Your Oral Health

The Canadian Dental Association recommends parents schedule their child’s first dental visit within six months of the eruption of the first tooth or by their first birthday.

Without proper dental care, cavities can begin to form as soon as baby teeth appear, around six to 10 months of age. Read Importance of baby teeth, Oral hygiene – brushing and flossing, and Early childhood caries (ECC) to learn more.

Purpose of the first dental visit:

• Learn how to care for your child’s teeth
• Have any oral health questions answered
• Find and treat dental problems early

Parents should not wait for an emergency to schedule their child’s first visit. Early, regular visits can help prevent cavities or early childhood caries.

At the first dental visit

The first dental visit is a short appointment.

The dentist or dental hygienist will:

• Check your child’s teeth for cavities and other dental problems
• Check that their jaws and teeth are developing properly
• Talk to you about your child’s risk for cavities
• Apply fluoride varnish depending on your child’s cavity risk
• Show you how to care for your child’s teeth
• Discuss proper nutrition to prevent cavities
• Discuss feeding practices
• Set up the next appointment before you leave

Oral health screening can be provided by a York Region Public Health registered dental hygienist at one of four convenient clinic locations. Parents and guardians may contact the Dental Program at 905-895-4512 or toll free at 1-800-735-6625 to schedule a dental screening appointment or to speak with a registered dental hygienist for more information about the first dental visit.

Primary teeth or baby teeth are important for eating, smiling, talking and holding space for adult teeth. The first primary tooth will start to erupt at six to ten months of age. This process is called teething and will end at two to three years of age. At the end of the eruption process, a child will have 20 primary teeth.

The primary teeth will start to naturally fall out at six years of age. Some of the primary molars will remain until 12 years of age. Keep in mind that all of these ages are guidelines only and children develop at their own pace.

Good dental habits, such as a healthy diet, cleaning the gums and brushing the teeth twice a day, combined with regular dental visits, help prevent tooth decay and promote good general health. Use an age and size-appropriate toothbrush. Do not use a finger brush as it can be a choking hazard.

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

When babies are born, they have a partially developed set of primary (baby) teeth under the gums waiting to erupt. At approximately six months of age this process begins and the first tooth starts to appear in the mouth. This is a natural process known as teething.

The teething process will be complete by two to three years of age and can be uncomfortable at times. Babies may drool excessively, have red cheeks, swollen gums, difficulty sleeping, be cranky or irritable and want to put everything in their mouths.

Do not confuse teething with illness. Keep in mind that fever, rashes and diarrhea are not symptoms of teething. If a baby has any of these symptoms, or remains cranky and irritable, ensure the baby receives medical attention.

Easing the discomfort of teething will help make the baby more comfortable. Babies massage their own gums by chewing on hard, smooth objects. Give them a teething ring, or a clean, wet, chilled cloth to chew on.

Avoid teething biscuits and wafers as they may contain sugars that can cause tooth decay. Also avoid using teething or numbing gels. If swallowed they can numb the throat and excessive consumption of benzocaine, the active ingredient in these products, may lead to a serious health risk.

It is important to take good care of these new teeth. Some of them will remain in the child’s mouth until 12 years of age.

Refer to the fact sheet in Dental Health Resources: "Oral Health for Babies and Children."

Tooth decay and gum disease are caused by a sticky film called plaque, which constantly forms on teeth and gums. Removal of this plaque with proper brushing and flossing on a daily basis is important in preventing dental disease. Establishing good dental hygiene practices early on can help develop positive, lifelong dental habits and a healthy smile.

Oral hygiene for babies without teeth

Even though babies do not have teeth, their mouths still need to be cleaned. It’s easy to keep a baby’s mouth clean. Swabbing the mouth with a clean, damp cloth after feedings will remove food residue and stimulate gums. Always use clean hands when touching a baby’s mouth. Rubber finger toothbrushes are not recommended as they can slip off the finger and cause a choking hazard.

Oral hygiene for children

Brushing

As soon as a child’s first tooth erupts, it is susceptible to tooth decay. The first tooth will appear at approximately six months of age. At this time, a small, soft toothbrush can be used to brush the teeth and this should be done twice a day, 30 minutes after meals, snacks or beverages, to help prevent tooth decay.

• Children under three years of age should use only water or a rice grain-sized amount of non-fluoridated toothpaste unless advised otherwise by their oral health professional
• Children three years of age and older should use a green pea-sized amount of fluoridated toothpaste if they are able to spit

Toothbrushing should always be supervised by an adult. Assistance with brushing is essential for small children up to six years of age. Children should be encouraged to spit out toothpaste and to rinse after brushing.

Flossing

Flossing removes plaque and food debris between the teeth where a toothbrush cannot reach. This is commonly where gum disease and tooth decay begin. Teeth should be flossed once a day to help prevent dental disease. Daily flossing should be the responsibility of the parent.

