Care of Teeth and Flouride

Children’s teeth need care from the time they erupt. The following guidelines should serve to keep your child’s teeth clean and free from cavities.

Cleaning Teeth

Infant teeth should be rubbed with a washcloth or soft toothbrush daily. By twelve months of age you should be using a toothbrush to clean the teeth twice daily. As of 2014, it is recommended that you use a “rice grain” sized bit of fluoride-containing toothpaste with each brushing. While we encourage independence, you should help your child with brushing until you are sure he or she is doing a good job without your help. (This may not be until middle school!) When your child is three and able to spit the toothpaste out effectively, you may increase the amount used to approximately the size of a pea. Note also that it is recommended that they not rinse their mouths with water after spitting out the toothpaste, in order for the fluoride to be most effective. This goes for adults, too!


Fluoride is a mineral long shown to strengthen teeth and prevent cavities when ingested. Many public water supplies have fluoride added for this reason. After decades of recommending oral fluoride supplements to children growing up in homes without fluoridated water, in 2014 we discontinued this practice on the advice of the American Academy of Pediatrics. This change came with the recognition that fluoride may be most effective topically, rather than systemically, and that proper levels can be obtained with use of fluoride containing toothpaste alone from the time of first tooth eruption. Please note that there is nothing wrong or unsafe about fluoride supplements or fluoridated water, and many dentists still recommend universal supplements. Others reserve its use for patients who have had multiple cavities, for those with “soft enamel”, and for those who are at higher risk for cavities. Please ask your dentist if your child should take a fluoride supplement, and, if so, for a prescription for the supplement. Fluoride is best given at bedtime after cleansing the teeth. As discussed with using toothpaste, the fluoride should not be rinsed off, but allowed to remain in the mouth, where higher concentrations of the mineral in the saliva will harden teeth and kill the harmful bacteria, which cause tooth decay. Don’t worry if your child just had a bottle or a meal—as long as the fluoride is the last thing at bedtime, it will do its job.

Visiting the Dentist

The recommendations for when your child should first visit a dentist are a little confusing. The American Academy of Pediatrics recommends establishing a “dental home” by one year of age, meaning you should pick a dentist for your child to see in the future. The American Academy of Pediatric Dentistry recommends a visit at first tooth eruption or by one year of age. We generally recommend that a child is seen between their first and second birthday, unless there are specific concerns about the teeth, there is a dental trauma, or if there is a family history of dental problems (like lots of cavities or “soft enamel”) early in life. We are fortunate to have many excellent dentists in the area who do a wonderful job taking care of children’s teeth, and will be glad to recommend one for you if you have not established a “dental home.”

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