Babies / Children (0-6y)

Good oral hygiene habits early in life can lead to lifelong oral health. Although a baby has all 20 primary teeth at birth, they only start appearing in the mouth at around six months old. The process of more teeth appearing continues until about age two and a half years. Caring for these little teeth is an essential foundation for good oral health when the permanent teeth start emerging. Remember to schedule your child’s first dental visit by 12 months old.


How frequently your child should have routine dental check-ups About early childhood caries or nursing bottle decay, and if your baby is at risk


Your dentist if teething continues for more than 7–10 days Your pediatrician or physician if your child has a fever (100.4°F) that does not subside with medicine such as acetaminophen


Start to clean your child’s teeth once they emerge into the mouth Use only a smear of fluoride toothpaste on a child’s toothbrush after 6 months old; increase this at 2 years to a pea-sized amount
Use sugar-free or Xylitol gum to stimulate saliva production help keep your mouth moist


Use a toothbrush specially designed for infants and their caregivers Do not put anything in the baby’s or infant’s mouth that has been in your mouth Teeth generally start to emerge from age six months but this can vary widely Arrange to have your child’s first dental visit by age 12 months If a child’s tooth is knocked out or knocked loose, take the child and tooth to a dentist as soon as possible. Keep the tooth clean and store it in a container of cool milk, replace it into the socket, or keep it in your own mouth.

Teething is a series of conditions that are noticeable in a child at the time when teeth are “erupting” from the jaw, through the gums and emerging into the mouth. The baby teeth emerge into the mouth starting at about six months until the last molars arrive at about two and a half years old. These times are only approximate and may vary by up to six months or more.

Teething is a perfectly normal process of childhood development and growth. Many children get through the process without any issues. However, for some children the process can be very challenging for both child and their caregiver.

During teething, the child is much more focused on their mouth than usual and may tend to want to chew on something at the site of the emerging tooth. Sometimes the gum around the emerging tooth may become inflamed, appearing red and painful. Teething itself does not cause fever or diarrhea, but these conditions often happen at the same time.

Consult your dentist, pediatric dentist, or pediatrician if your child develops a fever (over 100.4°F) while teething. No matter how old your child, call your pediatrician if your child:

  • Has a fever that does not go down with medicine
  • Is inconsolable
  • Is feeding much less than normal
  • Is listless, lethargic, or not waking up

Figure: An infant’s first teeth “erupt” from the jaw, through the gums and emerge into the mouth. The lower central incisors are normally the first to emerge. Often one appears several weeks before the other.

  • Biting or chewing on hard objects or fingers, knuckles, etc.
  • Drooling, which often begins before teething starts
  • Refusing food
  • Sleeping problems
  • Just being cranky and irritable

The baby teeth, also known as deciduous teeth, primary teeth, or milk teeth, tend to emerge in right and left pairs. The general pattern that most children show is:

  • Lower central incisors at approximately 6–8 months
  • Upper central incisors at approximately 8 months
  • Upper lateral incisors at approximately 10 months
  • Lower lateral incisors are approximately 10 months
  • First molars at approximately 14 months
  • Canines at approximately 18 months
  • Second molars at approximately 30 months

Figure: At 6–8 months the upper and lower central incisors emerge.

Figure: At 10–12 months the upper and lower lateral incisors emerge.

Figure: At 14–18 months the lower first molars emerge.

Figure: At 18–20 months the upper and lower canines emerge.

Figure: At approximately 30 months the upper and lower second molars emerge, completing the full set of primary teeth.

Though teething may be also known as cutting teeth, when the teeth do emerge they do not actually cut the gum, but special chemicals are released in the gum tissue allowing the cells to separate and enable the teeth to pass through. Minor infections and inflammation may occur during this change in the gum tissue.

First check that your baby is teething by running a clean finger gently over the gums, feeling for any swelling or the hardness of the tip of a tooth. Then if confirmed:

  • Dry the drool around the baby’s mouth, face, and neck with a clean cloth to prevent irritation.
  • Consider use of a teething ring if the baby needs to chew on hard items. Some babies enjoy a teething ring that has been gently chilled.
  • Make sure that the baby does not have access to small objects to chew on, as these can be dangerous if swallowed or lead to choking.
  • Gently rub the gums with a cool, clean, damp washcloth.
  • Try feeding your baby cool, soft foods such as yogurt or applesauce.

