Avoiding Tooth Decay in Toddlers

Some dentists blame tooth decay in toddlers on breastfeeding. However breastfeeding a baby or toddler with teeth is a normal and natural event and many children across the world breastfeed with a full set of teeth but do not have tooth decay. Our related article Breastfeeding and Tooth Decay looks in more detail at the evidence around whether breastfeeding causes early cavities (holes in teeth) and considers all the other factors that can cause tooth decay. This article looks at recommendations for caring for your baby’s teeth and ideas to avoid or reduce tooth decay when you’re breastfeeding a toddler.

Causes of tooth decay

There is no evidence that stopping breastfeeding will prevent or stop dental decay. It is much more likely that eating sugary food, poor dental hygiene, and the presence of certain bacteria in the mouth are the causes of dental decay. For a fuller discussion on all the possible causes of early tooth decay see Breastfeeding and Tooth Decay.

Clean teeth carefully

Preventing tooth decay in toddlers

Brush teeth regularly

It is important to keep children’s teeth clean to remove traces of food and reduce the levels of Strep mutans (a bacteria that cause cavities) irrespective of breastfeeding. It is generally recommended to brush teeth twice a day. The NHS (National Health Service) in the UK has information and a video to show you how to brush a baby’s teeth see; Looking After Your Baby’s Teeth (NHS, 2020)

Check teeth regularly

Check teeth regularly including under the top lip where the teeth meet the gums and visit your dentist for routine check ups. White spots on the upper front teeth or whitish lines at the base of the teeth along the gum line can be signs of early decay which may still be reversible with prompt treatment. White spots can also be associated with too much fluoride exposure (see below). How a tight upper lip frenulum might be associated with tooth decay is mentioned in Lip-Tie and Breastfeeding on this website:

Can lip-tie cause tooth decay?
If it is difficult to clean a baby’s front teeth due to a frenulum that can trap food or a frenulum that prevents the top lip from being lifted to clean the teeth, this could be associated with dental caries. However, as the labial frenulum changes over time, it may not be a problem by the time your baby has a full set of teeth (Santa Maria et al, 2017). Careful attention can be paid to cleaning the front teeth and any concerns can be discussed with your child’s dentist if problems arise. The Australian Dental Association says there is not enough evidence to support the idea that a short or tight upper lip frenulum could increase the risk of tooth decay (ADA, 2020)

A healthy diet

A heathy diet will help build strong teeth.1 A high sugar diet is associated with dental decay. Too much acidic food and drink (e.g. oranges, fruit juice, fizzy drinks) could also have the potential to damage tiny teeth by reducing pH (the overall acidity or alkalinity in the mouth) and coating them in sugar. Sipping water after meals may help rinse food and drink from the mouth.2

mother playing with her baby on a bed
There is no evidence that stopping breastfeeding will prevent or stop dental decay

Continue breastfeeding

Breastfeeding is part of a healthy diet and breast milk is thought to be protective against the loss of minerals from tooth enamel (enamel demineralisation)3 and may protect against cavities 4.

What about breastfeeding at night?

The mechanics of breastfeeding at night are no different to breastfeeding during the day. It is normal to breastfeed at night for quite some time; see Baby Waking up at Night and How Long Should I Breastfeed? on this website for more information.

Avoid sharing spoons or dummies?

Decay causing bacteria (mutans streptococci) are said to be associated with cavities in teeth in the presence of a high sugar diet. In addition to avoiding a high sugar diet, some authors suggest parents try to avoid passing items such as spoons or dummies mouth-to-mouth between parent and child to reduce the risk of transferring bacteria.56

Xylitol

Xylitol is a natural carbohydrate sugar substitute in chewing gum and other products that may help stop bacteria sticking to teeth. Reducing the level of bacteria in a mother’s mouth may lower the risk of passing them on to her baby.7

Fluoride

Fluoride is said to increase the quality and strength of tooth enamel, help to re-mineralize teeth and repair early decay8. However not everyone believes fluoride is a good thing as too much can cause marks on teeth (enamel fluorosis) and in excess it can be dangerous. Dr Sears’ website recommends considering how much fluoride exposure your baby already has before using toothpaste with added fluoride. He explains:

Toothpaste isn’t necessary, but if your toddler enjoys the foamy grins, use a dab of mildly flavored toothpaste. Before using a fluoride containing toothpaste, check with your dentist. If your child is already getting fluoride supplements or drinks a lot of fluoridated water, don’t use fluoridated toothpaste. If your dentist recommends fluoride toothpaste, only use a pea-sized dab. Children swallow toothpaste and too much fluoride can damage the teeth by causing fluorosis.

How much toothpaste?

NHS recommends using just a smear of tooth paste and to use different strengths of fluoride in toothpaste according to age see Fluoride (NHS, 2018).

Summary

Breastfeeding a baby with teeth is biologically normal and is not thought to be a primary cause of tooth decay for most children. Eating sugary food, not cleaning teeth properly, and the presence of decay forming bacteria in the mouth are likely to be more important causes of dental decay. Avoiding tooth decay in toddlers involves paying careful attention to cleaning teeth regularly, offering healthy foods, and avoiding sharing cavity causing bacteria from sharing spoons or dummies