Educational Resources

Oral Health From Pregnancy Through The Toddler Years

For children ages 0-2


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  • Welcome

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    Dear Early Head Start Educator:

    This program was created to improve the oral health of young children and their families. It focuses on the oral health of children from birth through age 3. Many young children suffer from Early Childhood Caries (Cavities) and other dental decay. Dental decay is preventable — but by the time some children get to Head Start or other preschool programs, it can already be too late.

    As you know, dental decay in young children can cause pain and infection. Early tooth loss can result in speech disorders, crooked permanent teeth, emotional trauma, and poor self-esteem.

    We hope that you will integrate the recommended oral health messages into your program and make them part of your routine. Since healthy teeth and gums are important to good health and positive self-esteem, this program can assist you in improving the overall health and self-confidence of children and families.

    We wish you much success with the program.

    Marsha Butler, Signature

    Marsha Butler, DDS
    BSBF Global Oral Health Initiative
    Colgate-Palmolive Company

  • About This Program

    Working Hand-in-Hand with Parents

    Colgate Bright Smiles, Bright Futures® From Pregnancy through the Toddler Years is designed to give you the information you need to talk to Early Head Start parents/caregivers about oral care for their young child, from birth through age 3.

    • Teacher Background: This manual provides you with current, need-to-know information on oral health for young children. Found on pages 5 through 13, this special section gives you the background you need to be able to talk about oral health with parents/caregivers. You’ll find details on topics such as Early Childhood Caries (Cavities), dental injury prevention at home, and the various ways a child can get the proper amount of fluoride.

    • Pregnancy Information: At the back of this guide, you’ll also find special information for pregnant moms, related to taking care of their own oral health to help ensure the health of the unborn baby. This important section, which includes a reproducible handout, can be found on pages 14-19.

    • Parent Take-Home: The program also includes a bilingual (English/Spanish) parent take-home provided in quantity. The Bright Smiles from the Very Beginning booklet supports the current information in this guide, presented in an easy-access, checklist format for at-home use.

  • Oral Care at Home

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    Good oral health starts even before a child’s first baby tooth comes in. As soon as a baby is born, parents can start to make sure the child can have a smile that lasts a lifetime.
    • As a child grows, there are easy actions parents can take at home every day to help protect the baby’s gums and teeth.

    • There are also specific changes to watch for… and ways to keep the child’s teeth safe and healthy for years to come!

    Oral Care at Home

    Parents can start to fight cavities even before the baby has teeth.

    1. Clean Gums and Teeth

    • Clean the baby’s gums every day after breast or bottle-feeding, and before bed with a soft, infant-sized toothbrush or a clean, damp cloth.

    • As soon as baby teeth begin to appear, parents should start brushing them twice a day, using a “smear” (very small amount) of fluoride toothpaste and a soft, infant-sized toothbrush. (illustration of smear v. pea-sized)

    • Once a child reaches age 2, parents should begin brushing with a “pea-sized” amount of fluoride toothpaste twice a day.

      • Right before bedtime is the most important time to brush.

      • It’s important that the child spits out the toothpaste and does not swallow it.

    • Remember that many children’s medicines contain sweeteners. These can cause tooth decay, so be sure to wipe your baby’s gums (or brush the child’s teeth) after giving medicine.

    2. Get To Know The Child’s Teeth and Mouth

    • Children change quickly, so it is important for parents to become familiar with their child’s mouth. This includes lifting the child’s lip and look for changes on the child’s teeth and gums monthly. That way, parents will able to notice changes and potential problems immediately.

    • In particular, parents should watch the child’s front and back teeth for white, brown or black spots. If they see these early signs of decay, they should take the child to the dentist as soon as possible.

    3. Avoid The Spread of Germs

    • Adults can spread the germs that cause cavities. Parents should never share spoons, cups, toothbrushes (or anything that has been in their own mouths) with their child. Sharing can pass along bacteria (germs) that a parent may have in their own mouth to the baby. This can cause tooth decay.

  • Understanding Fluoride

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    One of the best ways to protect teeth and help fight tooth decay is with fluoride. Fluoride is a natural element that combines with enamel on teeth and makes them stronger. Fluoride protects teeth by making them more resistant to acid and can even help reverse early signs of decay. Fluoride is an important part of making sure a child’s teeth stay healthy.

    Common Sources of Fluoride for Young Children:

    • Fluoride Toothpaste

    • Fluoride Varnish (applied at the dental or physician’s office or at school)

    • Fluoride Gel (applied at the dental office)

    • Drinking fluoridated tap water, when available, builds a foundation for healthy teeth. The fluoride that is added to public water supplies is absorbed and metabolized by the human body exactly as naturally occurring fluoride is.

      • Parents can call the water authority or local health department to find out if their water has fluoride.

