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Tooth decay remains one of the commonest reasons children in the UK are admitted to hospital for a general anaesthetic. Almost all of it is preventable, and almost all of the prevention happens at home.
How much toothpaste, by age
| Age | Amount | Fluoride |
|---|---|---|
| First tooth to 3 years | A smear | At least 1,000 ppm |
| 3 to 6 years | A pea-sized amount | 1,000–1,500 ppm |
| 7 and over | A pea-sized amount | 1,350–1,500 ppm |
Children at higher risk of decay are sometimes advised stronger paste by their dentist. That is an individual recommendation, not a general one.
"Children’s toothpaste" is not automatically appropriate — some have very little fluoride. Check the figure on the back rather than the age on the front.
Doing it for them
This is the part that surprises people. Children do not have the manual dexterity to brush their own teeth properly until around seven, and many need help beyond that.
That does not mean they should not try. Let them have a go first — then you go over it afterwards. The useful framing is that their brushing is practice and yours is the one that counts.
A practical position for a small child: stand or sit behind them with their head tilted back against you, so you can see what you are doing. Trying to brush a toddler’s teeth from in front is harder for both of you.
Twice a day, and the night one matters most
Last thing at night, after which nothing but water, and one other time. Saliva flow drops during sleep, so anything left on the teeth stays there for hours.
Two minutes. A song, a timer or an app all work.
Spit, do not rinse
Same rule as adults, and for the same reason: rinsing washes away the fluoride that was about to do the work. Teach it as "spit out the bubbles, don’t wash your mouth".
Fluoride varnish
NHS dental practices offer fluoride varnish for children from the age of three, usually twice a year. It is painted on, takes a minute or two, and meaningfully reduces decay. For children at higher risk it may be offered more often, and sometimes from a younger age.
It is worth saying yes to.
Bottles, cups and overnight drinks
- Move from a bottle to a free-flow cup from around six months, and away from bottles entirely by one year
- Only breast milk, formula or cooled boiled water in a bottle — never juice, squash or flavoured milk
- Nothing but water after the night-time brush. A bottle or cup of milk or juice in bed is one of the most reliable causes of early decay, because the liquid pools around the upper front teeth all night
- Sugar-free medicines where there is a choice, especially for long courses
Sugar
Both the amount and the frequency count, exactly as they do for adults — and frequency is the one most families can change without much argument. Keep sweet things to mealtimes rather than spread through the day, and make between-meal drinks water or plain milk.
