Caring for your toddler's teeth

How can I help my toddler to have strong teeth?

You can do a lot to ensure that your toddler's teeth are strong and will resist decay both now and in the future. Much depends on what he eats, as well as how often he eats it.

Try to keep sweets and other sugary snacks between meals to a minimum. This includes dried fruits such as sultanas and raisins, which are high in sugar and can stick to teeth, as well as chocolate and cakes.

When your child eats or drinks sugar, the bacteria in his mouth mix with the sugars to make a mild acid. This acid attacks the hard outer layer of the teeth and over time can cause cavities. If your toddler has lots of sugary snacks, you are continually topping up the levels of acid in his mouth.

Water and milk are the best drinks for your toddler between meals (BHDF 2010a, HPA 2008). Try not to give your toddler acidic, sugary or fizzy drinks between meals, or juice or cordial in a bottle.

If you give your toddler fruit juice, it should be well-diluted, and given only at mealtimes (HPA 2008, NHS 2011) in a sippy cup or cup. Or you could encourage him to drink the juice through a straw, which is better for his teeth (NHS 2011).

To have healthy teeth your toddler should eat plenty of fruit and vegetables (HPA 2008) and include calcium and vitamin D in his diet. Vitamin D helps his body to absorb calcium, which he needs to grow strong bones and teeth (ITF 2010).

Dairy products such as cheese are good sources of calcium, as are tofu and tempeh. And there's vitamin D in milk, oily fish, eggs, and fortified foods such as margarine and breakfast cereals (ITF 2010).

If your toddler won't drink much milk since being weaned from the breast or bottle, make sure he has dairy products such as yoghurt and cheese or dairy alternatives instead.

Are there treatments that will protect my toddler's teeth?

Some children are particularly prone to tooth decay. Fluoride strengthens tooth enamel and helps to resist decay. So when there’s an increased risk of decay, or early signs of decay, your dentist may consider a treatment of fluoride varnish.

The dentist paints this varnish on to your child's teeth to stop the process of decay, or at least delay potential fillings. Talk to your dentist to find out if your child would benefit from this treatment (NHS 2010).

How can I minimise the damage caused by lollies?

Preventive measures are always best. Take control of lollies before your toddler discovers them. If you don't eat lollies, and your toddler's friends don't, he may not meet a lolly until his second birthday. If the rest of your child's diet is healthy, even this period without lollies will help those first teeth to get a good start.

If banning lollies is impossible, you can reduce how much damage is done to the enamel on your toddler's teeth. The more times a day your toddler eats something sugary, and the longer the sugar stays in his mouth, the more likely it is that damage will occur.

Try to restrict sweet food and drink to less than four times a day, as part of three meals and one snack (BNF 2009, DH and BASCD 2009, HPA 2008). A small slice of cake or a piece of chocolate to finish off a meal is less harmful to his teeth than a lollipop that your toddler sucks all afternoon (NHS 2011).

Otherwise, encourage your toddler to eat all his sweet things in one short session. Give him a small piece of cheese after he’s finished these to neutralise the sugars (HPA 2008), and make sure that his next teeth-cleaning session is thorough.

Cakes and other high-sugar foods, even if they're homemade, can be just as damaging as sugary sweets.

Raisins, sultanas, dates and other dried fruits (whether loose or in bars) can cling to and harm teeth, even though they're a healthier option than lollies. Your toddler should also eat these as part of a meal, rather than as a snack.

Chewy lollies are worst of all, as they stick to the teeth and stay in the gaps until the next thorough brushing, or sometimes longer.

Tooth-friendly snacks include:

• cubes or slices of cheese
• plain yoghurt
• plain popcorn
• breadsticks
• plain rice cakes
• fresh fruit or vegetables
  (HPA 2008, NHS 2011)

How can I keep my toddler's teeth clean?

Cleaning your toddler's teeth should be part of his daily routine, though you may need to be persistent. But you can gradually give him more responsibility for the brushing as time goes on.

Clean your toddler's teeth twice a day, before or after breakfast, and after his last drink of the day. As you brush, clear all traces of food from on or between his teeth:

• Use a small toothbrush with soft, round-ended bristles of differing lengths, and a small, angled head. Change the brush at least every three months, or when the bristles start to spread out.
• Once your baby is 18 months old, use a smear of sugar-free toothpaste, increasing to a pea-sized amount once he’s older and able to spit out toothpaste. Children younger than six years should use a low-fluoride toothpaste containing about 500ppm (parts per million) of fluoride (NSWH 2014). If your drinking water doesn’t have fluoride added, your child should use a small amount of adult fluoride toothpaste once he’s one year old (NSWH 2014).
• Brush using small circular movements (NHS 2010). Don't saw from side-to-side, as this may damage his gums, and it won't scrub his teeth.
• Concentrate on one section of the teeth at a time, and don't forget the backs.

If he's reluctant to have them cleaned, brush your teeth first and then let him try to copy you. Or see if he'd like to brush your teeth for you.

Persuade, rather than force, your toddler to open his mouth, as he needs to learn to like the idea of brushing. Give him lots of praise and encouragement when he allows you to brush them. Letting him choose his own toothbrush may also make it more fun for him.

Supervise your child while he brushes his teeth until he’s at least eight years old (ADA nd). By then he'll have the manual dexterity needed to clean his teeth thoroughly. When he feels ready to try, let him have a go. Show him how to brush in small circular movements, rather than from side-to-side.

My toddler eats toothpaste out of the tube. Is this a problem?

If your toddler makes a habit of swallowing too much fluoride toothpaste while his teeth are forming, he may develop fluorosis. Fluorosis can give your toddler's teeth a mottled look (Wong et al 2010). So encourage your toddler to spit out toothpaste after brushing.

Eating too much toothpaste in one go is more likely to cause a tummy ache than anything more serious (Nochimson 2011). If you suspect your child has eaten a large amount of toothpaste, take your child to your doctor or to your nearest hospital emergency department.

Make sure your toddler can't get to the toothpaste tube without you knowing. He may be more likely to swallow toothpaste if it has a sweet or fruity flavour (Kobayashi et al 2011). So try a minty or neutral flavour instead.

When do we need to visit a dentist?

Take your child to the dentist when his first tooth appears or when he's about a year old, whichever comes first.

Dentists can help to prevent, as well as cure teeth problems. So don't wait until you see signs of tooth decay.

When you go to the dentist for your own appointment, take your toddler with you. He'll then get used to the sights, sounds and smells.

Find out what will happen if your child chips or knocks a tooth.