How to keep your pre-schooler’s teeth healthy

By Nicola Calder and Catherine Lippe

Shocking statistics about children’s teeth have only just been in the news. Recent statistics show that in 2015-2016 British children underwent 40,800 operations to extract teeth, that works out at roughly 160 procedures taking place every day of the year. 1 

Good oral hygiene and good dietary habits are both important in protecting children’s teeth from tooth decay. Children need healthy teeth and gums for biting, chewing and for forming sounds. And let’s not forget that we want children to smile too! Having good teeth helps children feel confident, but tooth decay can cause pain and worry, even in small children.

What causes tooth decay?
Tooth decay occurs when bacteria in the mouth reacts with sugar, causing acids to form that soften and dissolve enamel; and through acid erosion which happens when acid in food or drink comes into direct contact with enamel, both lead to cavities. The more often children have a sugary snack or drink between meals the more their teeth are under attack. And remember even sugar-free fizzy drinks or squashes can be acidic so should be consumed with caution.

Visiting the dentist with your child
As soon as your child gets their first milk tooth you are encouraged to register and visit the dentist with them. Dental surgeries can be full of bright lights, unusual smells and sounds, not to mention all the people in white coats, so it’s a good idea to get children used to the environment early. Simply sitting in the chair and opening up their mouth is great practice and will make them feel more relaxed about visits in the future. You could take your child with you whenever you have a routine check-up with the dentist. This will help your child to feel more comfortable in an otherwise unusual environment. Regular dental checks are important as they can detect any problems early on.

Which snacks and drinks are safe to offer my child?
A large number of foods and drinks that children enjoy contain too much sugar and can be harmful to their teeth. Try to avoid frequent consumption of sugary foods such as sweets, chocolates, cakes, biscuits and even some breakfast cereals. If you do offer these foods occasionally it’s best to include them as part of a meal rather than as a snack between meals. After eating a meal there will be more saliva in the mouth to help protect the teeth. It is also important to try and avoid eating these foods within an hour of bedtime when saliva protection is also low.

Tooth friendly drinks
Plain milk and water are the only ‘tooth friendly’ drinks for children so try to stick to these as much as possible. Getting children used to drinking water early sets up good practice for the future. Water quenches thirst but does not spoil the appetite and is not harmful to teeth. It also helps to prevent constipation. Milk is a rich source of calcium, and is essential in a child’s diet. Children from 1-2 years can be given whole cow’s milk, from 2 years of age children can be offered semi-skimmed milk as long as they are eating a varied and balanced diet and growing well.

If you do give fruit juice or smoothies you should limit them to mealtimes and keep an eye on quantity, because they are both sweet and acidic they can damage teeth. If you offer fruit juice ensure it is a 100% pure fruit juice, either freshly squeezed or made from concentrate, dilute it well with water (at least 50% water) and offer in a cup or free flow beaker - never a bottle.

Steer clear of sweet drinks such as juice drinks, squash or fizzy drinks. These types of drinks are not pure juices and will contain added sugars, or acids such as phosphoric acid and citric acid, both of which can damage tooth enamel.

Safer snacks
Dried fruit should be kept to mealtimes due to the relatively high sugar content and because it can stick to teeth. Safer snacks between meals might include: fresh fruit, vegetables, breadsticks, toast, cheese, a plain scone, a handful of rice crackers or rice cake.

Cups and dummies
It’s important to introduce a free flow cup or beaker to your baby from around 6 months and discourage drinking from baby bottles by the first birthday. Toddlers using lidded cups should have a free flow spout and not a valved one, to encourage children to drink normally rather than sucking. If your child sucks a dummy or thumb try to wean your child off, again by their first birthday, treating it as part of the growing up process. Never dip a dummy in anything sweet. Prolonged sucking may hinder early speech and language development and can lead to corrective treatment in the future if teeth are displaced.

Tooth brushing
It might seem over the top to be brushing a tiny baby tooth but the moment that first tooth erupts it is exposed to all the foods and the milk entering the mouth. Regular brushing will help prevent later decay and the advice is to start brushing the very first milk teeth twice a day with an appropriate toothpaste (for children up to the age of 3 containing no less than 1,000ppm fluoride, and for children aged 3-6, 1350-1500ppm).2 Use a slight smear of toothpaste for children under the age of 3 years and a pea sized amount for children over the age of 3 years. A small headed toothbrush is best as it can reach all corners of the mouth. Children should spit out after brushing but not rinse out with water so that the fluoride remains in contact with teeth. 

Public Health England also recommends brushing children’s teeth for a minimum of two minutes last thing at night and at least one other time during the day. Although they might protest, until your child is 7 years old you should supervise their teeth brushing ideally by doing it for them. Allowing your child to choose a colourful or cartoon branded tooth brush can encourage them to pick up the brush. Similarly, some popular apps for your phone or tablet can help to achieve the recommend two minutes of brushing time.

Tips to make tooth brushing fun

  • Encourage your child to be a lion or a dinosaur so that they have a wide open mouth for brushing
  • Let your child choose their own toothbrush
  • Brush together with your child if you can
  • Ask the dentist to praise brushing on visits
  • Try and find games and stories about tooth brushing
  • Use a novel timer to time two minutes of brushing

Looking after children’s teeth supports eating and speech development and can build a child’s confidence through a healthy smile. Wouldn’t it be nice if we could keep pushing the rate of tooth decay down and were able to see more of these happy smiles?!

Nicola Calder has a Postgraduate Diploma in Public Health Nutrition and a Masters in Public Health. She has worked as a research associate with the Food Policy Team at the Department of Public Health and Policy at the University of Liverpool and at the Food and Nutrition Programme for the Health Equalities Group, managing the Food Active programme delivered on behalf of the North West Directors of Public Health. She worked at the Department of Health North West as part of the food and nutrition team, and as a Food and Health Advisor within a community Nutrition and Dietetic Department for 7 years.
Catherine Lippe is a Registered Nutritionist based in Surrey, specialising in paediatric and maternal nutrition. Catherine has over 10 years’ experience working in both the public and private sector. She has previously worked as a Community Nutritionist for the NHS and has experience of working with over 55 Early Years settings across the London borough of Newham, supporting settings to improve all aspects of their food provision and eating environment.
The EYN Partnership would like to thank Catherine and Nicola for contributing their expert thoughts and personal views on this issue. Please note, that if you have any questions regarding the above as it relates to children in your care, please contact your healthcare professional for guidance.


1 Local Government Association. Media Centre. More than 160 operations a day to remove rotting teeth in children. Available here [Accessed February 2017].
2 Infant and Toddler Forum. Protecting toddlers from tooth decay. Available here