a soft toothbrush as soon as the teeth come in. Brush your child's teeth twice a day using a small, soft brush. If your child is younger than 3 years, ask your dentist if it's okay to use a rice-sized amount of fluoride toothpaste. Use a pea-sized amount for children ages 3 to 6 years. Teach your child not to swallow the toothpaste.
• Start flossing your child's teeth as soon as they touch each other. You may find plastic flossing tools helpful. Talk with your dentist about the right timing and technique to floss your child's teeth and how to teach your child to floss.
• Brush and floss your child's teeth for the first few years, until your child can do it alone. Your child can learn how to brush his or her own teeth at about age 3. Children should be brushing their own teeth morning and night by age 4, although you should supervise and check for proper cleaning.
• Encourage your child to watch you brush your teeth at a proper angle, so he or she knows how to brush the right way. A good teaching method is to have your child brush in the morning and you brush at night until your child masters the skill.
• Use disclosing tablets from time to time to see whether any plaque is left on the teeth after brushing. Disclosing tablets are chewable and will color any plaque left on the teeth after the child brushes. You can buy these at most drugstores.

Common Concerns

The following are some concerns that many people have about going to the dentist and dental care:

• What can I do about being scared? Dental anxiety is being nervous before or during a dental visit. This can make going to the dentist a difficult experience. You can take steps to limit your anxiety, such as explaining your fears to the dentist and setting up a system of hand signals.
• Do I need teeth whitening? Teeth whitening uses a bleaching product or an abrasive to make teeth whiter. Teeth whitening is not a medical procedure—it does not result in healthier teeth—but it can result in a brighter smile. This in turn can make people feel better about themselves. Teeth whitening works better for some types of stains than others, so talk to your dentist about whether it is right for you and about the products and procedures available.
• Do older adults have any special concerns? Concerns of older adults include dentures and trouble brushing.

Dental procedures

The following are some concerns about what might happen at the dentist's office:

• Will a routine visit hurt? If you go to the dentist regularly and take good care of your teeth, there will probably be no pain. If this is your first visit in a long time, or you do not take good care of your teeth and gums, there may be some irritation as the dentist cleans the spaces between your teeth and between your teeth and gums.
• Will I need a filling? A filling is a substance that dentists use to replace a decayed or broken portion of a tooth. You often need a filling to fix a cavity. Whether you need a filling depends on how well you take care of your teeth. If you brush and floss on a regular basis and limit how much sugar you eat, chances are you won't need a filling.
• Will I need dental X-rays? Dental X-rays can identify cavities, bone disease, and infections and help in planning orthodontic treatment. In children, they can also identify when new teeth are coming in. X-rays can help your dentist find problems at an early stage, which can save you time, money, and unnecessary pain or discomfort. You and your dentist will set up an X-ray schedule based on your needs.

Children

The following are some concerns about dental care for children:

• How can I make a trip to the dentist enjoyable for my child? A visit to the dentist can be a scary thing for children. You can reduce this possibility by choosing your dentist carefully and preparing your child for his or her first visit. Most importantly, don't communicate your own fears to your child.
• How do I brush my child's teeth? It is important to start brushing and flossing your child's teeth when they first come in. This keeps your child's teeth and gums healthy and provides a good model for what he or she will do in the future.
• Will my child need fluoride? Fluoride is a mineral that helps prevent tooth decay and cavities. Pediatric dentists recommend that you start to use a very small amount (a smear) of fluoride toothpaste on your baby's toothbrush as soon as your baby's teeth start to come in. Normal amounts of fluoride added to public water supplies and bottled water are also safe for children and adults. If your child needs extra fluoride, your dentist may recommend a supplement, or a gel or varnish that he or she would apply to your child's teeth. Use supplements only as directed. And keep them out of reach of your child. Too much fluoride can be toxic and can stain a child's teeth.

Note: Fluoride is safe in the amounts provided in water supplies but can be toxic in large amounts. Toxic levels depend on your child's weight. A lethal dose of fluoride for a 3-year-old child is 500 mg and is even less for a younger child or infant. Keep all products containing fluoride, such as toothpastes and mouthwashes, away from children. If you think your child may have swallowed too much fluoride, call your local poison control center or the National Poison Control Hotline right away at 1-800-222-1222.

Routine Checkups

Your dentist will recommend how often to have routine checkups. Many people should see their dentists once or twice a year. Your dentist will examine your teeth and gums for signs of tooth decay, gingivitis, and other health problems.

