Most tooth decay in children can be prevented with a few daily habits: brushing twice a day with fluoride toothpaste in the right amount for your child’s age, keeping sugary foods and drinks to mealtimes, avoiding bottles of milk or juice at bedtime, and regular dental check-ups from the first tooth.
How tooth decay starts in a child’s mouth
Tooth decay, also called dental caries, is damage to the tooth caused by acid. Plaque, the sticky film of bacteria that forms on teeth every day, feeds on sugar and turns it into acid. Each time a child eats or drinks something sugary, this acid attacks the enamel (the hard outer layer of the tooth) for a while afterwards.
Saliva slowly neutralises the acid and helps the enamel repair itself, especially when fluoride is present. Decay develops when the acid attacks happen too often for this repair to keep up. Baby teeth have thinner enamel than adult teeth, so once decay starts it can progress quickly.
The first sign is usually a chalky white patch near the gum line. At this early stage the damage can often be stopped, or even reversed, with better brushing, fluoride and fewer sugary snacks. If it continues, a brown spot and then a hole (a cavity) appear. Parents often wonder whether this matters in teeth that will fall out anyway; our article on whether cavities in baby teeth should be treated explains why it does.
Brushing: the right technique and the right amount of toothpaste
Brushing removes plaque, and fluoride toothpaste strengthens the enamel. Both work best when your child brushes twice a day for about two minutes, always including last thing at night before sleep.
| Age | Fluoride toothpaste | Who brushes |
|---|---|---|
| Under 3 years | A thin smear, at least 1,000 ppm fluoride | A parent |
| 3 to 6 years | A pea-sized amount, 1,000 to 1,500 ppm | The child, with a parent helping and checking |
| 7 years and over | A pea-sized amount, 1,350 to 1,500 ppm | The child, with a parent still checking |
The figure in ppm (parts per million) is the fluoride strength printed on the tube. These amounts follow the NHS guidance on children’s teeth; your dentist may adapt them to your child.
- Use a small, soft toothbrush and replace it every three months, or sooner if the bristles are splayed.
- Brush every surface: outside, inside and the chewing surfaces of the back teeth, where food gets trapped.
- Pay special attention to the gum line, where plaque collects first.
- After brushing, your child should spit out the toothpaste but not rinse with water, so the fluoride keeps working.
Most children do not have the hand control to brush well on their own until about the age of seven, so keep helping and checking until then.
Food and drinks: how often matters as much as how much
The number of times sugar reaches the teeth during the day matters more than the total amount. A child who sips juice all afternoon or nibbles biscuits between meals exposes their teeth to acid again and again, leaving no time for saliva to repair the enamel. The World Health Organization identifies free sugars, the sugars added to foods and drinks, as a main cause of tooth decay.
- Keep sweet foods, including cakes, biscuits, chocolate and traditional desserts, for mealtimes rather than between meals.
- Offer water and plain milk as the everyday drinks. Fruit juice, even when labelled natural, and soft drinks are best kept small and served with a meal.
- Choose tooth-friendly snacks: fresh fruit, vegetables such as cucumber or carrot sticks, cheese, labneh or plain yoghurt.
- Be careful with sticky or slowly dissolving sweets, such as lollipops, toffees and dried fruit, which stay on the teeth for a long time.
Babies and toddlers: good habits from the first tooth
Decay can start as soon as the first tooth appears, usually around six months of age. Early childhood caries, sometimes called bottle caries, typically affects the upper front teeth first, because milk or juice pools around them during sleep.
- Start brushing with a smear of fluoride toothpaste as soon as the first tooth comes through.
- Do not put your baby to bed with a bottle of milk, formula or juice. If a bottle is needed to fall asleep, it should contain only water.
- Offer drinks from an open or free-flow cup from around six months, and aim to stop bottles around the first birthday.
- Never dip a dummy (pacifier) in honey, sugar or syrup.
How the dentist helps protect your child’s teeth
Regular check-ups allow the dentist to spot early white patches before they become cavities and to give advice adapted to your child. A first visit is usually recommended when the first tooth appears or by the first birthday; our guide to your child’s first dental visit explains what happens on the day.
Depending on your child’s risk of decay, the dentist may recommend:
- Fluoride varnish: a concentrated fluoride coating painted on the teeth in a few minutes to strengthen the enamel. It is painless and needs no injection.
- Fissure sealants: a thin protective coating applied to the deep grooves of the permanent back teeth, often soon after they come through, around the age of six or seven.
