Avoiding Tooth Decay in Toddlers

Some dentists blame tooth decay in toddlers on breastfeeding. However breastfeeding a baby with teeth is a normal and natural event including breastfeeding at night. Many toddlers are breastfeeding with lots of teeth the world over and they haven’t all got 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

Caring for little teeth

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. Public Health England have produced a 98 page evidence-based toolkit for better oral health. This includes a section for prevention of tooth decay in children up to six-years-old.

  • Breastfeeding provides the best nutrition for babies
  • From six months of age infants should be introduced to drinking from a free-flow cup, and from age one year feeding from a bottle should be discouraged
  • Sugar should not be added to weaning foods or drinks
  • Parents/carers should brush or supervise toothbrushing
  • As soon as teeth erupt in the mouth brush them twice daily with a fluoridated toothpaste
  • Brush last thing at night and on one other occasion
  • Use fluoridated toothpaste containing no less than 1,000 ppm fluoride
  • It is good practice to use only a smear of toothpaste
  • The frequency and amount of sugary food and drinks should be reduced.
  • Sugar-free medicines should be recommended

there’s no need to keep your child from nursing at night since human milk by itself actually helps protect against cavities.

Avoid sharing spoons or dummies

Avoid passing items mouth-to-mouth between you and your baby to reduce the risk of passing decay causing bacteria from parent to child.


Xylitol is a natural carbohydrate sugar substitute in chewing gum and other products that helps 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 56.


Fluoride is said to increase the quality and strength of tooth enamel and help to re-mineralize teeth and repair early decay7. However not everyone believes it is a good thing as too much can cause marks on teeth (enamel fluorosis) and in excess it can be dangerous. See Dr Jay Gordon’s 2010 article Fluoride Supplements for more reading. Dr Sears’ website recommends considering how much fluoride exposure your baby already has before using fluoride toothpaste. 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.

How much toothpaste?

The American Dental Association8 describes the small smear of toothpaste needed as equivalent to a grain of rice. NHS Choices recommends different strengths of fluoride in toothpaste according to age see Fluoride (NHS, 2015).

Little baby asleep with mouth open


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