Brushing Baby's First Teeth: How Much Toothpaste and Preventing Cavities

Before teeth

• Wiping the gums with a clean, damp washcloth once a day, especially after the last feed, gets your baby used to mouth care. It's optional but helpful.
• Most first teeth arrive around 6 months, with a wide normal range. See the teething guide for timing and soothing.

From the first tooth

• Brush twice a day: once in the morning and, most importantly, the last thing before bed.
• Use fluoride toothpaste in a smear the size of a grain of rice. This small amount is safe even if swallowed, and it's the most effective way to prevent cavities. Move to a pea-sized amount at age 3.
• Use a soft, small-headed baby toothbrush. Replace it every 3 to 4 months or when the bristles splay.
• No need to rinse with water after brushing; leaving a little fluoride on the teeth helps.

How to brush a wriggly baby

1. Pick a position you can see from. Baby on your lap facing up, head against your chest or cradled in your arm. Two adults can sit knee to knee with the baby lying across both laps.
2. Lift the lip gently to see the front teeth and gumline.
3. Small circles along the gumline, front and back of each tooth, about two minutes total once there are several teeth.
4. Make it a routine, at the same point in the bedtime routine each night, with a song.
5. Let them hold a second brush, or take a turn after you. Many babies chew the brush; that's fine, but an adult does the real brushing until about age 7 or 8.

Preventing cavities

• No bottle in bed. Milk or formula pooling on teeth overnight is a major cause of early decay. Brush after the last feed when you can. If your baby still feeds at night, that's normal; wiping or brushing in the morning still helps.
• No juice before age 1, and only water or milk in bottles and cups. Offer water in an open or straw cup from about 6 months with meals.
• Limit grazing. Sipping or snacking all day keeps teeth bathed in sugar.
• Germs spread by mouth. Clean pacifiers with water rather than in your own mouth, and try not to share spoons. Caring for your own teeth helps too.
• Fluoride varnish: the pediatrician or dentist can paint it on the teeth every few months from the first tooth. It's quick and painless.
• Water: if your tap water is fluoridated, it helps protect teeth. With well water or unfluoridated water, ask the dentist or pediatrician what they recommend.

The first dental visit

• By the first birthday, or within about 6 months of the first tooth, whichever comes first. See the toddler teeth and first dentist guide for what happens there.

When to check in

• Mention it at the next checkup or dental visit if you see white chalky lines or brown spots near the gumline, a chipped or dark tooth after a fall, or no teeth at all by about 18 months.
• Bring up swelling of the gum or face, or a baby in obvious tooth pain, promptly.