      • Some bottled water contains fluoride, too – encourage parents to check the label to see if it says it says “fluoride” or “fluoridated.”

    • Fluoride supplements, like drops. These are prescribed by the dentist only if a child is not drinking fluoridated water.

    • Some foods can contain fluoride, too – especially if they are made from fluoridated water (like some beverages) or “reconstituted” with fluoridated water (like infant formula or cereal).

    Understanding Fluoride


    The Right Amount of Fluoride

    Fluoride is critical for preventing tooth decay – but it is possible for a child to get too much fluoride if an area has a high natural fluoride content in the water. Remind parents to ask the dentist about the potential of fluorosis, a condition that can cause defects on the tooth enamel, like white marks. Fluorosis only affects permanent teeth.

    The dentist can help make sure that a child gets enough – but not too much – fluoride.

  • Visiting the Dentist

    Visiting the Dentist
    Regular visits to the dentist should start at 6 months of age. The dentist is a child’s lifelong partner in oral health. Parents should not wait until there are problems with tooth color or when the child is in pain – the overall goal is to prevent problems.

    At the Dental Visit

    The dentist and dental hygienist will check the baby’s gums and teeth and answer any questions. They may:

    • Clean and polish the teeth.

    • Apply fluoride treatments (put gel or varnish on teeth).

    • Take x-rays of teeth or jaw if necessary.

    • Floss the teeth once the child’s baby teeth are touching each other.

    Dental Visit Checklist

    Remind parents to:

    • Talk to the dentist about fluoride – especially if their drinking water is not fluoridated. If a child does not drink fluoridated water, the dentist may prescribe fluoride drops.

    • Ask the dentist about the use of “antimicrobials” for the child. These can help prevent tooth decay and may be recommended for some children.

    • Take care of their own oral health. Children learn by watching, so parents should brush, floss and visit your dentist regularly, too. This will help prevent the spread of decay-causing bacteria to the baby/child.

  • All About Baby Teeth

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    A child will start getting baby teeth at about 6 months of age. By the age of 2, there will usually be 20 baby (primary) teeth – ten teeth on the top, and ten on the bottom.

    Parents need to take care of the child’s baby teeth every day. It sets the child on the path of good oral health for a lifetime!

    Why Baby Teeth Are Important

    Even though baby teeth will be replaced by permanent teeth, they are a very important part of a child’s healthy development. Baby teeth:

    • Save space for the permanent teeth. They help make sure that the permanent teeth growing underneath grown in straight.

    • Help children form sounds and words. If a child loses baby teeth prematurely to dental disease or trauma, his/her speech could be affected.

    • Round out the shape of the face. This helps the child smile and feel good about the way he or she looks, and helps promote positive self-esteem.

    Help for Teething Pain

    From six months to age 3, a child may have tender gums as baby teeth “erupt,” or grow in. Parents might want to try:

    • Having the baby chew on a clean teething ring (they can chill it first), cool spoon or cold, wet washcloths.

    • Rubbing the baby’s gums gently with a clean finger.

    • For toddlers, parents should ask the dentist about teething gels.


    Parents should begin taking their children to the dentist at least by the child’s first birthday. From that point on, the dentist can create an individualized plan for the child regarding risk factors and protective factors. Parents play an important role in brushing and maintaining a balanced diet at home.
  • Preventing Early Childhood Cavities

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    There is a dental disease called Early Childhood Caries (Cavities) that can affect young children. Sometimes called Baby Bottle Tooth Decay, it is caused when sugary liquid surrounds the teeth too often – like when a child goes to bed with (or walks around with) a bottle.

    It can lead to pain and severe cavities in a child’s baby teeth. However, the good news is that Early Childhood Caries (Cavities) are preventable.

    Preventing Early Childhood Cavities

    What Parents Should Do:

    • Breastfeed at regular feeding times. After feeding, mothers should remove the baby from the breast and wipe baby’s gums and teeth with a damp washcloth or brush the teeth.

    • If parents bottle feed, they should remove the bottle as soon as they are done feeding the baby. This keeps the child from spending too much time with a bottle. They should then wipe the baby’s gums and teeth with a damp washcloth or brush the teeth.

    • Never put baby to bed with a bottle with anything other than water in it, and never let the baby hold or walk around with the bottle for long periods of time.

    • Never let the baby drink fruit juice from a bottle. Fruit juice should only be offered in a cup with meals or at snack time.

    • Train a child to use a sippee cup by the age of 6 months. However, they still should not let the child walk around and suck on the sippee cup for long periods of time.

    • Limit the amount of food and drinks that contain sugar. Make sure the child drinks water afterwards and brushes teeth with fluoride toothpaste.

    • Wean their child from the bottle by age one. Parents should not allow continual bottle use or nursing on demand because frequent exposure to the sugars in drinks, formula, milk and breast milk can lead to cavities.

