Start Healthy Smiles Early: A Paediatric Dentist’s Guide

From the moment your baby is born, their oral health plays a crucial role in their overall well-being. Establishing good dental habits early on sets the foundation for strong, healthy teeth and can even influence jaw development and airway health.

In this article, Dr. Raveena Manga, a local paediatric dentist, shares professional advice on how to care for your child’s teeth at every stage—from infancy through to the early school years. She covers essential topics such as when to start brushing, the role of dummies, the importance of airway health, and why fluoride-free options like hydroxyapatite toothpaste may be the best choice for growing children.

Babies (0-6 months)

From the time your baby is born, you should try to wipe their mouths with a clean piece of gauze or a damp face cloth. Start by wiping the top of the tongue, the insides of the cheeks and the gums. This will remove any plaque build up and milk residue. Implementing an oral hygiene routine from infancy will also desensitise your baby to having foreign objects in their mouths, which may make the transition to toothbrushing a lot smoother.

When your baby’s first little tooth pops out (usually between 6-10 months), start brushing it with a silicone/soft-bristled toothbrush. No toothpaste is needed at this stage.

If possible, breastfeeding should be continued for as long as possible. The benefits of breastfeeding are well understood, but from an orofacial perspective, it encourages nasal breathing and stimulates the jaws to grow to the maximum genetic potential.

Dummies can be great tools in this time, but ensure that you use a dummy with a flat teat – avoid the ones with round or bulbous teats.

Toddlers and Younger Kids (1-5 years)

This is typically quite a tricky time for parents to maintain a consistent oral hygiene routine, as many toddlers protest. Consistency, strong boundaries and perseverance are key to making it through this tricky time. Continue brushing your child’s teeth twice daily, and regular flossing can be introduced if your child’s teeth are close together, or once the second set of molars erupt – usually between 2-3 years old. Flossing helps ensure that the areas where the teeth touch remain clean, as the bristles of a toothbrush cannot reach these areas.

Toothpaste can be introduced around the age of 12 months. While the taste of the toothpaste may make it more appealing for some toddlers, emphasis should still be put on the efficiency & frequency of brushing.

If your child is still using a dummy, try to create some boundaries around the frequency and duration of their dummy-usage. Try to limit the dummy to nap and bed time only, and try to avoid having their dummy attached to their clothes or school bag. Prolonged dummy sucking can have a significant impact on the development of the jaws and alignment of the teeth, which sometimes have further repercussions with breathing, swallowing, speech and emotional regulation.

Older Kids (6-12 years)

The milk or primary incisors (front teeth) usually start becoming wobbly around the age of 6 years old. Around the same time, the permanent 6 year old molars will start erupting at the back of the jaw (they don’t replace any baby teeth). Often parents give their children the freedom to brush and floss their teeth on their own. I wholeheartedly encourage parents to empower their kids to take care of their own bodies, but I also encourage regular reinforcement of brushing and flossing by the parent or caregiver to ensure that all plaque and food debris are removed from the hard-to-reach areas. The flossing routine should be well-established by now, especially since the permanent teeth are rapidly making their appearance in your child’s mouth.

What is “Airway Health”?

Airway health is a facet of dentistry that encompasses disordered or dysfunctional breathing patterns. Symptoms such as an underdeveloped jaw, poorly aligned teeth, speech issues, restlessness, sleep issues, fatigue, hyperactivity, chronic respiratory illness, to name a few – can all stem from poor airway health.

So, what is “ideal” airway health?

Humans are obligate nasal breathers, and should be able to comfortably breathe through the nose, except during physical exertion. While breathing through the nose, the tongue should completely be sealed against the palate, and the lips should be closed without straining any of the oral or facial muscles. The primary muscle of breathing should be the diaphragm, and not the muscles in the neck, chest or jaw.

Sometimes this may not be possible, or may be uncomfortable for some people. There are two different ways that airway health may be compromised:

1. When the anatomy is compromised: Certain pathologies or anatomical deviations can compromise the functioning of the upper airway space. Examples include: a tongue or lip tie, enlarged adenoids, tonsils or turbinate (nasal) bones, a deviated septum etc. When the architecture of the upper airway is not conducive for nasal breathing, mouth breathing becomes the default breathing pattern.
2. When Myofunctional habits are not optimal (Myofunctional = the way the muscles function): Essentially, “form” or the anatomy, follows “function”. If you are not functioning properly, there can be a ripple effect on the anatomy. Examples of poor myofunctional habits include: low tongue posture, a reverse swallow / tongue thrust, lip incompetence (when your lips cannot seal at rest), mouth breathing.

Why Fluoride-Free?

The fluoride debate is a highly controversial, polarising and nuanced one. There is no doubt that fluoride has been well studied and proven to remineralise and strengthen teeth. However, what most of the literature fails to acknowledge, is the systemic effects that fluoride has on the rest of the body, especially in growing children.

Dental decay remains the number one most prevalent chronic disease globally, despite campaigns such as water fluoridation and adding fluoride to dental products. Clearly this is an indication the root cause of dental disease stems from something deeper and more internal, as opposed to insufficient fluoride?

I used to be quite the fence-sitter regarding the use of fluoride in the dental world. As a dental student, we were taught that water fluoridation and using fluoridated dental products were the holy grail of preventative dental health. However, since the emergence of hydroxyapatite on to the global market, the use of fluoride has become even more questionable and controversial.

In my professional opinion, a hydroxyapatite toothpaste is the gold standard.

Hydroxyapatite is a crystal that the enamel naturally consists of. By infusing it into toothpaste, it strengthens and remineralises teeth, while remaining completely biologically compatible and inert. This means that if your young child swallows the toothpaste, there will be little to no adverse short or long term effects.

A child will only learn to spit out on demand around the age of 3-4 years. This means that if you expose them to fluoride toothpaste from a young age, chances are, they will be ingesting small, but cumulative amounts of fluoride on a daily basis. The adverse effects of systemic fluoride exposure are becoming better understood. Some include neurological disease, dental or skeletal fluorosis, oral & gut dysbiosis, thyroid issues, to name a few.

Additionally, there is fluoride present in many other environmental sources too, such as in the drinking water in certain areas, in pesticides, fertilisers and in some food and drinks. When you add fluoride toothpaste to the mix, and your child is likely not spitting it out, there’s no way to accurately quantify how much fluoride your child is being exposed to on a daily basis.

In my opinion, ditch the fluoride, switch to a hydroxyapatite toothpaste, and focus on optimising your gut and oral microbiome, ensure that you are a nasal breather, consume a diet that is rich in protein and fat-soluble vitamins and ensure that you are using dental products that efficiently remove the plaque from your teeth and tongue.