Taking care of a child’s oral health is an important matter, and it starts as early as infancy (0–12 months). Strong, healthy teeth and gums during this time will help support weaning and speech development and hold spaces for permanent teeth to come through later. The habits created in infancy will also form the foundations upon which lifelong good oral hygiene and preventative habits will be built.
Tooth decay
Tooth decay is caused when bacteria in the mouth convert sugar into acid, which starts to break down the teeth, creating cavities. Without proper oral care, tooth decay can occur even in primary teeth. This can cause pain, sensitivity and eventual tooth loss if left untreated. Below are details of the steps that can be taken to avoid this.
Toothbrushing
Brushing will remove the harmful bacteria that can build up on teeth if it is not disrupted. Brushing should begin as soon as the first baby tooth erupts and should be done twice a day – just before bedtime and on one other occasion. Starting this at a young age will promote good oral health and establish good brushing habits early.
The toothbrush should be moved in small circles, covering all tooth surfaces. A flat smear of toothpaste should be used, which contains at least 1000 ppm of fluoride: see Figure 1 (Department of Health and Social Care, 2021). Afterwards, encourage the child to spit out the toothpaste – rinsing out with water isn’t recommended, as it will wash away the fluoride protecting the teeth from decay.
Many infants will resist toothbrushing, and brushing all tooth surfaces may prove difficult. However, keeping to the habit of brushing twice a day will help to slowly acclimatise them to the process, making effective cleaning more achievable. The best position for brushing is to sit the baby on your knee with their head resting on your chest or cradling their head in your arms in front of you (National Health Service, 2020).
Try different ways of engaging the baby during brushing time. For example, encourage curiosity by brushing your own teeth first or pretending to brush their favourite toy’s teeth. YouTube is also filled with toothbrushing videos lasting two minutes that will make brushing time more exciting. There are also smartphone apps such as MAM Brushing Time.
Before the teeth erupt, wet gauze or a clean, soft washcloth wrapped around a finger can be used to clean the mouth. This will also help the baby get accustomed to having a foreign object in their mouth, facilitating a smoother transition to using a toothbrush.
Diet
During the first six months of life, milk will meet all the baby’s nutritional requirements. Breastmilk will provide the best nutrition for a baby’s overall health, with evidence supporting a lower occurrence of tooth decay in breast-fed children. If a baby is being bottle-fed, only infant formula, breast milk or cooled boiled water should be given in the bottle – never any sugar-containing liquids.
When the baby is six months old, drinking through a free-flow cup should be encouraged. Solid foods can also be introduced at this age, providing the baby is developmentally ready. Foods given during infancy have importance in developing healthy eating habits and food preferences. Therefore, it is vital to feed a wide variety of foods with different textures and tastes to help diversify the diet and meet nutritional needs. Fruit and vegetables are the recommended first foods to try.
Keeping the amount and frequency of sugar intake as low as possible during the first year of life is essential. Limit sugary snacks to mealtimes only. Sugar should never be added to food or drink or into a pacifier/bottle. Such prolonged exposure to sugar will increase the risk of tooth decay. Sugar intake before bedtime, in particular, should be avoided. Try to ensure toothbrushing is done as close to bedtime as possible (Department of Health and Social Care, 2021).
Teething
You can expect the lower front teeth to be the first to make an appearance in a baby’s mouth, usually at around six months, followed by the upper front teeth. The first molars can also be expected at approximately twelve months. Teething can be a painful process for babies, but some measures can be taken to help ease symptoms.
Signs that indicate teething has begun include a temperature, chewing on fingers or objects, ear rubbing and inflammation of the gum overlying the erupting tooth.
The following can be utilised to help relieve symptoms:
- Gently rub the gums with a clean finger or wet gauze.
- Teething rings – these can be cooled in the fridge first as per the instructions. Never place them in the freezer, as this can cause trauma to the gums.
- If the baby is six months or older, healthy foods can be given, e.g, raw fruit and vegetables, sugar-free rusk or breadsticks.
- Sugar-free liquid paracetamol or ibuprofen can be considered, as per a dentist's or doctor's advice.
Dental visits
As soon as the first teeth appear, dental check-ups are recommended. Visits to the dentist will help acclimatise a baby to the dental environment. The dental team will also be able to offer further advice for teething pains, and any problems can be identified early so that preventative measures can be put in place.
A high standard of oral hygiene is a lifelong venture. Beginning good habits as early as infancy will teach children to value a hygienic and healthy mouth. Infancy is a busy and often overwhelming time for parents or carers, so don’t forget to take care of your own health and teeth. This will also set a good example for a baby who is growing and begin to interact more with their surroundings.
Useful links for further information
British Society of Paediatric Dentistry https://www.bspd.co.uk/Portals/0/A%20Practical%20Guide%20to%20Childrens%20Teeth.pdf
Toothbrushing
https://www.nhs.uk/conditions/baby/babys-development/teething/looking-after-your-babys-teeth/
Weaning
https://www.nhs.uk/start4life/weaning/
References
Department of Health and Social Care (2021) Delivering better oral health: an evidence-based toolkit for prevention. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (Accessed: 10 April 2022).
National Health Service (2020) Looking after your baby’s teeth. Available at: https://www.nhs.uk/conditions/baby/babys-development/teething/looking-after-your-babys-teeth/ (Accessed: 10 April 2022).
Written by Sahajta Chauhan RDT, RDH