    • Wean their child from sucking on other items, like a thumb or pacifier, by two years of age.

    • Schedule regular dental checkups for the family.

  • Snacking and Food Choices

    There is bacteria, called “plaque,” that lives in everyone’s mouth – including the mouth of every young child. When food (or any drink other than water) comes in contact with plaque, it makes an acid that can attack teeth. The more often this “plaque attack” happens, the more likely that it will cause cavities.

    Snacking and Food Choices

    Remind parents to:

    • Limit their child’s food and drinks that contain sugar to no more than three times a day. Many children love sweet snacks, but sugar causes the quickest plaque attack. Make parents aware that it’s best for their child to have sweet snacks as part of a main meal, instead of as a snack during the day.

    • The sooner a young child learns to make healthy food, snack and drink choices, the better! Encourage parents to offer choices that are low in sugar to help prevent too much exposure to sweet snacks. Lowfat snacks like raw vegetables, fresh fruits, low-fat cheese, yogurt and milk, or whole-grain crackers or bread are good choices.

    Not all sugars are sweet! Starchy foods, including snacks kids like such as pretzels and chips contain sugars, and sugar contributes to tooth decay! Limit sweet and salty snacks, and offer water instead of sweetened beverages.


    Parents can help prevent decay by limiting the number of times their child eats snacks throughout the day!
  • Injury Prevention

    Tooth and mouth injuries are very common among children. However, by taking care and following simple safety guidelines at home, parents can often prevent them.
    Injury Prevention

    Encourage parents to:

    • “Childproof” their home by removing tripping hazards like cords and covering sharp table edges. They should cover electrical outlets and keep children away from electrical cords to avoid shocks and burns.
    • Lock away all cleaning products and other potentially harmful materials; if swallowed, these can burn the lining of the mouth and cause serious injury.
    • Always make sure their child is buckled into a car seat, and make sure it is properly secured. Many local car dealers or police stations offer free car seat inspections.
    • Be sure to use safety belts in strollers and shopping carts.
    • Make sure the child wears a helmet when he/she is ready for a tricycle. A helmet should also be used if the child is riding in a seat on a parent’s bike.
    • Keep emergency numbers handy, including the number for the dentist in case of any mouth injury.
  • Common Questions & Answers

    As you know, working with families in your community puts you in the position to answer a variety of questions regarding the oral health of children and families. Even though many of these questions and answers are already familiar to you, we've compiled this at-a-glance Q & A list to highlight the most commonly-asked ones. Additionally, the first two questions may be of particular interest to you, as they cover new scientific information from the field of oral health.

    Can I transmit oral germs to my baby?

    Yes. Cavity-causing germs can be transmitted through contact — like when baby puts hands in your mouth, and then in his/her own mouth. That’s why it’s so important to keep your own teeth and gums healthy. (Note: As an educator, you should be aware that in some cultures, it is common for mothers to pre-chew food for baby.)

    In addition, research has shown that since a pregnant woman shares blood with her unborn baby, an infection of the mouth — such as periodontal (gum) disease — may contribute to preterm, low birth weight babies.

    What is the relationship between oral health and (systemic) overall health?

    Recent and ongoing studies have shown that there is a definite relationship between diseases of the oral cavity, especially periodontal infections, and systemic diseases. The effects of periodontal disease in the mouth are well known, but this new research indicates that it may also produce systemic effects — such as in increased risk of heart disease and diabetes — in the body. Families should discuss medical and dental conditions with both their dentist and their medical doctor.

    Is breast-feeding better than bottle-feeding in preventing early childhood cavities?

    Many experts recommend breast-feeding over bottle-feeding for the overall health of your child. However, breast-feeding can lead to Early Childhood Caries (Cavities) in the same way that bottle-feeding can. To prevent Early Childhood Caries if Breast Feeding: Avoid overnight feeding (e.g., if you take baby to bed with you and allow him/her to nurse at will). Milk can “pool” in the child’s mouth and cause acid to form continuously throughout the night. This acid leads to decay. Remove baby from the breast as soon as you are done feeding; do not let baby fall asleep on the breast after feeding. Wean baby from the breast by 12 months.

    Is it okay if my child sucks his/her thumb?

    Thumbsucking is normal for infants; most stop on their own by age 2. If your child sucks his/her thumb beyond age 2, try to discourage it by age 4. Thumbsucking beyond age 4 can lead to crooked, crowded teeth and/or bite problems.

    Is it okay for my baby to use a pacifier?

    Yes, but don’t dip it in sugar, honey or sweetened liquid. In addition: Try to have your child give up the pacifier by age 2. Keep in mind that while a pacifier and thumbsucking create no health difference for the child, a pacifier may be a better choice because it can be easier to wean a childfrom a pacifier than from thumbsucking.

    When should I start cleaning my baby’s teeth?