Consult your dentist, pediatric dentist, or your pediatrician if a single episode of teething lasts more than 5–7days. Seek advice from your pediatrician about how to measure your child’s temperature and at what temperature to seek medical help.

What not to do:

Do not tie a teething ring or similar item around your child’s neck.
Do not place anything frozen (or taken directly from the freezer) against your child’s gums or face.
Do not give your child aspirin and do not place it against gums or teeth.
Do not use rubbing alcohol on your baby’s gums.
Do not enable your child to play with painted toys due to risk of lead ingestion.

When the very first teeth appear they can be wiped with the corner of a clean, moist washcloth or gauze square. As the teeth emerge fully they should be cleaned by gentle brushing. Use a specially designed, ultra-soft toothbrush with a very small head. Try to brush all surfaces of every tooth. A smear of fluoride toothpaste can be used from six months. Do not re-load the brush with more toothpaste.
Brushing can be challenging. Lay your child on their back, head nearest to you, on the changing table. Use your fingers to gently pull the lip away for better access.

Figure: GUM® Crayola™ Pip-Squeaks™ Toothbrush with a “smear” of fluoride toothpaste

Babies are born without the bacteria that help cause cavities. They pick it up from their parents or caregivers by the sharing of saliva through spoons when testing foods, toothbrushes, and the cleaning of pacifiers in the adult’s mouth rather than with water. So avoid sharing saliva and make sure all adults and other family members with whom the baby will come into contact have regular dental checks and a healthy mouth, too. Other important actions include:

  • Daily cleaning of the baby’s mouth with a soft, moist washcloth before the teeth emerge
  • Twice daily brushing once the teeth do start to emerge
  • Ask your dentist, pediatric dentist or pediatrician about the right amount of fluoride.
  • Avoid sticky foods and unhealthy snacks between meals. Cheese, yogurt and purred fruit are good snacks.
  • Do not fill bedtime bottles or sippy cups with anything but water. The natural sugars in milk or juice are converted to acid by the bacteria and can cause cavities.
  • Schedule the first dental visit no later than 12 months of age.

Remember your dental health is important not only for you but for the baby. Have regular dental check-ups, brush your teeth twice a day, do between-teeth cleaning at least once a day, and do not put anything in your baby’s mouth that has been in your mouth or that of another family member or caregiver.

Loss of the baby teeth starts around 6–7 years old and will continue until age 12–14 years. Usually, the first baby teeth to be lost will start to get wobbly around age 5–6 years and will then fall out. The baby or primary teeth are important for eating, speaking, smiling, and most importantly, to hold and maintain the spaces for the adult teeth.

Figure: The tooth fairy will start to visit at approximately 6 years old.

The period of time when there are both baby and permanent teeth, from 6–14 years, is a time of changing appearances as there are some small baby teeth mixed with some permanent teeth that look very large due to the size of a child’s face. During this transitional phase of a mixed dentition many caregivers worry the child will not look so pretty and may need corrective orthodontic tooth movement. From 12 months old, the child should have a “dental home” and commence regular dental visits. Routine examinations by the dentist will enable proper monitoring of the child’s dental growth and appearance.

Figure: Newly emerging adult size permanent teeth can look out of proportion to the child’s face and remaining baby teeth

At age 6–7 years the first permanent teeth begin to appear and are usually the lower first molars—at the back of the mouth in the lower jaw. When these teeth appear it is important to make sure that regular toothbrushing reaches far back to keep these teeth clean and to receive the fluoride carried in the toothpaste. Sometimes the lower incisors will appear first, replacing the baby incisors. Crowding of teeth as they emerge and settle into their own natural position is not unusual.

