Healthy teeth start before the first tooth. Even before birth!
Most parents assume you start caring for teeth once the first tooth appears. I believe it starts much earlier. Even before your baby is born.
Oral health isn't simply something we inherit, passed down through our genes. It is something that builds over time, shaped by our environment, the foods we eat, our parents oral bacteria, caregivers, and our daily habits.
Understanding this changes the way we think about children's oral care. Instead of waiting for cavities to happen and then trying to fix them, you can build a healthy oral environment from the very beginning, avoiding cavities all together, and setting your child up with a healthy mouth that will last their lifetime.
Your Baby's Oral Health Starts With You
Babies aren't born with an established oral microbiome. Their oral bacteria develop over time, influenced by their environment and the people closest to them. They get their oral bacteria from YOU, directly from your mouth.
This is why I encourage parents, especially mothers, to think about their own oral health before pregnancy, during pregnancy, and after their baby arrives.
Rather than thinking, "Bad teeth run in our family," I want parents to understand that genetics are only one small piece of the picture. You have more control that you think.
For expectant parents, one of the greatest gifts you can give your child is to improve your own oral health before your baby arrives. You can learn more about my Complete Mouth Care System here and start doing it today!
Oral Health Built in Childhood Matters For Life
During the first years of life, a child's oral microbiome is developing rapidly. These early microbial communities shape the oral microbiome that your child will have as an adult.
This is one reason I place so much importance on the first few years of a child's life. We aren't simply protecting a set of baby teeth that will eventually fall out. Baby teeth will colonize with bacteria that your child will have forever.
When Should Children Start Using Toothpaste?
Okay, so what should you do?
(First of all, please note that my recommendations for healthy children are different from conventional pediatric dental advice. If your child is anything but healthy, please always follow advice from your in-person pediatric health professional.)
During infancy and the early toddler years, I focus on xylitol and positive exposure to brushing rather than making toothpaste the center of the routine. Xylitol will help feed the good bacteria in their mouth, and eliminate the harmful plaque-causing bacteria that cause cavities and gum disease. Xylitol after meals, snacks, and drinks will neutralize acidity and protect teeth after sugary juice drinks, animal crackers, popsicles, and more.
I've created a Children's Oral Care Guide below to make these stages easier to understand.
PRE-PREGNANCY & PREGNANCY: I recommend that mothers (and fathers or other caregivers) get their mouths as healthy as possible using xylitol appropriately alongside my Complete Mouth Care System and oral care techniques (mouth resting, etc.).
0-6 MONTHS OLD: Dilute a small amount of granular xylitol in warm water, dip a toothbrush or teething toothbrush into the liquid, and allow baby to suck on it. You can do this a few times a day. You can also use a washcloth or similar to wipe baby's gums with the xylitol solution.
6-12 MONTHS OLD: As babies start eating solid foods, xylitol mints can be introduced age appropriately. Until they can reliably suck and/or swallow, the mint can be broken or crushed as needed. Granular xylitol dissolved in water is still a great option at this age. A good general rule of thumb is # of years = # of mints per day. So a 1 year old can have 1-2 mints a day. A 2 year old can have 2-3 mints per day, and so on. This is a great time to hand your baby a regular toothbrush and allow then to watch you brush and "play brush" their own teeth.
12-24 MONTHS OLD: The child should be able to reliably suck or swallow at this point and can be handed a xylitol mint after meals, snacks, and drinks throughout the day. Continue "play brushing" more regularly morning and night. The start of a routine!
2.5-6 YEARS OLD: Around this age, children can start brushing with a gel or Kid's Crest toothpaste. Continue with the xylitol mints after meals, snacks, and drinks. You can introduce xylitol gum as you feel appropriate, but keep it to 1-2 minutes of chewing maximum. Once your child can spit independently, you can start using ACT Fluoride Anticavity Rinse which is available in a children's bubblegum flavor.
6 YEARS OLD: At this point, your child should be having xylitol mints regularly throughout the day after meals, snacks, and drinks. They should be brushing with toothpaste and using ACT Fluoride rinse twice a day (morning and night).
7 YEARS OLD: Once adult teeth start coming in, children can begin using my Complete Mouth Care System in its entirety. The "spicy" Listerine can be done for only a short amount of time (a few seconds) or skipped until they can handle it. Xylitol regularly throughout the day will help prevent cavities and support a healthy oral microbiome that will protect teeth from sensitivity, gum disease, and a lifetime of pain and worry (not to mention, expensive dental treatments!).
*A xylitol mint last thing before bed is always a good option for all kids — even teenagers. Then no water, juice, snacks, or anything after the xylitol mint.
Please note: this is a general outline for healthy children. A child with existing decay, enamel defects, developmental differences, or other dental concerns may need individualized care.
