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The time when babies get their first primary teeth (milk teeth) varies.

A few are born with a tooth already through. Others have no teeth at one year old. Most get their first tooth at around six months, usually in front and at the bottom. Most have all their primary teeth by about two and a half. The first permanent ‘second’ teeth come through at the back at around the age of six.

There are 20 primary teeth in all, 10 at the top and 10 at the bottom.


Some teeth come through with no pain or trouble at all. At other times you may notice that the gum is sore and red where the tooth is coming, or that one cheek is flushed. Your baby may dribble, gnaw and chew a lot, or just be fretful, but it’s often hard to tell whether this is really due to teething.

It can help to give your baby something hard to chew on such as a teething ring, or a crust of bread or breadstick, or a peeled carrot (stay nearby in case of choking). Avoid rusks because almost all contain some sugar. Constant chewing and sucking on sugary things can cause tooth decay, even if your baby has only one or two teeth.

For babies over four months old you can try sugar-free teething gel rubbed on the gum. You can get this from the pharmacist. For younger babies you should talk to your GP or health visitor. You may also want to give sugar-free baby paracetamol. Follow the instructions on the bottle for your child’s age, or check with your pharmacist, GP or health visitor. People put all sorts of things down to teething – rashes, crying, bad temper, runny noses, extra dirty nappies. But be careful not to explain away what might be the signs of illness by saying it’s ‘just teething’.


Fluoride is a natural element found in our diet, mostly in fish and tea, which can help prevent tooth decay. It is also present in many water supplies, but usually at a level too low to be beneficial. In the UK, Birmingham and Newcastle have fluoride added to the water supply at the ideal level, as do most cities in the USA.

In areas with little or no fluoride in the water, some children may benefit by taking fluoride drops (for babies) or tablets as dietary supplements. They should not be used in areas with fluoride naturally present or artificially added to the water, as an excessive fluoride intake is undesirable. Therefore advice from your dentist is essential before giving them. Fluoride in toothpaste is very effective – for babies use a tiny smear and for children only use a small pea-sized amount on the brush.

Caring for your child’s teeth

Keep down the number of times each day that your child eats or drinks something sugary.

Brush your child’s teeth thoroughly, twice each day, using a small pea-sized amount of fluoride toothpaste or a tiny smear for babies; help an older child. Let your child see you brushing your teeth too.

Cutting down on sugar

Sugar causes tooth decay. It’s not just the amount of sugar in sweet food and drinks that matters but, perhaps more importantly, how often there are sugary things in the mouth. This is why sweet drinks in a bottle and lollipops are so bad. The teeth are bathed in sugar for quite a long time.

  • From the time you start your baby on foods and drinks other than milk, avoid giving sweet things. Try to encourage savoury tastes. Watch for the sugar in baby foods in tins and packets (even the savoury varieties), and rusks and in baby drinks, especially fizzy drinks, squash and syrups.
  • If you give your child sweet foods and fruit juice try to limit these to mealtimes to avoid tooth decay. Well-diluted fruit juice containing vitamin C and given with a meal, in a cup, can also help iron to be absorbed. Between meals, it is better to give milk or water as a drink.
  • Try to find treats other than biscuits or sweets, and ask relatives and friends to do the same. Use things like stickers, badges, hair slides, crayons, small books, notebooks and colouring books, soap and bubble baths. These may be more expensive than one small sweet, but they all last longer. 
  • If children are given sweets or chocolate, it’s less harmful for their teeth if they eat them all at once and after a meal, than if they eat, say, a little every hour or so.
  • Children who eat sweets every day have nearly double the decay compared to children who eat sweets less often.
  • Be aware of the amount of sugar the whole family’s eating. Look for ways of cutting down. See feeding your child for some suggestions.
  • Avoid giving baby juices or sugar-sweetened drinks at bedtime or in a bottle, and keep drinking times short. Only milk or water should be given as a drink during the night (unless your baby is still young enough to need a night feed).
  • Ask your pharmacist and doctor for sugar-free medicine for your child. 
  • Try to avoid giving drinks containing artificial sweeteners such as saccharin or aspartame. If you do, dilute with at least 10 parts water to 1 part concentrate. 

Looking for sugars on the label

  • The following are sugars that can cause dental decay – sucrose, glucose, dextrose, maltose, fructose, hydrolysed starch.
  • Invert sugar or syrup, honey, raw sugar, brown sugar, cane sugar, muscavado and concentrated fruit juices all contain sugars.
  • Fruit juices contain sugars, which can cause decay too. Always dilute these.
  • Maltodextrin is not a sugar, but may cause decay.

Brushing your child’s teeth

  • Start early, as soon as your baby’s teeth start to come through. Buy a baby toothbrush and use it with a tiny smear of fluoride toothpaste. Check with your dentist whether baby toothpaste has enough fluoride for your baby’s needs. Don’t worry if you don’t manage to brush much at first. The important thing at the start is to get teeth brushing accepted as part of the everyday routine. That’s why it’s important you do it too.
  • Gradually start to brush your child’s teeth more thoroughly, brushing all the surfaces of the teeth. Do it twice a day - just before bed, and whatever other time in the day fits in best. Not all children like having their teeth brushed, so you may have to work at it a bit. Try not to let it become a battle. If it becomes difficult, try games, or try brushing your own teeth at the same time and then helping your child to ‘finish off’.
  • Go on helping your child to brush until you’re sure he or she is brushing well enough – at least until the age of seven.

How to brush

The best way to brush a baby’s teeth is to sit him or her on your knee with the head resting against your chest. Stand behind an older child and tilt his or her head upwards. Brush the teeth in small circles covering all the surfaces and let your child spit the toothpaste out afterwards. Rinsing with water has been found to reduce the benefit of fluoride. You can also clean your baby’s teeth by wrapping a piece of damp gauze with a tiny amount of fluoride toothpaste over your finger.

Taking your child to the dentist

You can take your child to be registered with a dentist under the NHS as soon as your child has been born – even before any teeth come through. Your dentist can give advice on your child’s oral health. NHS dental treatment for children is free.

Take your child with you when you go to the dentist, so that going to the dentist becomes a normal event. If you need to find a dentist, you can ask at your local clinic or contact your local health authority, or in Northern Ireland your Health and Social Services Trust – the address and telephone number will be in the phone book.

We are indebted to Health Promotion England for their help in compiling this section.