Baby teeth get a bad rap. People assume that because they fall out, they're disposable. Then 1 in 4 five-year-olds in England turns up with visible tooth decay (Public Health England survey data), and tooth decay becomes the leading cause of children being admitted to hospital for a general anaesthetic. Almost all of it is preventable with habits that take 4 minutes a day to set up.
This article covers exactly how to brush a baby's teeth, what toothpaste to use, what to do when your toddler refuses to open their mouth, and when to see the dentist.
Healthbooq helps you track teething, oral care milestones, and other early development.
When Teeth Come In
The first tooth usually breaks through between 6 and 10 months, but the normal range stretches from 4 months to 14 months. Some babies are born with a tooth (a "natal tooth") and some don't get their first until well past 1 — both are within the range of normal as long as it's tracked.
Eruption order is usually:
- Lower central incisors (front bottom)
- Upper central incisors (front top)
- Upper and lower lateral incisors (the ones either side)
- First molars (the back chewing teeth)
- Canines (the pointy ones)
- Second molars
By around 2.5 years most children have all 20 baby teeth.
Teething symptoms: drooling more than usual, gum rubbing, chewing on fists and toys, irritability, sometimes mild sleep disruption, and a slightly raised temperature (under 38°C). What teething does not do: cause a fever above 38°C, cause diarrhoea, cause persistent vomiting, or make a child seriously unwell. If those things happen during teething, look for another cause — they're usually just a coincident illness.
For comfort: a chilled (not frozen) teething ring, a clean cold flannel to chew on, and one dose of paracetamol or ibuprofen at the appropriate weight if your baby is genuinely distressed. Avoid teething gels with lidocaine for under-2s (MHRA changed guidance on these — they're not recommended). Avoid teething necklaces (amber or otherwise) — they're a strangulation and choking risk and there's no evidence they work.
How to Actually Brush Baby Teeth
Start the moment the first tooth shows.
What to use:
- Small-headed, soft-bristled baby toothbrush (most supermarket baby ones are fine)
- A smear of fluoride toothpaste with at least 1,000 ppm fluoride. A smear means a thin film, the size of a grain of rice, not a pea. Standard family toothpaste with 1,350–1,500 ppm fluoride is what's recommended. Specific "baby toothpastes" with low fluoride (under 1,000 ppm) aren't recommended — they don't have enough fluoride to protect, and the small smear means the actual fluoride dose ingested is fine.
- From age 3: a pea-sized amount of toothpaste with 1,350–1,500 ppm fluoride.
Twice a day, for 2 minutes each time. Once after breakfast, once before bed.
The bedtime brush is the most important. During sleep, saliva flow drops, which removes one of the main natural defences against acid. After bedtime brushing, no food, no milk, no juice — only water until morning. A bottle of milk in the cot is one of the strongest predictors of early childhood decay.
Spit, don't rinse — once your child is old enough to follow this (usually around age 2–3). Rinsing washes off the fluoride film that protects the teeth for hours afterwards.
Position matters. For babies, a useful position is laying them across your lap with their head between your knees, looking up. For toddlers, standing behind them with their head tilted back against your stomach lets you see all surfaces. Brush every surface — front, back, chewing surface — for the recommended 2 minutes (set a timer; it's longer than you think).
Toothbrushing Refusal
Toddlers refuse toothbrushing. This is universal. A few approaches that genuinely help:
- Make it a fixed routine, not a question. "We're going to brush teeth now" beats "Shall we brush teeth?". Keep it consistent — same time, same place, every night.
- Hand-over-hand. Let your toddler hold the brush and have a go themselves first, then you take over to do the proper job. Most under-7s don't have the dexterity to clean their own teeth properly — parents need to brush or finish brushing until at least 7.
- Brush together. Mirror the action of brushing your own teeth at the same time.
- Sing the song or use an app. A 2-minute song, a brushing-timer app (Brush DJ, Disney Magic Timer), or a simple sand timer turns it into a known game.
- Try lying down. Often easier to see all surfaces with the toddler lying back across your lap.
- Pick your battles in the moment, not the principle. If a brush goes badly, finish what you can, move on, and try again next time. Don't skip nights though — that's the one rule that doesn't bend. Bedtime brushing especially.
First Dental Visit
Take your baby to the dentist when the first tooth arrives, or by their first birthday at the latest. NHS dental care is free for under-18s. You don't need to wait until they have a problem — the first visit is about familiarising them with the chair, getting them comfortable with the dentist looking in their mouth, and catching anything early.
Most children should see the dentist every 6 to 12 months. The dentist will check for early signs of decay (white spots on the front teeth near the gumline are an early sign), apply fluoride varnish from age 3 (NHS-funded), and give specific advice about your child's mouth.
Sugar — the Other Half of the Equation
Brushing is half. Sugar exposure is the other half. The risk isn't a single sweet — it's the frequency of exposure. Each sugar contact resets the acid attack on enamel for about 20 minutes. Constant grazing, sippy cups of juice, frequent fruit pouches, milk sips through the night — these are far worse than a chocolate biscuit at the end of a meal.
Practical rules:
- Drinks between meals: water or plain milk only. Not juice, not squash, not flavoured milk.
- Fruit juice: limited to 150ml a day, with a meal, in a cup not a bottle. Whole fruit is far better than juice.
- No bottle of milk in the cot at night, no bottle to fall asleep with.
- Sweet snacks at the end of meals, not between.
- Read labels — many savoury baby snacks and "fruit-based" pouches are heavily sweet.
When to See the Dentist Beyond Routine Visits
- Visible white, brown, or black spots on teeth
- A tooth that looks chipped or broken (especially after a fall)
- Persistent bad breath that doesn't clear with brushing
- Bleeding gums
- A child who reacts to cold or sweet things with pain
- A tooth that came out completely after a knock — bring the tooth (in milk) to a dentist or A&E urgently for adult teeth; baby teeth don't get re-implanted, but you still need to be checked
Key Takeaways
Start brushing the moment the first tooth comes through, usually between 6 and 10 months. Use a smear (the size of a grain of rice) of fluoride toothpaste with at least 1,000 ppm fluoride — standard family toothpaste works fine. Brush twice a day; the bedtime brush is the one that matters most. Tooth decay in baby teeth is the single most common reason children aged 5–9 need hospital admission for a general anaesthetic in the UK — and it's almost entirely preventable. The two big drivers are sugar exposure and not brushing properly. Take your baby to the dentist when the first tooth arrives — NHS dental care for children is free.
