Your Child's Teeth from Birth to Age 6

To give your child a healthy start in life, it's important to take care of his or her teeth and gums. Dental health is a big part of total health. If a child gets dental disease that is not treated, he or she can suffer serious health problems.

You can protect your child from dental disease with daily cleanings, regular dental visits and good nutrition. Children learn healthy habits from their parents and carers. This leaflet will give you simple steps to help your child have a lifelong healthy smile.

Baby's First Teeth

Your child's baby teeth help your child chew and speak normally. They also hold space in the jaws for the adult for the adult teeth that come in later. Starting infants with good oral care can help protect their teeth for decades to come.

A baby's teeth start to come in (erupt) when the baby is about six months old. By age three, most children will have a full set of 20 primary teeth. Baby teeth will later be lost (shed) as your child develops and grows. This makes space for adult (permanent) teeth, which begin to come in around age 6. By the age of 21, a person usually has all of their adult teeth.

Teething Tips

As teeth begin to erupt, some babies may have sore or tender gums.

Signs of teething can be:

Irritability and pain are reported by parents to be the most common symptoms of their teething babies.
Waking up in the middle of the night and not sleeping well is another very common symptom.
Not wanting to eat solid foods is an understandable symptom of teething because their gums are often tender.
Biting things. You may notice that your child seems to want to bite a lot of things
Increased salivary flow and drooling. You may notice that your child starts producing more saliva which causes them to drool more when they are teething.
Rubbing their gums. Babies will sometimes try to rub their gums to alleviate the pain.
Ear rubbing is a common finding among teething babies.
A mild fever has been found to occur during teething, but it's important to keep in mind that major fevers are not associated with teething. If your child has a really high fever, chances are that something else is causing it.
A rash on their face - While a rash on your baby's face can be a symptom of teething, rashes anywhere else on their body haven't been found to be associated with teething.
Sucking on things. You might find your child sucking on their fingers more than before or sucking on random objects around the house that then become covered in drool!
Bruising or swelling on the gum. An eruption haematoma may be seen occasionally in the site of an erupting tooth. This bluish swelling will usually spontaneously burst on its own but if it causes problems please see your dentist.

It is important to note that the following are not normally associated with teething:

Congestion
Diarrhoea
Rashes that aren't on the face
A high fever (teething can cause a minor fever)
Nausea
Convulsions
Paralysis
Vomiting
Sicknesses such as croup and primary herpetic gingivo-stomatitis

What are the best ways to soothe my baby's painful gums?

There are plenty of things you can try before resorting to pain relief products or teething gels. Giving your baby something cool to bite on can relieve the pressure and ease the pain. You could try the following:

Rub a finger or a cold spoon over your baby's sore gums to numb the pain temporarily.
Give your baby a teething ring. Solid silicone-based teething rings are recommended over liquid-filled products, which could leak and can't be sterilised. You could try putting the teething ring in the fridge for a while before giving it to your baby.
Give your baby a dummy. Chewing on the teat may help your baby to soothe herself.

If your baby is more than six months old, you could try the following:

Let your baby chew on hard non-sweetened rusks, breadsticks or oven-hardened bread. You could also use frozen bread, such as bagels, for a cool chew.
Use fresh and frozen fruit and vegetables, such as cucumber to use as a chewable soother.

Watch your baby if you give her hard bread or vegetables to chew on. Don't use raw carrots, for example, once she has her first tooth, as she may bite off lumps that might choke her.

Never tie anything around your baby's neck for ease of use, as it puts her in danger of strangling herself. This includes teething rings, dummies or attachable teething biscuits.

You could also try chilled water in a bottle or, if she prefers, a feeding cup. If she is old enough for solid foods, try offering her cold fruit puree or plain yoghurt. There will be times when your baby will reject all of these offerings and a cuddle is the best therapy you can give.

Should I use teething gels?

Teething gels usually contain a local anaesthetic and an antiseptic, which work together to ease the pain and prevent infection. A small amount rubbed onto the sore gum with a clean finger or cotton wool pad has a numbing effect that lasts for about 20 minutes. However, you should not use teething gels more than six times a day.

If you are breastfeeding, it's best not to give your baby teething gels just before a feed. They can numb your baby's tongue and make it hard for her to suck properly. They might also numb your areola, which is the dark skin around your nipple. This will make feeding difficult for both of you.

Can I give my baby infant paracetamol?

Yes, you can give your baby infant paracetamol or ibuprofen if she is three months or older. Don't give both together. Check the dosage information on the packet or ask your doctor or pharmacist if you are unsure how much to give your baby.

It's also worth checking whether there is something else upsetting your baby. Ear infections are often mistaken for teething. If your baby seems unwell and upset, or has a fever, take her to the doctor to check what the problem is.

Prevent Cavities

Tooth decay can begin as soon as a baby’s teeth come in. Decay in baby teeth can lead to cavities and cause pain. Left untreated, it can destroy the teeth of an infant or young child. Tooth decay can also have an effect on a child’s general health. He or she may have difficulty eating, resulting in poor nutrition.

Babies have a high risk for decay if their teeth are in contact with sugary liquids often or for long periods of time. These liquids include fruit juice, soda and other sweetened liquids. Bacteria in the mouth feed on the sugar in these drinks. The bacteria release acids that can attach teeth and cause cavities.

