Should I start cleaning my baby's gums even before his teeth come in?
Yes. Even before your baby sports his first tooth, it's a good idea to get into the habit of wiping his gums with gauze or a wet washcloth at least twice a day. You don't need to use any toothpaste yet. Simply wrap the cloth or gauze around your index finger and rub it gently over the gums as you would a toothbrush. Bacteria in the mouth cannot harm the gums before the teeth emerge, but it can be hard to tell when the teeth are starting to push through, so you'll want to start early. It's also good to get your baby used to having his mouth wiped as part of his daily routine, so that it's easier to transition into tooth brushing later on.
What's the best way to brush my baby's teeth after they start coming in?
As your child's teeth start to appear (generally around 6 months), you can continue to use a washcloth or gauze to wipe out his mouth. (If your child still hasn't sprouted his first tooth by the end of his first year, don't worry -- some children don't start getting them until 15 to 18 months.) Or you can switch to a soft nylon-bristle children's toothbrush if you want to. As long as you're cleaning your child's teeth regularly, you don't need to use any toothpaste yet. Just gently brush the teeth on both the outside and inside surfaces twice a day. Brush his tongue as well (if he'll let you) to dislodge the bacteria that can cause bad breath. Replace the toothbrush as soon as the bristles start to look worn or splayed out.
When does my baby need fluoride and how can I tell if he's getting the right amount?
Your baby's developing teeth can benefit from a little fluoride. This mineral prevents tooth decay by strengthening tooth enamel and making it more resistant to acids and harmful bacteria. Most municipal water supplies are fortified with fluoride (you can call your local water authority to find out about yours). If it isn't, or if you get your water from a well, consider buying a test kit from a hardware store to determine the natural fluoride level in your water supply. If it's less than .3 parts per million, ask your pediatrician whether you should give your child a supplement (the amount recommended for children under 3 is .25 milligrams per day). She can prescribe it in the form of drops that you can add to your baby's bottle or cereal once a day. The American Academy of Pediatrics doesn't recommend fluoride supplements for babies under 6 months old.
A little fluoride is a good thing for your baby's teeth, but swallowing too much of it can lead to a condition called fluorosis that causes white spots to show up on your child's adult teeth. If you live in an area with fluoridated water, your child will get fluoride from your breast milk or from the water you use to make his formula. Bottled water and fruit juices may also contain fluoride, although the amount is rarely listed on the label. There's usually no need to use fluoridated toothpaste until your child's back teeth come in (usually around 18 months), and even then you should let him use only a tiny amount each time. This is because young children tend to swallow their toothpaste rather than spitting it out. Swallowing too much toothpaste over time can lead to fluorosis.
When should I start taking my child to the dentist?
The American Academy of Pediatrics recommends that all babies have their mouth and gums checked by their primary care doctor before they turn 6 months old. If your baby shows signs of cavities or tooth decay or if he's at risk for developing these problems, the doctor will recommend a follow up visit to a dentist. (Risk factors include a family history of cavities and poor dental health while you were pregnant.) The doctor should also check to see if your child's teeth are coming in normally and ask you questions about how you're caring for your baby's teeth.
The AAP and most pediatric dentists say it's a good idea to bring your child to a dentist around the time he turns 1, just in case there's a problem that your family doctor missed or couldn't diagnose.
What should I do if my child won't let me brush his teeth?
If your child fusses every time you brush his teeth, it might help to buy him a special cartoon character toothbrush or toothpaste. According to Liz Birka White, a mother of three in Diablo, California, this worked well for all of her children: "Adam, my firstborn, really hated brushing until I bought him an Elmo toothbrush. From that day on, he couldn't get enough. It was just the ticket I needed to interest him in brushing."
You can also let your child have several brushes in different colors so he can choose the one he wants when it's time to brush. Let him brush his own teeth first while you're brushing your own, and then "check" each other's teeth to see if they're clean, and finish the job for him if he "missed a spot."