Both are quick and comfortable; you can read more in our article on fluoride and fissure sealants for children.
Warning signs to look out for
Look at your child’s teeth regularly, for example while brushing, gently lifting the upper lip to see the front teeth near the gum. Book an appointment if you notice:
- white, chalky patches or lines along the gum line;
- brown or black spots, or a visible hole;
- sensitivity to cold or sweet foods, or a child who suddenly chews on one side only;
- toothache, swollen gums, or a small pimple-like bump on the gum.
Pain, swelling or a bump on the gum can be a sign of infection and should be seen promptly. A child with swelling of the face and fever, or difficulty swallowing, needs urgent medical care.
Children’s dentistry at Ajam Dental Clinic in Tripoli
At Ajam Dental Clinic, all dental care for children, from babies to teenagers, is handled by Dr. Soumaya Ajam, who holds a University Diploma in Paediatric Dentistry from Université Saint-Joseph de Beyrouth. Our children’s dentistry includes check-ups, advice on brushing and diet, and the treatment of decay when it is needed.
Families come to our clinic on Fouad Chehab Boulevard from across Tripoli (Zahriyeh, Al-Tall, Dam wa Farez, Azmi Street, Bahsas and Beddawi) as well as from the rest of North Lebanon. To book a check-up for your child or to ask a question, contact us by phone or WhatsApp.
Frequently asked questions
At what age can my child brush their teeth alone?
Most children can start brushing by themselves from about three years old, but they usually do not clean well enough on their own until around the age of seven. Until then, let your child brush first to build the habit, then go over the teeth again yourself, especially the back teeth and along the gum line. Even after seven, it is worth checking from time to time, particularly in the evening, when brushing matters most. An electric toothbrush can motivate some children, but a manual brush works just as well when it is used properly for about two minutes.
Is fluoride toothpaste safe for young children?
Yes, when the right amount is used. Fluoride is one of the most effective ways to protect teeth against decay, which is why fluoride toothpaste is recommended from the very first tooth. The main precaution is the quantity: a thin smear for children under three and a pea-sized amount from three years. Regularly swallowing large amounts of toothpaste while the adult teeth are forming can cause faint white marks on them, called fluorosis, so keep the tube out of reach and supervise brushing. Fluoride-free toothpaste does not give the same protection against decay.
Are fruit juice and dried fruit good for my child's teeth?
They contain vitamins, but they are not tooth-friendly. Fruit juice, even when freshly squeezed or labelled without added sugar, contains natural sugars and is often acidic; when it is sipped through the day, it keeps the teeth bathed in sugar and acid. Dried fruits such as dates, raisins and apricots are sweet and sticky and cling to the teeth. Whole fresh fruit is a better choice. If you give juice, offer a small glass, diluted with water, with a meal rather than between meals, and keep water and plain milk as the everyday drinks.
My child falls asleep with a bottle. How can I stop this habit?
Change things gradually. Give the milk a little earlier, as part of the bedtime routine, then brush the teeth and put your child to bed without the bottle. If your child insists on a bottle at night, you can dilute the milk with a little more water every few days until the bottle contains only water. A calm, repeated routine helps: a bath, a story, a song or a soft toy can replace the bottle as the signal for sleep. Expect a few difficult nights at first; being consistent usually works within one or two weeks.
Does sugar-free chewing gum help prevent tooth decay?
For older children who can chew gum safely, sugar-free gum after a meal can help, because chewing increases the flow of saliva, which neutralises acid and washes away food particles. It is a useful extra, for example after lunch at school when brushing is not possible, but it never replaces brushing with fluoride toothpaste. Chewing gum is not suitable for young children because of the risk of choking. Check that the packet clearly says sugar-free: ordinary chewing gum adds sugar and has the opposite effect.
Can medicines cause tooth decay in children?
Some can. Many syrups for children, such as cough or fever medicines, contain sugar, and children who take them often or for long periods may have a higher risk of decay, especially when the dose is given at night after brushing. Ask your doctor or pharmacist whether a sugar-free version exists. Never stop or change a medicine prescribed by a doctor because of your child's teeth. When a sweet medicine has to be given in the evening, give it before brushing rather than after when possible, or offer a few sips of water afterwards.
Have a question about your teeth?
Send a WhatsApp message to Dr. Abdel Rahman Ajam or Dr. Soumaya Ajam, or call the clinic to book a consultation.
This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.