Tips

• Use a toothbrush that is the correct size for the child’s mouth
• Do not let children share toothbrushes – the bacteria that causes dental decay can be spread from person to person
• Store toothbrushes where they do not come in to contact with other brushes and are allowed to air dry
• Children model what they observe – set a good example

A cavity (tooth decay) is a hole in the surface of a tooth. It starts off small, but gets larger over time if left untreated. Cavities begin to form when our teeth are attacked by acid. Acid develops when sugar from our food mixes with the plaque (bacteria) in our mouth. The acid breaks down the hard outer layer of the tooth called enamel, resulting in tooth decay.

The Ontario Association of Public Health Dentistry

Early childhood caries (ECC) is a disease of the primary teeth. It is defined as one or more cavities (dental decay) in the upper front teeth of children three years of age or younger. Dental decay in the primary teeth is one of the most common diseases of childhood.

In the past ECC has been referred to as “nursing bottle mouth, milk bottle mouth, baby bottle syndrome, nursing bottle caries and baby bottle tooth decay.”

Decay is a result of the frequent or prolonged exposure to acid and sugar on the teeth. Sugar is one of the many factors that can cause tooth decay. Whether the sugar is natural or refined, it does the same damage when it comes to the teeth. Sugars found in food and drink, mix with dental plaque in the mouth to form acid. The acid attacks the hard outer layer of the tooth’s surface called enamel and over time will create a cavity. The damage the sugar can do depends on how long it stays in the mouth and how often it is consumed.

In the early stages of ECC, the tooth can have a chalky appearance that cannot be removed with toothbrushing. As the disease progresses, these areas can turn brown. In severe cases the teeth will have dark brown spots and appear to have large holes or spaces between the teeth.

Tooth decay in children can be extensive and may need to be treated in the hospital while the child is sedated with a general anaesthetic. Treatment of this disease is both financially and emotionally costly. If left untreated, the child may experience pain and infection that can interfere with their ability to eat, drink, sleep, play or with other areas of development.

ECC is preventable. Prevention must start early, though, because the decay process can begin as soon as a tooth erupts in the mouth. Regular dental care can prevent tooth decay and other dental problems that can lead to disease in later life.

Lift the lip

Children should have their teeth checked once a month by parents or guardians. The purpose is to check for signs of ECC. If detected early it is much easier to treat. Parents may consult with a dentist or registered dental hygienist on how to lift a child’s top lip.

Tips

• Be aware of Early Childhood Caries (ECC) (one or more cavities in the upper front teeth of children three years of age or younger) and what it looks like so it can be prevented or identified at an early stage
• Parents should lift their child’s upper lip regularly to check for early signs of tooth decay; hands should always be washed before and after touching the lip
• Parents should have their children’s teeth checked regularly by a dental health professional starting at one year of age
• Any dental concern should be mentioned to a dental health professional as soon as possible

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

Sucking is the natural way for babies to comfort themselves and feel secure. Ultrasound images have shown some babies sucking their thumb while still in the womb.

Babies and small children can be comforted by breastfeeding, rocking, cuddling and singing.

Pacifier use can cause a variety of dental problems. Tooth decay can result if pacifiers are dipped in sugar, honey or syrup. Changes to the shape of the palate and jaw can occur if a child is allowed to use a pacifier for extended periods of time, which can also affect speech development. The risk of these changes increases with the amount of time a sucking habit is allowed throughout the day and the aggressiveness of the latch.

A child’s need to suck decreases around two years of age. The earlier children discontinue the use of pacifiers or finger and thumb sucking, the less risk there is of affecting their teeth and jaws. If the habit persists beyond three years of age, parents should consult a dental health professional to ensure there are no negative effects to the teeth and jaws.

Baby bottle use should stop by 18 months of age. Children can learn to drink from an open cup as early as six months of age, with help from a caregiver. At 12 months of age, offer beverages by open cup rather than a training cup. Children should never use a baby bottle as a pacifier, especially at night, or be allowed to continuously sip from a bottle throughout the day.

