0-2 Years

In your child's first two years, he or she will likely develop all their primary baby teeth, making it a critical time for good dental care.

Welcome – or welcome back – to parenthood! Caring for an infant in their first 2 years is a time of great joy, but it’s also a lot of work and there’s a lot to learn along the way.

Mixed messages, a lack of information and persistent misinformation about infant oral health piled on top of all the other challenges can seem overwhelming at first. The key is to keep things simple.

Teething

The timing may vary a little with each child, but babies usually begin teething by the time they’re 6 months old, and have all their primary baby teeth by age 3. Infants’ teeth also tend to erupt in a predictable order:

6-10 Months: lower central incisors

7-12 Months: upper central incisors

7-16 Months: upper lateral incisors and lower lateral incisors

12-23 Months: first molars and canines, top and bottom (but teeth in the upper jaw usually come in first)

What’s also predictable about teething is that it is often quite uncomfortable for infants. To make them more comfortable without compromising their oral and dental health, try:

Gently rubbing their gums with your finger (be sure to wash your hands first!)
Gently rubbing their gums with a small spoon—the cool surface can provide some relief
Talk to your doctor or pharmacist about a mild, over-the-counter painkiller if they’re particularly uncomfortable

Unfortunately, some of the most common techniques we’ve been taught to use to help babies feel better as they’re teething should actually be avoided. The Canadian Dental Association recommends against

Painkillers meant to be rubbed on your child's gums, as they may swallow it
Teething biscuits, because they often contain added or hidden sugars
Assuming that fever and other illnesses are symptoms of teething. In fact, getting new teeth never make babies sick or causes temperature spikes. Anytime your little one is ill or has a fever, you should consult your family doctor or pediatrician

Early Childhood Tooth Decay

When dealing with your baby’s teething discomforts, it can be easy to lose track of this: once their teeth begin coming in, tooth decay must be reckoned with. All the nutrients they ingest in their first 6 or so months – such as breast milk, formula, cow's milk and fruit juice – contain sugar. Many of the solid foods you’ll begin introducing them to beyond the 6-month mark may also be high in sugar.

Nutrition makes a huge difference in how healthy your children’s teeth will be. Believing teething biscuits to be safe for babies’ teeth or that fever is a symptom of teething aren’t the only pieces of misinformation circulating – so let’s settle some other key points about infant feeding and oral health.

Breastfeeding

Since the 1970s, a number of scientific studies have been published claiming that breastfeeding, especially unrestricted feeding through the night, is particularly bad for babies’ oral and dental health.

More recent scientific studies, however, show that breastfeeding is just one of many factors that determine whether or not infants experience early childhood tooth decay.

In fact, preventative dental hygiene – or the lack of it – is likely the biggest determinant of whether or not children experience early tooth decay. In 2013, the Canadian Dental Association issued an official position statement emphasizing the great nutritional benefits of breastfeeding and the importance of proper dental hygiene.

Baby Bottle Tooth Decay

Early childhood tooth decay is caused by prolonged and frequent exposure to sugary drinks or foods without frequent enough cleaning. Bottles, however, can be particularly problematic.

Many babies won’t go to sleep, either at night or for naps, without a bottle, so try the following to help keep your young ones happy without increasing their chances of tooth decay:

Fill the bottle with water rather than milk or juice
Dilute their usual bed- or nap-time drink with water, slowly over a couple of weeks, if switching fully to water upsets them
Try giving them a clean soother, favourite toy or blanket instead of a bottle
Be comforting but firm; such changes can be difficult, but your baby will soon adjust

In the meantime, work slowly at making sure your child is fully weaned by around 14 months.

Sippy Cups

There’s no denying that sippy cups are handy – not only are they useful for getting little ones used to drinking out of cups rather than bottles, but they’re also basically indestructible and their lids are designed to stay on no matter how far or energetically they’re tossed around.

However, they should only be used for a short period and only as a transitional tool from bottles to regular cups. Sippy cups can cause early childhood tooth decay in exactly the same way bottles can, especially if they’re taken to bed at nights or for naps — by exposing young teeth, for long periods of time, to cavity-causing sugars.

Similar strategies for mitigating the harm therefore apply:

Fill sippy cups only with water between meals and prior to sleep
Milk or juice only at meal times, as the extra saliva created by eating helps wash away sugars in the mouth
Wash young ones’ teeth and gums frequently

Also like bottles, sippy cups shouldn’t be given to infants over 1 year old.

Pacifiers & Thumb-Sucking

Pacifiers (or soothers) can help you wean your baby off the bottle or even the sippy cup; they’re also useful for helping babies relax at night or when they’re upset.

Most children will naturally lose interest in soothers between 2 and 3 years of age, but if they don’t, don’t force the issue — they may begin sucking their thumb instead. Pacifiers are better options than thumbs because you have more control over when they do it, as well as because it’s easier to keep pacifiers clean — and the less dirt and bacteria in the mouth, the less likely your child will be to develop tooth decay.

There are two other things to keep in mind when giving your baby a pacifier:

If your baby doesn’t immediately take to the pacifier you offer instead of a bottle or sippy cup, don’t put sugar in any form on it to tempt them – they’ll just end up with all the destructive aspects of sugar but none of the nutritional value of actual food
Never clean off a dropped pacifier by putting it in your own mouth – use water instead. Babies don’t have decay-causing bacteria in their mouths when they’re born; they get it from sharing saliva with someone who does

So, what’s the best way to care for your baby’s teeth and gums, to make sure they get maximum nutritional benefit without the decay caused by naturally sugary liquids such as milk and juice?

Care

Before your baby has teeth:

Place a damp, clean washcloth over your index finger and use it to wipe your baby’s gums. Make sure you get good coverage, cleaning the gums at the front, back and flat surfaces.

Try to wash your infant’s gums anytime they finish breastfeeding or drinking from a bottle or sippy cup.

Once their teeth begin erupting:

Begin daily brushing as soon as your baby’s first tooth or teeth erupts (usually by 6 months). Ask your pediatric dentist or pharmacist about techniques and baby-sized toothbrushes.
Start daily flossing when there are 2 teeth touching each other, also usually by 6 months since the bottom front teeth often erupt at the same time
And don’t forget to take them to see the dentist either within 6 months of their first tooth erupting or by their 1st birthday, to make sure everything is developing normally

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