Tooth decay is caused by sugars in the food and drinks your child has. Plaque on the teeth contains bacteria which feed on sugar and produce acid. This acid damages teeth and leads to holes.

What causes tooth decay?

There are three simple steps to help stop tooth decay:

1. Only give sugar-containing foods and drinks at mealtimes, up to three times a day.
2. Brush all surfaces of your child’s teeth twice daily with fluoride toothpaste.
3. Visit the dentist regularly and ask about fluoride varnish.

This page gives more advice on each of these steps.

Diet advice

A tooth-friendly diet is also good for your child’s overall health. There are two key points to follow:

• Reduce the overall amount of sugar your child eats.
• Reduce how often sugar is eaten during the day, keeping sugary foods and drinks to mealtimes and avoiding sugar before bed.

Foods and drinks that contain hidden sugars

It can be difficult to tell when food or drinks contain sugar. Many foods and drinks aimed at babies and children contain sugar, even if packaging says “no added sugar”, “natural ingredients” or “organic”. This does not mean they are sugar free.

Checking ingredients can help. Sugar may be listed as:

Dextrose, glucose, fructose, fruit juice concentrate, corn syrup, hydrolysed starch, isoglucose, levulose, maltose, molasses, sucrose, honey, treacle, dried fruit or syrup.

Foods with naturally occurring sugars or added sugars can still cause tooth decay and should be avoided between meals.

Savoury foods

• Many sauces, such as pasta sauce or chilli sauce
• Fresh or tinned soups
• Flavoured crisps
• Sandwich meats and fillers
• Condiments such as tomato sauce, BBQ sauce, mayonnaise, pickles and relish

Drinks

• Flavoured water
• Flavoured milk
• Diluting juice, including those with no added sugar
• Fruit juice, including fresh fruit juice
• Smoothies

Tooth-friendly snacks

When children are hungry between meals, it helps to offer a small selection of tooth‑friendly snacks so they know what they can have between meals.

Bread and crackers

Plain bread such as wholemeal, brown, granary, white, high fibre or rye bread. Pitta, chapatti, rolls or baguettes. Small portions of plain breadsticks, plain rice cakes, plain oatcakes and cream crackers.

Fruit and vegetables

Whole fruits and vegetables. Do not give juiced, dried or pureed options.

Dairy

Cheese such as cheddar, soft cheese, cheese spread and string cheese. Unsweetened natural yoghurt or plain fromage frais.

Protein

Eggs, tuna, hummus, beans and pulses.

Always check ingredients for flavoured foods, as added flavours often mean added sugars.

Tooth-friendly drinks

Plain milk and plain water are the safest drinks during the day.

After brushing teeth at bedtime, only water should be given if a drink is needed. Milk during the night can cause tooth decay.

Tea and coffee, even with milk only, are not suitable for children as they contain caffeine and can affect iron absorption.

All other drinks contain sugar and/or acid and should be avoided or kept to mealtimes.

Medicines

Some medicines contain sugar. Ask your doctor, dentist or pharmacist for sugar‑free medicines where possible.

If a sugar‑free option is not available:

• Ask if the medicine can be taken with a meal.
• Avoid giving the medicine before bedtime.
• Rinse your child’s mouth with water after taking the medicine.

Toothbrushing

What toothpaste should my child use?

Most children should use toothpaste containing 1450 parts per million (ppm) fluoride.

Some older children at higher risk of tooth decay may be prescribed a higher strength toothpaste by their dentist.

How much toothpaste?

• Children under 3 years: a smear of toothpaste
• Children over 3 years: a pea‑sized amount

How often should teeth be brushed?

• Brush teeth twice a day.
• Once last thing before bed, with no food or drink afterwards.
• Once at another time, such as in the morning after breakfast.
• Brushing at school or nursery should be in addition to brushing at home.

Who should brush?

Children should be helped with brushing until they can brush well themselves, which is usually not before the age of 7.

You should continue to supervise brushing until you are confident it is being done properly.

Spit or rinse after brushing?

After brushing, your child should spit out excess toothpaste but should not rinse with water or mouthwash.

Not rinsing allows the toothpaste to work for longer and helps reduce tooth decay.

Toothbrush type

Manual or electric toothbrushes can be used. Choose a toothbrush with a small head so it can reach the back teeth.

How long should brushing take?

Brushing should take about two minutes. It may take longer when learning a new brushing technique.

Using a timer or app can help keep young children focused.

Brushing technique

Use a short scrubbing motion. A systematic approach helps ensure all tooth surfaces are cleaned.

Brush the following surfaces for the top teeth, then the bottom teeth:

• Outside surfaces, starting at the back teeth and working around to the other side.
• Inside surfaces, using a vertical brush position for front teeth if needed.
• Biting surfaces, working from one side of the mouth to the other.

When brushing a child’s teeth, it may help to stand behind them, kneel in front of them, or lay small children across your lap.

Bleeding gums

If gums bleed when brushing improves, this is common and usually settles with continued good brushing.

If you are concerned, speak to your dentist, dental therapist or hygienist.