Oral health for children

It is never too early to start looking after your child's mouth and teeth. Even before they get their first tooth, it is important to begin good oral hygiene habits. 

Early Childhood Tooth Decay

Children can get a cavity (tooth decay) as soon as their first tooth arrives. If a child develops tooth decay before the age of 6, this is called Early Childhood Tooth Decay (ECTD). It is also known as Early Childhood Caries (ECC).

ECTD is a severe form of tooth decay that can affect baby teeth, especially the upper front teeth. Tooth decay is the most common, yet preventable, childhood chronic disease in Canada and around the world.

ECTD is caused by food and liquid left in the mouth from feeding, including:

  • milk
  • juice
  • breast milk
  • drinks other than plain water

The sugars found in food and drinks combine with the bacteria in plaque to create an acid that damages the enamel of a tooth. The longer and more often food and drinks are left in the mouth, the greater chance of developing tooth decay.

Untreated tooth decay can lead to pain and infection. It can affect your child's sleep, as well as learning, speaking and eating abilities. Tooth decay can require treatment by surgery under general anaesthesia.

Treatment of dental problems is the leading cause of day surgery (under general anaesthesia) in Canada among children under the age of 5. It occurs more than ear tube placement and tonsil removal.

Preventing tooth decay

Preventing tooth decay for your child is very important. Take your child to an oral health professional by age 1, or within 6 months of their first tooth coming in.

Talk to your oral health professional about applying fluoride varnish to your child's teeth to help prevent tooth decay. Fluoride varnish is a tinted liquid resin containing fluoride, that is applied to all visible enamel surfaces of the teeth.

After your child's permanent teeth (adult teeth) begin to appear, talk to your oral health professional about having sealants applied. A sealant is a clear or tinted plastic covering put on the chewing surfaces of some teeth.

A sealant acts like a barrier and keeps food from getting stuck in the grooves and pits. This will help to keep teeth free from cavities. Sealants can be applied to permanent teeth as soon as they come into the mouth.

At home, you can help prevent tooth decay by establishing good oral health habits early.

Checking for Early Childhood Tooth Decay

You can check your child's mouth for ECTD by lifting the lip and checking their teeth.

Visit an oral health professional with your child immediately if you see any:

  • stained grooves or changes to the front teeth
  • white, chalky or brown stains on your child's teeth, especially near the gums

Early treatment can prevent the problem from getting worse and help maintain good oral health.

For more information, watch this helpful video on the “Lift the Lip” technique.

Cleaning your child's mouth

There are different ways to clean your child's mouth at different ages.

How to clean your baby's mouth: 0 to 6 months old

Use these tips when cleaning your baby's mouth:

  • wrap a clean, soft, moist cloth around your pointer (index) finger and hold your baby in your arms
  • gently wipe your child's gums, starting at the back of the mouth and working toward the front, rubbing them and taking away any leftover milk or formula
  • a small, wet and soft toothbrush should be used as soon as the first tooth appears in your child's mouth
  • clean your child's mouth and teeth after each feeding, especially at night
  • prevent prolonged contact between sugars in formula/breastmilk and teeth, especially at night
    • as the mouth produces less saliva during sleep to rinse away acids, it becomes even more important to reduce the sugar intake before bedtime
  • if you think of using pacifiers or soothers, they should never be dipped in honey or other sweeteners, as this increases the risk of tooth decay

The bacteria found in plaque can lead to the development of Early Childhood Tooth Decay. For this reason, it is important to remove plaque from your child's mouth daily.

These bacteria can be transferred between you and your child or between your child and any other adult or child. Early transfer of these bacteria is considered a major risk factor for future tooth decay. To prevent this transfer of bacteria, avoid:

  • sharing toothbrushes
  • kissing your baby on the mouth
  • sharing utensils and blowing on your child's food

How to clean your child's mouth: 6 months to 3 years old

Use these tips when cleaning your child's mouth:

  • when your child's first teeth come in, use a small, soft-bristled toothbrush
  • brush your child's teeth, tongue and gums for 2 minutes, twice a day, most importantly before bedtime
  • find out from your oral health professional if your child requires fluoridated toothpaste
  • for children who are using fluoridated toothpaste, teach your child to spit out the excess toothpaste. Do not rinse the mouth with water after brushing so that the fluoride in the toothpaste continues to protect the teeth
  • once your child's teeth grow closer and are touching, start flossing your child's teeth every day
  • be smart about the liquids you put in your child's bottle or open-lid cup. After 6 months of age, water is the best liquid to give your child if he or she is thirsty between meals
    • learning to use an open cup around one year of age is an important part of your child developing healthy feeding practices

For more information and tips about your baby's oral health, consult our tip sheet.