    Cleaning should begin when the first tooth erupts. Clean gums every day after breast or bottle-feeding and before bed. Use a soft, infant-sized toothbrush or a clean, damp cloth. When baby teeth begin to appear, start brushing them twice a day. Use a “smear” (very small amount) of fluoride toothpaste and a soft, infant-sized toothbrush.

    What is the best way to brush a toddler’s teeth?

    Use a small, soft-bristled brush. Use a circular or wiggling motion on all tooth surface, especially where the tooth meets the gumline. When fluoride toothpaste is introduced, use a pea-sized amount until 6 years of age.

    When should I start using fluoride toothpaste for my child?

    Once your child understands that he/she should spit out the toothpaste, even though it tastes good. Fluoride is safe and necessary to keep teeth strong, but only at appropriate levels. Younger toddlers tend to swallow toothpaste in excess amounts, and this may lead to fluorosis, which causes white spots on the teeth. And remember — even if your water is fluoridated, you still need to use fluoride toothpaste. Fluoride is necessary in both “topical” forms (like toothpaste and fluoride gel or varnish) and “ingested” forms (like water or fluoride supplements).

    I use bottled water at home, and it’s not fluoridated. Is this okay?

    If you use bottled water for drinking and cooking — or if your community water is not fluoridated — be sure to tell your doctor or dentist. They may prescribe fluoride supplements for the baby.

  • Special Oral Care Information for Pregnant Women

    The Big Picture

    During pregnancy, the most important things a woman can do for herself and her baby are to pay attention to her general health and follow the advice of herhealthcare professionals. The most important things a pregnant woman can do for her oral health are to brush and floss daily and see a dentist early in her pregnancy for a checkup.

    Pregnant Women

    Oral Care for Expectant Mothers

    It is not unusual for pregnant women to develop sore and bleeding gums. This can usually be prevented, or at least lessened, with daily brushing and flossing. A visit to the dentist is also important because she may have cavities or gum disease that require treatment. Most dentists prefer not to take X-rays or do complicated treatments in the first trimester. And, because it may be uncomfortable to lie in the dental chair in the last trimester, the second trimester is usually the best time for dental treatment.

    Mother’s Oral Health Can Affect Baby

    Research shows that the more unfilled cavities a mother has, the more cavity-causing germs she may have. These cavity-causing germs could be passed on to the baby, through daily contact such as sharing food and letting baby stick her fingers in her mother’s mouth. This is an important reason to have any cavities filled before the baby is born. There’s also evidence showing the possible relationship between periodontal disease of the mother and potential risk of low birth weight or preterm birth.

    Diet is Important, Too

    As for diet, there are two messages. Pregnant women should avoid snacking on soda pop, sweets, and starchy snacks because they can cause cavities. They should also understand that baby’s teeth are already forming and this requires an adequate supply of all nutrients, especially calcium. (It would, however, take a serious calcium deficiency to cause harm to the baby’s teeth.) Calcium is found in milk, cheese, yogurt, dried beans, and leafy green vegetables. 

  • Key Oral Health Messages: Prenatal

    1. Get a Dental Checkup

    It is crucial for pregnant women to understand the importance of getting their teeth cleaned and checked during their pregnancy and having any needed dental work done. You can reinforce this message by telling them how the blood that runs through the teeth and mouth is the same blood that runs through their entire body. An infection in the mouth — like periodontal (gum) disease — affects the health of the whole body, and can affect the health of the baby. Let mothers know that the more unfilled cavities they have, the more cavity-causing germs they have; these germs can be passed along to the baby.

    2. Brush Thoroughly at least Twice a Day with Fluoride Toothpaste

    Pregnant women should understand that they need to take extra special care of their teeth and gums during pregnancy. Encourage them to brush at least two times a day using a soft toothbrush and a fluoride toothpaste, especially after eating breakfast and before bedtime. It is important that they put the toothbrush where the teeth and gums meet. This is where gum disease starts.

    3. Floss Daily

    Flossing should be done once a day. Demonstrate how to hold the floss.

    4. Limit the Number of Times You Eat Sweet or Starchy Snacks Each Day

    You can reinforce the importance of the woman’s overall health at this point. Remind women to limit snacking on soda pop, sweets, and starchy snacks like potato chips because they can cause cavities.

    5. Seek Prenatal Care

    During pregnancy, the most important thing a woman can do for herself and her baby is to pay attention to her general health and follow the advice of her healthcare professionals.

    6. Eat Nutritious Meals and Snacks and Get Adequate Calcium

    Baby teeth are already forming, and therefore it is important to eat nutritious meals and get plenty of calcium. Calcium and other nutrients are needed for baby’s teeth and bones. Eating healthy foods such as fruit, vegetables, grains and dairy products are important to the mother’s and baby’s health and development.

  • Printouts