Never put a baby to bed with a bottle or use a bottle as a pacifier. If your child uses a pacifier (or dummy), do not dip it in sugar or honey, or put it in your mouth before giving it to your child. The bacteria release acids that can attack teeth and cause cavities.

Sippy cups or 'no-spill' cups should only be used until around a child's first birthday. After that, try to get your child to drink from a small open cup.

If a child's tooth decays badly the tooth may become infected, pus forms under the tooth and eventually appears on the gum below the tooth. Commonly referred to as a 'gum boil', these swellings are an important sign of dental disease and your child should see a dentist at the earliest opportunity. These dental abscesses are often painful and untreated may lead to damage to the underlying developing permanent tooth.

Cleaning Your Child's Teeth

Good news: Tooth decay can be prevented. Cleaning your child’s teeth is an important step towards preventing cavities. Cleaning also helps remove plaque, a sticky film of bacteria that builds up on teeth.

After each feeding, wipe the baby’s gums with a clean, damp gauze pad or washcloth. This will remove plaque and bits of food that can harm erupting teeth.

When your child’s teeth begin to erupt, brush them gently with a child-sized toothbrush

Tips for proper brushing:

Brush your baby's teeth with a small, pea-size amount of low fluoride toothpaste after your baby turns six months in non-fluoridated areas and after 18 months in fluoridated areas. Low fluoride toothpastes created especially for children under six years of age are available in most supermarkets or pharmacies.

Children only require a small amount of fluoride toothpaste and should not be allowed to dispense toothpaste without supervision.

Toothpaste should be kept out of reach of children. Parents should assist with brushing of teeth until children are about eight years of age.

Position your child so you can see into the mouth easily. You may want to sit, resting his or her head in your lap.
Place the toothbrush against the gums.
Move the brush back and forth gently in short (tooth-wide) strokes. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method in the inside surfaces and chewing surfaces of the teeth.
Finish by brushing the tongue to help freshen breath and remove bacteria.
Begin using floss when your child has two teeth that touch. Flossing removes plaque between the teeth.

Flossing:

When your child is about two and a half years old, you can try introducing them to flossing their teeth. Flossing helps remove decay causing bacteria from between their teeth and keeps their gums healthy. It will take time for your child to get used to having their teeth flossed, however, ideally their teeth should be flossed at least twice a week in areas where the teeth are touching.

Slide the floss between your child's teeth and gently work it up and down, against the surfaces of each tooth. Do not snap the floss down between the teeth as the floss may hurt their gums. After flossing, have your child rinse with water, then brush (or if you prefer, brush then floss) your child's teeth.

If you find flossing your child's teeth difficult, ask your dentist to show you how to do it. Floss holders are available, which can make flossing easier for some children.

Fluoride

Fluoride is a mineral that is very effective in protecting teeth from decay. When a child’s teeth are still forming, fluoride works by making tooth enamel more resistant to the acid that causes tooth decay. Fluoride also helps repair areas where the acid attacks have already begun.

Children can get added protection from fluoride if they get it from more than one source. Fluorides may be found in toothpastes, mouth rinses and professional fluoride applied by your dentist or hygienist. People can also get fluoride from fluoridated tap water or from fluoride tablets, drops or lozenges. Most bottled water does not contain fluoride so children who regularly drink bottled water or un-fluoridated tap water may be missing the benefits of fluoride. Check the bottle label to see if fluoride has been added.

Excessive fluoride ingestion can lead to enamel discolouration so consult with your dentist before considering fluoride products.

Breast milk is widely considered the most complete form of nutrition for infants. If you use formula milk to feed your baby, ask the paediatrician, GP or dentist about the best water to use.

Sucking Habits

Many infants and young children like to suck on thumbs, fingers and pacifiers or dummies. Sucking is a natural reflex that may make them feel safe, happy and relaxed. However, in some cases a child’s sucking habits can cause problems with tooth alignment and the proper growth of the mouth.

An open bite caused by long term thumb sucking leaves the child with a lisp

Sucking habits usually stop between the ages of two and four. If your child uses a pacifier or sucks his or her fingers, talk to your dentist about how to wean your child off this habit. Pacifiers should not be used after age two, and finger or thumb sucking should end by age four.

First Dental Visit

As soon as your child’s first tooth appears, schedule his first dental visit. It is a good idea to have the first dental visit within six months after the first tooth appears, but no later than your child’s first birthday. It is best to meet the dentist when your child is having no dental problems – don’t wait until an emergency comes up.

Having a check-up at this age connects your child to a 'home base' for dental care, a place where you can take your child from year to year. This helps the dentist get to know your child’s and your family's specific needs, so they can provide the best care.

During the first visit, your child's dentist can do several things, such as:

Learn your child’s health history
Give a complete oral exam to check growth and development, oral hygiene, injuries, cavities and other problems
Tell you if your child is at risk of developing tooth decay
Clean the teeth and provide tips for daily care
Find out whether your child is getting enough fluoride to prevent cavities
Review feeding practices that may lead to tooth decay
Discuss teething, pacifier use, or finger/thumb sucking habits
Talk with you about common dental injuries and what to do if one happens
Discuss treatment if needed and schedule the next check up

Teaching children the importance of good oral care early is a great way to set healthy habits for life. Dental disease is almost entirely preventable, and untreated dental disease can lead to serious health problems.

Keep your child healthy by brushing his or her teeth twice a day, flossing once a day and by visiting your dentist regularly.