Healthy teeth are happy teeth
© 2015 Roy Benaroch, MD
Kaitlyn wrote in:
I know you’re not a dentist, but I have a few questions about fluoride and teeth. My daughter is five months and it seems to suddenly be a big source of concern. I’ve been told that you should start brushing your baby’s teeth as soon as they come in, but the advice on what type of toothpaste to use is conflicting. Some dentists say to use fluoride from the very beginning, while others recommend fluoride-free toothpaste until a child can spit it out properly, around age two. I’ve also seen people say that it’s not necessary to use anything besides water to brush a baby’s teeth until they’re one. Which method is really best, or is there not a very big difference when they’re so young? Also, I’ve recently heard that breastfed babies should be taking fluoride supplements starting at six months. Is that really needed, and if so does it still apply to breastfed babies with access to fluoridated water? I get that six month olds typically drink very little water, but I have been told you can give some with solid foods or between feedings at that age and I think I’d start to worry about her getting too much fluoride.
Many good questions! Let’s start with the fluoride. The old advice was that it was best to avoid fluoride toothpaste until age two. The concern had been that babies can’t spit well (ironically, they seem to spit up just fine when they want to), and that early fluoride could lead to fluorosis, or a staining of teeth. That worry is way overblown. The vast majority of children who’ve been exposed to excessive fluoride have minimal cosmetic changes that are only noticeable by a dental professional. Mild fluorosis actually strengthens teeth. An appropriate amount of fluoride toothpaste, when used very young, will lead to fewer cavities and better dental health.
What’s the “appropriate amount”? American Dental Association recommends a tiny dab, the size of a grain of rice. Even for older kids and adults, we’re only supposed to use a pea-sized amount. Those toothpaste commercials with the huge, ribbon-like blob? Those are meant to sell toothpaste, not give instructions on how to use the stuff.
About fluoride supplements for babies: they’re rarely needed for families consuming ordinary municipal tap water. Though six month olds don’t drink a lot of water, they should sip some with their meals, and many of their foods are made with water, too. If you’re drinking well water or live in an area without water fluoridation, ask your dentist or pediatrician more more-specific advice about your situation.
Speaking of water—one of the best ways to help keep your child’s teeth healthy is to encourage a “water habit” early on. People should drink water with meals (not juice, not soda). Set a good example, and don’t even offer juice to your child until… well, never. Juice is pretty much fruit with all of the good taken out. It’s just sugar water, really, and sugar water is not good for teeth or anything else.
When you start brushing baby teeth, remember the whole point of it is to develop a healthy lifetime habit. You have to keep it fun, even if that means you’re not doing a perfect job brush every single tooth. Use that tiny smidge of toothpaste, and make a game of it, and maybe even let your child take turns on your teeth. Don’t turn it into a struggle—if toothbrushing is unpleasant, it’s unlikely your child will ever get good at it.
As my dad used to say, “Take care of your choppers, and your choppers will take care of you!”