Safe use of pacifiers

Always

• Check daily for brittleness, cracks or tears, especially the nipple end, as brittle nipples can be a choking hazard
• Wash after each use with warm, soapy water
• Ensure a baby’s needs (hungry, tired or bored) are met before offering a pacifier
• Respect a child’s choice – do not hold the pacifier in place or keep putting it into the baby’s mouth if pushed out

Never

• Clean by putting it in your own mouth
• Dip in sugar, honey or syrup as this can cause tooth decay
• Use a pacifier in place of feeding or to extend the time between feedings
• Tie a pacifier around a baby’s neck, as this can cause strangulation
• Hold a pacifier in a baby’s mouth when the baby is crying or refusing it by turning head away

Helpful tips on how to stop children from their sucking habit

• Never scold children for sucking, gently remind them to stop and offer praise when they are not sucking their thumbs, fingers or pacifiers
• Offer other forms of security such as lots of encouragement and hugs, teddy bears or blankets
• If children are having difficulty stopping this habit, limit the amount of time they are allowed to have their pacifiers or to suck their thumbs and fingers; slowly keep decreasing the amount of time until the habit is broken.
• If a child still has a sucking habit past six years of age, parents should speak with their dental health provider

Tips

• Do not allow children to fall asleep with bottles of milk, juice or any sweetened drinks
• If a bottle is needed during sleep times, fill it with water only
• Do not dip pacifiers in sugar, honey or syrup
• Any dental concerns should be mentioned to a dental health professional as soon as possible

Refer to the fact sheets in Dental Health Resources: "Oral Health for Babies and Children."

The sippy cup was developed for children transitioning from a bottle to a regular cup. Children can learn to drink from an open cup as early as six months of age, with help from a caregiver. A link has been established between sippy cups and early childhood caries.

It’s not the cup itself that is responsible for tooth decay, but the type of liquid within. When sippy cups are filled with milk, juice and sugary liquids, children’s teeth are bathed in sugar every time they sip from the cup, throughout the day and sometimes even at nap and sleeping times. Never provide pop, sport drinks, fruit-flavoured drinks or sweetened tea in a sippy cup.

Outside of meal and snack times, offering only water in the cup is recommended. This will allow children to quench their thirst and prevent the constant sugar intake. Provide milk or juice during meal or snack times only.

By 18 months of age, children should be drinking from a cup without a lid and should be encouraged to stop using a sippy cup.

Tips

• Provide only water in sippy cups outside of meal and snack times; limit juice and milk to meal and snack times
• Use sippy cups as a transitional step, not a long-term solution
• Disassemble and properly clean sippy cups at least once a day to prevent the growth of microorganisms such as bacteria, viruses and fungus that can cause illness

Eating a variety of nutritious foods by following Canada’s Food Guide is good for our general and oral health. A diet that contains many sugary snacks can lead to dental decay or cavities.

When choosing snacks that are good for teeth, there are three things to consider:

1. How much sugar is in the food?

   Sugar in food reacts with bacteria naturally present in the mouth and produces acid. Over time, this acid eats away at the enamel or outer layer of the tooth and can cause decay.  
   Read food labels to know if a product is high in sugar. On the Nutrition Facts Table, look at the % Daily Value (% DV). If it has 5% or less % DV, it has a little sugar. If it has 15% or more % DV, it has a lot of sugar.  
   You can also look at the Ingredient List since sugars-based ingredients are now grouped together by weight after the name “Sugars” to help see how much total sugar is in a product. Ingredients are listed in order of amount, if sugar is one of the first ingredients, the product contains a high amount of sugar by weight.  
   Read here for more information about food labels and sugar by Health Canada. By 2026, you will also see front of the package labelling to make it easier to see when a product is high in sugar. 

2. How sticky is the food?
   If food sticks to the teeth, it means the sugar in the food is in contact with the tooth for a longer period of time. This can happen with foods such as fruit leather, chewy fruit snacks and raisins. This makes the tooth more susceptible to decay.
3. How frequently is the food being eaten?
   The number of times children are eating and drinking throughout the day plays a part in the decay process. It is important to limit food and drinks that may contain sugar to meal and snack times so the exposure to sugars is reduced. Children who have food and drinks limited to meal and snack times are being exposed to sugar less often than children allowed to eat and drink whenever they want.

Making healthy diet and food choices at a young age will foster better food choices later in life. Examples of healthy snacks for good oral health include fruits, vegetables, cheese, whole grain crackers, unsweetened cereals, whole grain muffins, eggs, hummus and plain yogurt.

Refer to the fact sheet in Dental Health Resources: "Oral Health for Babies and Children."

For more information about feeding babies and young children, visit york.ca/feedingkids

• Fluoride is a mineral found naturally in our environment and has been proven to prevent tooth decay
• Fluoride can be found in food, drinking water, toothpaste and in fluoride treatments
• Fluoride strengthens tooth surfaces, prevents dental decay and reduces tooth sensitivity

Recommendations for the use of fluoridated toothpaste:

• Children under three years of age should use only water or a rice grain-sized amount of non-fluoridated toothpaste unless otherwise advised by their oral health professional
• Children three years of age and older should use a green pea-sized amount of fluoridated toothpaste if they are able to spit
• Teach children to spit out the toothpaste and to rinse well after brushing

Refer to the fact sheet in Dental Health Resources: "Fluoride Information."