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Upper Jaw Age
Central incisor 7–8 years
Lateral incisor 8–9 years
Canine 11–12 years
First premolar 10–11 years
Second premolar 10–12 years
First molar 6–7 years
Second molar 12–13 years
Third molar 17–21 years
Lover JawAge
Central incisor 6–7 years
Lateral incisor 7–8 years
Canine 9–10 years
First premolar 10–12 years
Second premolar 11–12 years
First molar 6–7 years
Second molar 11–13 years
Third molar 17–21 years

Figure: The teeth are developing deep in the jaws for many years before they emerge into the mouth. Left image of a child aged about 8; Right image of a child aged about 10–11 years.

For children less than two years of age, use only a light smear of fluoride toothpaste. From age 2–5 years use a small, pea-sized amount, and after six years the amount can be increased. Your dentist, pediatric dentist, dental hygienist, or pediatrician can give advice tailored to the needs of your child and their risk for developing dental decay.

A small amount of fluoride is very good for teeth, strengthening them and protecting against tooth decay. Too much fluoride can be harmful, so all fluoride sources (toothpaste, fluoride drops, and tablets) should be kept out of the reach of children.

Figure: A smear of toothpaste for 6–24 months; a pea-sized dab of toothpaste for 2–5 years; a normal strip of toothpaste for 6 years and older

Select a brush specifically designed for infants. Soft or ultra-soft, end-rounded bristles are gentle on both teeth and gums but will clean well, removing dental plaque. The handle should be easy for both infant and caregiver to hold.

Brushing can be challenging. Lay your child on their back, head nearest to you, on the changing table. Use your fingers to gently pull the lip away for better access.

Do not use anyone else’s toothbrush, and avoid placing your baby’s toothbrush into your own mouth, even just for persuasion and demonstration purposes. Toothbrushes may harbor bacteria and can spread infections.

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Changing the toothbrush frequently is important for overall dental health. The toothbrush has the potential to harbor bacteria and fungi at the very base of the bristles. It is best to change the toothbrush every one to three months or immediately following the flu, a cold, or throat infection.

Both expert groups for children’s general and oral health, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry, recommend all children to have their first dental visit by 12 months. Early childhood caries (cavities or tooth decay) is the most common of all diseases affecting young children.
An initial dental examination should occur by the first birthday and then routine and regular check-ups should be performed as recommended by your dentist. Routine dental check-ups are one of the essential things a caregiver or parent should do to protect the child’s health and development.

Figure: For the first dental visits, infants are usually held jointly by dentist and caregiver.

The beneficial effects of fluoride to prevent tooth decay have been proven again and again in clinical studies worldwide. However, too much can be a bad thing. Fluoride occurs naturally in some water sources, and in others it is adjusted (increased or decreased) to the optimal level. Fluoride is also added to toothpaste and is available as supplements in the form of drops or tablets. Discuss with your dentist, pediatric dentist, or pediatrician the ideal levels and sources of fluoride for your child’s individual circumstances.

If you think a child has accidentally consumed an excessive amount of fluoride, such as the contents of a tube of toothpaste, a bottle of fluoride mouthrinse or a bottle of vitamins that also contain fluoride, contact a poison control center immediately (Tel: 1-800-222-1222) or call 911.

Too much fluoride could lead to fluorosis of developing permanent teeth. Fluorosis is usually mild, showing tiny white specks or streaks in the tooth enamel. In more severe cases the enamel may be brown and pitted. The appearance of teeth affected by fluorosis can be greatly improved by fairly simple treatments that your dentist can perform.

Children have many accidents and frequently encounter minor injuries. If an injury happens around the mouth, it can be very distressing for both the child and caregiver, as there is often much bleeding that may look worse than it is, as the child’s saliva makes the blood look to be much more than it is.

Young children have many falls and accidents and the primary teeth easily can be injured. If the teeth or mouth are injured contact a dentist, pediatric dentist, or pediatrician as soon as possible. Do not hesitate to call the emergency number if after normal office hours.

If a tooth is knocked out or knocked loose, keep the tooth clean and store it in a container of cool milk, replace it into the socket, or keep it in your own mouth until further instructions are provided by a health care professional.