How to care for your baby's gums and emerging teeth

Do I need to clean my baby's gums before his teeth come in?

Yes. Even before your baby sports his first tooth, it's a good idea to get into the habit of wiping his gums with gauze or a soft wet washcloth during bath time. You don't need to use any toothpaste yet. Simply wrap the cloth or gauze around your index finger and rub it gently over his gums.

Bacteria in the mouth usually can't harm the gums before the teeth emerge, but it can be hard to tell when the teeth are starting to push through, so you'll want to start early. Getting your baby used to having his mouth cleaned as part of his daily routine should make it easier to transition into toothbrushing later on, too.

What's the best way to brush my baby's teeth after they start coming in?

As your child's teeth start to appear (generally around 6 months), look for a baby toothbrush with a small head and grip suitable for your hand. (If your child is healthy and still hasn't sprouted his first tooth by the end of his first year, don't worry – some children don't start getting teeth until 15 to 18 months.)

Use a tiny amount of fluoride toothpaste. A dot the size of a grain of rice (or a thin smear) is all you need. To avoid giving your child too much fluoride, be sure to follow this recommendation.

Twice a day, gently brush on the inside and outside of each of your baby's teeth, as well as his tongue (if he'll let you), to dislodge bacteria that can cause bad breath. No need to rinse, because you're using such a small amount of toothpaste.

Replace the toothbrush as soon as the bristles start to look worn or splayed.

For now your baby's teeth are probably far enough apart that you don't have to worry about flossing. In fact, there's no evidence that flossing baby teeth makes a difference. To be on the safe side, though, many dentists recommend starting to floss when tooth surfaces touch so that you can't clean them with a toothbrush.

When does my baby need fluoride?

Your baby's developing teeth can benefit from a little fluoride. This mineral helps prevent tooth decay by strengthening tooth enamel and making it more resistant to acids and harmful bacteria. Your baby can get fluoride from toothpaste and from water.

Note: In general, it's not a good idea to give your baby water until he's about 6 months old. Until then, he'll get all the hydration he needs from breast milk or formula, even in hot weather. If the water that you use to make your baby's formula contains fluoride, he'll get fluoride from his bottle feedings. Read more about giving water to your baby.

Keep in mind that while little fluoride is a good thing for your baby's teeth, too much of it can lead to a condition called fluorosis, which causes white spots to show up on your child's adult teeth. This is why it's important to use only the tiniest amount of toothpaste until your child is old enough to learn to rinse and spit it out.

Most municipal water supplies are fortified with adequate fluoride. (Call your local water authority to find out about yours). If yours isn't, or if you get your water from a well, you might consider buying a test kit from your local health department, a hardware store, or a pharmacy.

If the results show a fluoride content of less than .3 parts per million, ask your child's doctor or dentist whether you should give your child a fluoride supplement. (The amount recommended for children under 3 is .25 milligrams per day). The doctor can prescribe fluoride in the form of drops that you can add to your baby's bottle or cereal once a day. Experts don't' recommend fluoride supplements for babies under 6 months old.

Bottled water and fruit juices may contain fluoride, although the amount isn't always listed on the label.