Baby teeth and sugar: protecting first teeth

Why baby teeth matter

Cavities can start as soon as the first tooth appears. The AAP says tooth decay is the most common chronic health problem in children, and that 23% of children get cavities before their 5th birthday. Baby teeth hold space for adult teeth, and children need them to chew and speak clearly (AAP, AAPD).

Decay happens when bacteria in the mouth feed on sugar left on the teeth and make acid that attacks the enamel. The NHS explains that it isn’t just the amount of sugar that matters, but how long and how often teeth are in contact with it. Even the natural sugars in breast milk and formula can start decay if they sit on teeth for long periods (AAP).

For sore gums and teething, see teething and eating.

Brushing from the first tooth

• Before teeth: the AAP suggests wiping your baby’s gums with a clean, damp cloth after feeds.
• From the first tooth: brush with a soft, small baby toothbrush and fluoride toothpaste (AAP, AAPD, NHS).
• How much toothpaste: a smear the size of a grain of rice until age 3, then a pea-sized amount from 3 to 6 (AAP, NHS).
• How often: twice a day. The NHS says last thing before bed and at one other time; the AAP suggests after breakfast and before bed, so the toothbrush is the last thing to touch the teeth at night.
• Spit, don’t rinse. Encourage your child to spit out the toothpaste. Rinsing with water washes the fluoride away (NHS).
• You do the brushing. Young children can’t brush well on their own. The NHS says to keep helping until at least age 7, and the AAP says supervise until about age 10.

The NHS suggests sitting your baby on your knee with their head resting against your chest. If your baby protests, keep going a little each day and let them watch you brush your own teeth.

Fluoride

Fluoride strengthens enamel and helps stop decay (AAP, NHS). The NHS recommends a children’s toothpaste with at least 1,000 ppm fluoride (check the box). Make sure your child doesn’t eat or lick toothpaste from the tube (NHS).

The AAP says your tap water probably has fluoride added, and you can check with your local water supplier. If your water isn’t fluoridated or comes from a private well, the AAP says to ask your doctor whether your child needs fluoride drops or tablets. Don’t give fluoride supplements unless a doctor or dentist prescribes them.

Fluoride varnish is a coating painted onto the teeth. The AAP says pediatricians can start applying it at around 6 months, every 6 months until age 5. In the UK, the NHS offers it at least twice a year from age 3, or earlier if your dentist thinks your child needs it.

Drinks, bottles and cups

Drinks are one of the biggest risks to new teeth.

• No juice under 12 months (AAP). After that it isn’t needed. If you offer it, the AAP says no more than 4 oz (120 ml) a day of 100% juice, mixed half and half with water, in a cup and never in a bottle. See juice for babies.
• No sugary drinks in bottles. The NHS says sweet drinks in a bottle are especially damaging because they bathe the teeth in sugar. Bottles are for breast milk, formula or water only.
• No bottle in bed. Falling asleep with a bottle lets milk sugars sit on the teeth all night. The AAP says if your baby does go to bed with a bottle, it should hold only water. (UK advice differs slightly: see below.)
• Don’t use a bottle or cup to soothe. The AAP suggests a plain pacifier instead, and never dipped in honey, sugar, jam or anything sweet (AAP, NHS).
• Cups, not bottles, from about 12 months. The AAP suggests moving from bottle to cup around the first birthday, and plain water in the cup between meals. Start offering a cup from 6 months so your baby gets the practice. See cup and straw drinking and weaning from the bottle.
• Water is the best drink for teeth. The AAP says fluoridated tap water helps wash away food and bacteria.

Sugar: none added up to age 4

The 2025–2030 US Dietary Guidelines say to avoid added sugar completely for children aged 4 and under (HHS), and the NHS says to avoid food and drink with sugar or sweeteners for children aged 4 or younger, including honey, syrup, fruit juice and smoothies. Eating fruit is fine (NHS).

Honey has a second rule: never before 12 months in any form, because of the risk of infant botulism (NHS). From 12 months it’s safe in that sense, but it’s still an added sugar. See honey and botulism and salt and sugar for babies for where sugar hides on labels.

The NHS says the sugars found naturally in whole fruit and milk are less likely to cause tooth decay.

Sticky foods and snacking

• Sticky foods cling to teeth. The AAP names raisins and other dried fruit, gummy candies, taffy, fruit roll-ups and snack bars with honey or molasses. Limit them, and offer water afterward.
• Dried fruit with meals, not as a snack. The NHS says dried fruit like raisins can bathe the teeth in sugar if eaten often between meals. Uncooked dried fruit is also a choking risk for young children (CDC): soak or cook it until soft, then chop it small or mash it into a moist food. See the choking hazards list and raisins.
• Keep sweet foods to mealtimes. If you do give something sweet, the NHS says to offer it with a meal, not as a snack, and not before bed.
• Avoid grazing. Every snack or sip of something sugary starts a new acid attack. If your baby or toddler has snacks, plan them at set times: see toddler snacks and toddler meal schedule.
• Check baby foods and rusks. The NHS says to check for sugar in ready-made baby foods (including savory ones), rusks and baby drinks.
• Don’t share spoons. The AAP says decay-causing bacteria pass from mouth to mouth, so don’t lick your baby’s spoon or pacifier.

Good everyday snacks for teeth include soft fruit, plain full-fat yogurt, cheese cut into thin strips, and soft cooked vegetables, each in a safe form for your child’s age.

The first dental visit

Take your baby to the dentist when the first tooth appears, and no later than their first birthday (AAPD, NHS). The AAP says by the first birthday or within six months of the first tooth. NHS dental care for children is free.

Tell your pediatrician, health visitor or dentist if you see white spots on the teeth (an early sign of weakening enamel), or brown or black spots or pits, which can be decay (AAP). Some children are more likely to get cavities, including children with special health care needs or whose main caregiver has had tooth decay in the past year, and may need fluoride varnish or checks more often (AAP).

Where US and UK advice differs

• Bedtime and night drinks. The AAP says not to put your baby to bed with a bottle, and if you do, to fill it only with water. The NHS says that at bedtime or during the night, only give breast milk, formula or cooled boiled water. Both say no juice or sugary drinks at night, and brush before bed.
• Added sugar. The US Dietary Guidelines (2025–2030) and the NHS say to avoid added sugar up to age 4. An AAP page still says to avoid added sugar until age 2, then less than 25 g (about 6 teaspoons) a day. This site follows the stricter advice.
• Juice. The AAP says no juice under 12 months and up to 4 oz (120 ml) a day from 1 to 3 years. The NHS says babies under 12 months don’t need juice; if you give it, dilute it (1 part juice to 10 parts water) and serve it only with meals. Its foods-to-avoid page suggests avoiding juice and smoothies up to age 4.
• Snacks under 12 months. The CDC’s mealtime advice for children aged 6 to 24 months says your child may have about 3 meals and 2 to 3 snacks a day. The NHS says babies under 12 months don’t need snacks, and to offer extra milk feeds if they seem hungry between meals. Either way, keep snacks to set times and keep sweet foods to meals.
• Fluoride varnish. The AAP says from about 6 months, every 6 months until age 5, often at the pediatrician’s. The NHS offers it from age 3, or earlier if your dentist advises.
• Supervised brushing. The NHS says help until at least age 7; the AAP says until about age 10.