How to clean your child's mouth: 3 to 6 years old

When children can write (not print) their name, they are able to brush their teeth by themselves.

It's hard for children to hold and move a toothbrush well enough to reach all teeth and areas of their mouth. You can help your children to brush their teeth by:

  • brushing your child's teeth, tongue and gums for 2 minutes, twice a day. It is especially important to brush before bedtime
  • making it part of your daily routine to brush together, so your child can learn to brush their teeth by watching you
  • using only a small amount (small green pea-sized or 5mm maximum) of fluoridated toothpaste
  • teaching your child to spit out the excess toothpaste
  • not rinsing the mouth with water after brushing so that the fluoride in toothpaste continues to protect the teeth
  • flossing your child's teeth every day once they grow closer and are touching. Do this until your child develops the ability to floss on their own (usually around 9 years old)

For more information and tips about your child's oral health, consult our tip sheet.

When your child's baby teeth should come in

Baby teeth (primary teeth) are in your child's jaws at birth. They begin to come into the mouth around 6 months of age.

All 20 baby teeth should have broken through the gums (erupted) by the time your child is 2 or 3 years old. Every child is different. Some children will get their first teeth earlier or later than usual.

Baby teeth

Image 1 shows the age ranges when children usually get their first teeth.

Image of first teeth - upper and lower
Baby Teeth - first teeth

Upper teeth:

Table 1 provides the information about upper teeth from Image 1.

Table 1: Upper teeth
Tooth name When teeth come in When teeth fall out
Central incisors 7 to 12 months 6 to 8 years
Lateral incisors 9 to 13 months 7 to 8 years
Canines (cuspids) 16 to 22 months 10 to 12 years
First molars 13 to 19 months 9 to 11 years
Second molars 25 to 33 months 10 to 12 years
Table 2: Lower teeth
Tooth name When teeth come in When teeth fall out
Second molars 20 to 31 months 10 to 12 years
First molars 12 to 18 months 9 to 11 years
Canines (cuspids) 16 to 23 months 9 to 12 years
Lateral incisors 7 to 16 months 7 to 8 years
Central incisors 6 to 10 months 6 to 8 years

Even though baby teeth eventually fall out, they are very important for:

  • eating
    • strong teeth help to chew and break down food. Once teeth become decayed, chewing can be difficult and painful
  • talking
    • teeth play an important role with speech. The tongue and lips use teeth for positioning and for forming words
  • saving space for adult teeth
    • baby teeth hold a space in the mouth for adult teeth. When adult teeth arrive, the baby teeth guide them into the proper spot. Without baby teeth as a guide, the adult teeth could shift in the empty space. This may lead to crowding and problems with the bite
  • smiling
    • losing teeth too early can have an effect on self-esteem. It is not normal to lose baby teeth too early

Babies usually begin teething around 6 months of age. The teething can continue on and off until all of your child's primary teeth have appeared (around 2-3 years old). Teething can be uncomfortable.

Sucking on fingers and thumbs is not uncommon. However, it is best if your child stops this habit before the permanent teeth come in. This is because the sucking can permanently change the shape of the mouth and the position of the teeth and lips.

Help your child stop. Do not hesitate to talk to oral health professionals about it, as they may be able to help you find strategies.

When your child's adult teeth should come in

Your child's permanent teeth (adult teeth) will usually start to come in around 6 years of age. The 20 primary teeth are fully replaced by 28 permanent teeth between the ages of 6 and 13. The wisdom teeth (third molars) usually grow in later on, by the age of 21.

However, wisdom teeth can sometimes remain below the gums. These are described as “impacted”. Consult your oral health professional about the eruption of primary and adult teeth.

Every child is different. Some children will get their permanent teeth earlier or later than usual.

Adult teeth

Image 2 shows the age ranges when children usually get their permanent teeth.

Image of permanent teeth - upper and lower.
Adult Teeth - permanent teeth

Table 3 provides information about upper teeth from Image 2.

Table 3: Upper teeth
Tooth name When teeth come in
Central incisors 7 to 8 years
Lateral incisors 8 to 9 years
Canines (cuspids) 11 to 12 years
First bicuspids 10 to 11 years
Second bicuspids 10 to 12 years
First molars 6 to 7 years
Second molars 12 to 13 years
Third molars 17 to 21 years

Table 4 provides information about lower teeth from Image 2.

Table 4: Lower teeth
Tooth name When teeth come in
Third molars 17 to 21 years
Second molars 11 to 13 years
First molar 6 to 7 years
Second bicuspids 11 to 12 years
First bicuspids 10 to 12 years
Canines (cuspids) 9 to 10 years
Lateral incisors 7 to 8 years
Central incisors 6 to years
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