What Parents Need to Know About Childhood Oral Health

Childhood caries (cavities) are the most common preventable infection in childhood.

When untreated, caries can lead to deeper infections, pain, trouble eating, speaking, learning, and other chronic diseases. However, only 1.5% of all children receive preventive dental care every year. Furthermore, children in low-income households have higher rates of dental caries than children in high-income households. Good oral health starting in childhood lays the foundation for lifelong oral and overall health.

Childhood caries are an infection that happens when mouth bacteria and sugars interact with teeth. Over time, these bacteria create acids from sugars that break down tooth enamel. Protective factors like fluoride can help strengthen teeth after acid exposures. Other preventive measures include avoiding sugary foods and drinks, brushing teeth twice daily, and visiting the dentist regularly.

Fluoride works to prevent caries in 3 ways: preventing tooth breakdown, helping teeth get stronger, and preventing bacteria from causing tooth decay. Fluoride is available through many sources. Water fluoridation programs are proven opportunities to help whole communities. If your child’s community does not have adequate fluoride levels in the water supply, fluoride supplements are recommended. For infants to age 3 years, parents should brush their teeth with toothpaste containing fluoride as soon as baby teeth come in by applying a smear of toothpaste (or the size of a grain of rice) to a toothbrush and brushing twice daily. For children 3 years and older or when the child can spit, the recommended amount of fluoride toothpaste is the size of a pea. Also, children 6 years and older can use fluoride mouth rinses, especially if they are considered at higher risk for cavities.

Dentists start seeing children at age 1 year. In addition, many pediatric and family practices apply fluoride varnish when children come for preventive health visits. During the examination, the clinician will dry the teeth with gauze and use a small brush on their teeth to apply the varnish. The child can be on the examination table if they are cooperative or in their parent’s lap if they are younger. Children can drink or eat soft foods right away, but parents should not brush their child’s teeth that evening so the fluoride can have longer contact time with the teeth. They can start regular, twice-daily, brushing the following day. Also, the dentist should refer the child to a dental home if they do not have one.

Some parents have heard concerns and myths about fluoride. Rarely, teeth can be exposed to high amounts of fluoride, which causes permanent white streaks called fluorosis. However, the risk of fluorosis decreases if a child is supervised while brushing their teeth and does not receive additional fluoride if the water already has good fluoride levels. Other fears associated with fluoride include low IQ or cancer. These are not true. Fluoride varnish is safe and effective to apply.

All these different ways of getting fluoride are important to avoid and reduce childhood caries. Parents, dentists, and physicians should work together to find the best ways to prevent dental caries in children, determine their risk for developing caries, and offer types of fluoride available for children at each age group.

The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com.