Read on for our expert advice on how to care for your child’s teeth – plus, what to do if problems arise.
Medically reviewed by Dr Juliet McGrattan (MBChB) and words by Claire Chamberlain
Teething can be traumatic for both baby and parent, but it’s exciting, too! The appearance of your child’s milk teeth is something of a landmark… but how should you best care for them? And how can you encourage good oral hygiene as your child gets older?
The appearance of your child’s first tooth is a landmark moment of parenthood.
Every baby reacts differently to the sensations of teething and, while some may be wholly unconcerned by a tooth pushing through their gum (in fact, you may only be alerted to the process by the appearance of a tooth one day!), others will be a lot more distressed by the experience.
Some common signs your baby might be teething include:
- dribbling lots
- being unsettled/difficult to settle
- crying more than usual
- refusing food (if already on solids) or getting upset while being breast/bottle fed
- pulling at their ear or rubbing their cheek
Sometimes, people point to other symptoms of teething, including rashes, fever and additional dirty nappies, but there is no evidence to support these claims, and it’s important not to simply attribute these symptoms to teething, in case your baby is actually unwell with something else.
When do babies start teething?
So, when can you expect your baby’s first tooth to make an appearance?
‘Baby teeth generally start to appear from around six to 12 months of age,’ says Dr Okoye. ‘It’s usually always the bottom two teeth first, followed the top two teeth, so it’s the incisors that come through first.’
What order to baby teeth come in?
After the initial incisors, bottom and top, the remainder of your baby’s teeth will generally come through in the following order:
- Lateral incisors
- First molars
- Second molars
‘Children have 20 teeth and most children usually have their full set of milk teeth by the time they’re around three years old,’ says Dr Okoye.
Best teething remedies
You can help your baby during teething with the following:
Allowing them to chew
One of the best ways you can help relieve the discomfort of teething for your baby is by allowing them to chew: chewing provides counter pressure, which can ease the ache felt from the tech pushing their way up and out of the gums. Teething toys can work well and they’re even better if they’re cold, so store them in the fridge or freeze for additional relief.
Providing additional comfort
Extra cuddles and comfort may also be necessary, so take a deep breath and hold them close – your baby may be cranky, so you’ll need a little more patience and understanding to help them through.
Offering pain relief
If your baby is in pain, you can give them a sugar-free painkiller, such as paracetamol, provided your baby is over the age of three months. Always follow the instructions on the medicine packet and speak to your pharmacist if you have any questions.
According to the NHS, there is no evidence that teething gels or powders (either those that contain a local anaesthetic or homeopathic options) work.
Brushing your children’s teeth
When it comes to caring for your child’s teeth, the earlier you get started the better.
‘I say start brushing even when they haven’t got teeth!’ says Dr Okoye. ‘You don’t even need a brush at this stage – you can just use a flannel to clean their gums, to get them used to the whole sensation.
‘And when to start brushing? As soon as teeth appear. Once there are teeth in there, you need to start brushing, and kids should have their teeth brushed by an adult until they’re about eight years old. So obviously as they get older, let them have a go – the adult should do it first, and then let them go over them afterwards, saying, “Now you have a go, to make sure I’ve done it properly,” to get them involved. Most parents stop too early. It’s not just adult supervision that’s required – the adult actually has to brush up until they’re about eight.’
Toothpaste and toothbrush choices
As soon as your child’s first tooth appears, you’ll need to get them a toothbrush and toothpaste. Dr Okoye says it’s very important to use a toothpaste designed specifically for children at first, because the higher fluoride levels in adult toothpaste can be harmful and, as they haven’t got the reflex at that age to be able to spit the toothpaste out, they will end up swallowing a lot of it.
‘It’s fine to move onto an adult toothpaste as soon as you’re confident they can spit it out,’ she says.
When it comes to choosing a toothbrush, a small, soft head is best.
‘Electric toothbrushes are also fine for kids,’ says Dr Okoye. ‘I like the Oral B one, because it’s a small head and it has a blue stripe on it, so it lets you know when you should change the brush. Your child (and you!) should have a new toothbrush every three to four months.’
Best times of day to brush your child’s teeth
It’s important to brush your child’s teeth twice a day, first thing in the morning and last thing at night, before they go to bed.
While brushing straight after breakfast, to remove remnants of food, may seem logical, Dr Okoye actually says this can be one of the most damaging times to brush teeth.
‘Always brush first thing in the morning,’ she says. ‘You shouldn’t brush your teeth after breakfast, because whatever you’ve had for breakfast will always have some sugar or acid in it.’