• Your dental hygienist will begin to clean your teeth by scraping hard mineral buildup (tartar) off of your teeth with a small metal tool. Then the hygienist will floss your teeth, use a polishing compound, and apply fluoride. Cleanings usually aren't painful.
• Occasionally your dentist will want to take X-rays. The X-rays take only a few minutes.
  • Your dentist or technician will have you put on a heavy apron to shield your body from X-rays. Everyone else in the room will either wear a protective apron or step behind a protective shield.
  • Your dentist or technician will have you bite down on a small piece of plastic. This will help align the teeth properly for the machine. Your dentist or technician will repeat this process several times to get pictures of all your teeth.
• If needed, your dentist will put a sealant on the chewing surface of your back teeth to help prevent cavities. Sealants keep food and bacteria from getting stuck in the rough chewing surfaces or grooves of your teeth, and they protect your teeth from plaque.
• Your dentist or hygienist may apply a fluoride solution directly to your teeth to help prevent tooth decay. Your dentist may recommend a series of fluoride applications.
• If you are prone to infections, or if infections are particularly dangerous for you, you may need to take antibiotics before you have some types of dental work. Talk to your dentist or doctor if you have questions about the need for antibiotics. You may need to take antibiotics if you:
  • Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
  • Have an impaired immune system.
  • Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.
• Your dentist or hygienist may ask you about the foods you eat. What you eat and whether you get enough vitamins and minerals can affect your dental health.
• If you have active tooth decay or gum disease, your dentist will talk to you about changing your brushing or flossing habits. In severe cases, he or she may recommend antibiotics, special mouthwashes, or other dental treatments. If your teeth and gums appear healthy, your dentist will recommend that you continue your usual brushing and flossing.

Home Treatment

Developing good dental health habits is the best way to prevent tooth decay and gum disease. Older adults may have special concerns about dentures, and those with arthritis may have trouble holding a toothbrush.

• Dental Care: Brushing and Flossing Your Teeth

Brush daily

• Get into a routine of brushing and flossing. Brush your teeth twice a day, in the morning and at night, and floss once a day.
• Use a toothbrush with soft, rounded-end bristles and a head that is small enough to reach all parts of your teeth and mouth. Replace your toothbrush every 3 to 4 months.
• You may also use an electric toothbrush that has the American Dental Association (ADA) seal of approval. Studies show that powered toothbrushes with a rotating and oscillating (back-and-forth) action are more effective than other toothbrushes, including other powered toothbrushes.^{footnote 2}
• Use a fluoride toothpaste. Some fluoride toothpastes also offer tartar control, which may help slow the formation of hard mineral buildup (tartar) on the teeth.
• Place the brush at a 45-degree angle where the teeth meet the gums. Press firmly, and gently rock the brush back and forth using small circular movements. Do not scrub. Vigorous brushing can make the gums pull away from the teeth and can scratch your tooth enamel.
• Brush all surfaces of the teeth, tongue-side and cheek-side. Pay special attention to the front teeth and all surfaces of the back teeth.
• Brush chewing surfaces vigorously with short back-and-forth strokes.
• Brush your tongue from back to front. Some people put some toothpaste or mouthwash on their toothbrush when they do this. Brushing your tongue helps remove plaque, which can cause bad breath and help bacteria grow. Some toothbrushes now have a specific brush to use for your tongue.
• Use disclosing tablets every now and then to see whether any plaque remains on the teeth. Disclosing tablets are chewable and will color any plaque left on the teeth after you brush. You can buy them at most drugstores.

Floss daily

Floss at least once a day. The type of floss you use is not important. Choose the type and flavor that you like best. Use any of the following methods:

• The finger-wrap method: Cut off a piece of floss 18 in. (45 cm) to 20 in. (50 cm) long. Wrap one end around your left middle finger and the other end around your right middle finger, until your hands are about 2 in. (5 cm) to 3 in. (8 cm) apart.
• The circle method: Use a piece of floss about 12 in. (30 cm) long. Tie the ends together, forming a loop. If the loop is too large, wrap the floss around your fingers to make it smaller.
• A plastic flossing tool that makes flossing easier: Child-size flossing tools are available for parents to use to floss their children's teeth. You can buy them at most drugstores.

Gently work the floss between the teeth toward the gums. Curve the floss around each tooth into a U-shape, and gently slide it under the gum line. Move the floss firmly up and down several times to scrape off the plaque. Popping the floss in and out between the teeth without scraping will not remove much plaque and can hurt your gums.

You may want to try electric cleaning devices (interdental cleaning devices or interdental brushes) that are made to clean between your teeth. They can be as effective as using dental floss.

If your gums bleed when you floss, the bleeding should stop as your gums become healthier and tighter next to your teeth.

Eat a mouth-healthy diet

• Eat a balanced diet that includes whole grains, vegetables, and fruits and is low in saturated fat and sodium. Good nutrition is vital to maintaining healthy gums and avoiding tooth decay.
• Mozzarella and other cheeses, peanuts, yogurt, milk, and sugar-free chewing gum (especially gum that contains xylitol) are good for your teeth. They help clear your mouth of harmful sugars and protect against plaque. These make great after-meal snacks.
• Avoid foods that contain a lot of sugar, especially sticky, sweet foods like taffy and raisins. The longer sugar stays in contact with your teeth, the more damage the sugar will do.
• Do not snack before bedtime, because food left on the teeth is more likely to cause cavities at night. Saliva production decreases while you sleep, so saliva does not clean the mouth well during sleeping hours.

Quit using tobacco

It is also important to stop using tobacco products. Using any tobacco product makes it more likely you will have mouth cancer or gum disease (periodontal disease). Using tobacco can also delay healing after you have a tooth pulled or other surgery on your teeth or mouth.^{footnote 1} Tobacco use also causes bad breath and stains your teeth and tongue.

Caring for your child's teeth

It's best to start good oral health habits before permanent teeth come in.