Baby Teeth Don't Need to Become a Battle
Once those first little teeth begin appearing, many parents suddenly feel enormous pressure to brush them perfectly for exactly 2 minutes (or whatever you've been told). This is where I encourage parents to think differently.
Oral care should be easy, gentle, and happy.
I don't want a baby's earliest experiences with oral care to involve being pinned down while someone forces a toothbrush into their mouth. That can turn toothbrushing into a battle that continues for years. Instead, introduce a baby toothbrush or teether and let your child become familiar with it. I call this "play brushing." Let them chew on the toothbrush. Play with it. Explore it. Copy you while you brush your own teeth.
At this age, my favorite tool is xylitol.
USING XYLITOL: Granular xylitol can be gently wiped around the mouth, or a small amount can be dissolved in water and applied with an age-appropriate baby toothbrush or teether. The goal is not aggressive cleaning. The goal is to support a healthy oral environment while making oral care feel completely normal.
Xylitol after meals, snacks, and drinks neutralizes acidity and protects teeth from soaking in a sugary, acidic environment.
Nutrition Builds More Than Healthy Teeth
Children need good, whole, diverse nutrition while their bodies, jaws, airways, and teeth are developing.
As babies become developmentally ready for solid foods, I encourage parents to introduce appropriate textures and foods that require chewing rather than relying too heavily on soft and puréed foods for years. Chewing is part of normal oral and facial development.
We want children using their mouths. We want them chewing age-appropriate whole foods, developing oral skills, and getting the nutrients their growing bodies need. Good nutrition isn't simply about preventing cavities. You are building a child. Their teeth, bones, muscles, immune system, and entire body are developing rapidly during these years.
What About "Weak Enamel"?
I hear from many frightened parents who have been told their young child's enamel simply "isn't mineralizing properly."
Sometimes there truly are developmental enamel defects that require professional care. But I don't want parents to assume that every dental problem appearing in childhood means their child was simply born with "bad teeth." Teeth exist within an environment that is under your control.
The type of bacteria in the mouth, frequency of sugars and carbohydrates, saliva, nutrition, breathing habits, and daily oral care can all influence what happens to those teeth after they erupt.
This is why prevention needs to be bigger than brushing. Xylitol is your friend.
Pay Attention to Breathing, Too
I encourage parents to notice how their child breathes. Ideally, children should breathe comfortably through their nose rather than habitually breathing through an open mouth.
Persistent mouth breathing can be associated with sleep and airway problems and deserves evaluation, particularly if your child snores, sleeps poorly, struggles to breathe through their nose, or regularly sleeps with their mouth open. Oral health isn't isolated from the rest of the body. The mouth, jaw, tongue, airway, sleep, nutrition, and development are interconnected.
If you're concerned about your child's breathing or airway, I suggest meeting with an airway health dentist. This may be an airway-focused biomimetic dentist or orthodontist. I never suggest orthodontics too early, unless absolutely necessary. Always get a second opinion, always try non-invasive options first, and always trust your gut.
Don't Panic During the "Ugly Duckling" Years
There comes a stage that causes many parents unnecessary worry. Permanent teeth start erupting. Suddenly there are weird spaces. Teeth look enormous. Front teeth may flare outward or look crooked. Everything seems completely out of proportion.
Most parents panic. Don't panic.
This is a recognized developmental stage called the "ugly duckling" phase. And it is extremely common. A child's face and jaws are still growing while permanent teeth are erupting. What looks awkward at one age may look very different (and absolutely beautiful) several years later. The mouth needs to expand to fit adult teeth. Teeth need to erupt telling the mouth to expand. It is a beautiful dance our bodies do all on their own. Do not interfere too early.
I warn parents NOT to run to orthodontic treatments too early.
That doesn't mean orthodontic treatment is never necessary. Some bite and developmental problems absolutely benefit from earlier evaluation or treatment. But not every imperfect-looking tooth in a growing child needs to be immediately straightened. Sometimes the right treatment is simply time and growth.
Give the child's body time to develop.
Don't Make Children Afraid of Their Teeth
This may be the most important message I can give parents. Please don't make oral care frightening, traumatic, or painful.
Don't teach a three year old that their mouth is a problem that constantly needs fixing. Don't create years of battles around brushing. And don't assume that every crooked erupting tooth means something has gone terribly wrong.
Create healthy conditions and habits instead.
Support a healthy oral microbiome with a healthy lifestyle. Use xylitol appropriately. Provide nourishing foods. Encourage chewing solid foods as your child develops. Pay attention to breathing and sleep. Introduce oral care gently and positively. Find a dental professional you trust to monitor your child's development and identify problems that truly need intervention. And then give their growing body some time to do what it was designed to do.
Children's oral care doesn't have to be complicated, expensive, scary, or difficult.
When you start early and focus on prevention, you have an incredible opportunity to help your child grow up believing that healthy teeth are normal, and that taking care of them is a simple, easy, and empowering part of life.