Dr Okoye explains that the sugar in food actually weakens the enamel on teeth, making it more porous and prone to damage.
‘When you eat something sugary, it dissolves the enamel of your teeth, so if you then use a brush, you’re actually brushing the enamel away,’ she says. ‘Sweet or acidic foods makes your teeth a bit like chalk – the calcium starts dissolving. If you imagine you got a toothbrush and started brush a piece of china – something hard – with the brush, versus brushing a piece of chalk, you get the idea. Brushing after you’ve eaten, when your teeth are in that softer state, can actually damage the enamel of the teeth.’
When it comes to caring for your child’s teeth, the earlier you get started the better.
The same is true if you decide to brush your teeth in the middle of the day – always brush before, not after, the food.
‘If you’re going to eat something sweet, you need to be premeditative – brush first, then have your chocolate bar or whatever it is afterwards, because that will mean you’ve gotten rid of all the plaque and bacteria first, which are going to cause the problems.’
However, Dr Okoye says that brushing twice a day is adequate.
‘Always brush before bed – the night time brush is the most important one,’ she emphasises.
When do adult teeth usually appear?
The next phase of your child’s dental development occurs when they begin to lose their baby teeth, to make way for their permanent adult teeth.
‘Children’s adult teeth used to come through at about the age of six, but now I tend to say it happens between the ages of four and six, because children’s teeth have started coming out much earlier,’ says Dr Okoye. ‘It’s usually always the bottom two teeth first, and then the top two teeth, so it’s the incisors that come through.
‘Children usually have all their adult teeth by the age of about 12 to 14. By the age of 14, they should have everything bar wisdom teeth – these tend to come out much later, between the ages of 18 and 21.’
Helping your kids avoid sugar
As well as brushing twice a day with the correct brush and toothpaste, your child’s diet will play a part in their dental health.
Aim to avoid excess sugar in their diet – for example, start them off drinking plain water rather than squash or fizzy drinks.
‘All of us are born liking sweet flavours – breast milk is sweet – so that’s normal, but if you can instil good habits early, such as only drinking water, then it does pay off long term,’ says Dr Okoye.
She also says that hidden sugars can be a real problem.
‘Sugar is sugar, no matter the source,’ she explains. ‘Things like raisins, which everyone thinks are a healthy snack, is just the same as eating a gummy bear really, because they are so thick and sticky, and get into all the crevices of the teeth. And some of these “health” bars – it’s just the same as eating a Mars bar when it comes to your teeth. People just aren’t aware of that – they think they’re making the right choice. But if it ends in -ose, – whether it’s lactose or fructose – it makes no difference. It’s still sugar.’
And when it comes to sweets, quantity can be far lass damaging than frequency.
‘If you give your child a bag of sweets and they’re eating them slowly all day long, it takes 45 minutes to an hour to neutralise the effects of eating something sweet,’ she explains. ‘I’m not against kids having sweets, but what I say to parents is, have a day at the weekend, where they can choose a packet of whatever and eat it all in one go and be done with it, rather than letting it extend the whole course of the day.’
Eating for good dental health
Obviously sugar is a no, but what other changes can you make to your child’s diet to help promote good oral and dental health?
‘People get really caught up in this and I just say, whatever is good for your body is good for your teeth,’ says Dr Okoye. ‘The only supplement you should really consider is vitamin D. Everybody now knows how important vitamin D is and the role it plays in helping the body absorb calcium, so even if your kids have lots of calcium in their diet, if you haven’t got the vitamin D their body won’t be able to use it.
‘But aside from that, you just need to ensure your child has a well-balanced diet, with vitamin C from fruits and vegetables – that’s important for keeping their gums healthy. But generally, people don’t need to worry – it’s hugely hugely rare for a nutritional deficiency to be the cause of teeth problems.’
Cavities in children
Sometimes, of course, cavities will happen.
‘Cavities are very common in children,’ says Dr Okoye. ‘One of the things that the research is showing is that we used to think it was more prevalent in deprived areas, but we now know this is not the case any more. A lot of it happens in the middle classes.’
Dr Okoye says this again comes down to those hidden sugars, in organic cereal bars or juices, and a greater need for educational awareness – that sugar is sugar.
It’s important to address issues, including pain or sensitivity, as soon as they arise, and regular dental appointments are paramount. You child should start seeing a dentist from around the age of two, and should have check-ups every six months.
‘The main thing we see is just not brushing well, or not being supervised, so there can be a lot of plaque, and as a result of the plaque kids can get gum problems, such as bleeding gums,’ says Dr Okoye. ‘But the most common issue is still cavities and the consequences of that.’