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Ages & Stages

By age two and a half, your child should have all his primary (or baby) teeth, including the second molars, which usually erupt between twenty and thirty months. His secondary (or permanent) teeth probably won’t start coming in until he’s six or seven, although it’s quite normal for them to arrive a little earlier or later than this.


During this process of “teething,” your child may experience some signs and symptoms including:

  • Upset stomach
  • Irritability
  • Mild fever

Although teething does not cause the above, it is recommended that you consult with your child’s pediatrician if the condition persists. Some children while teething may experience irritation in their gums and respond by chewing on objects. Therefore it may be helpful that teething rings and other objects handled by the child be wiped down and kept clean, thereby reducing any infections.

Preschoolers & Tooth Decay

As you might guess, the number-one dental problem among preschoolers is tooth decay. Approximately one out of ten two-year-olds already have one or more cavities; by age three, 28 percent of children do; by age five, nearly 50 percent of children do. Many parents assume that cavities in baby teeth don’t matter, because they’ll be lost anyway. But that’s not true. Dental decay in baby teeth can negatively affect permanent teeth and lead to future dental problems.

The best way to protect your child’s teeth is to teach him good dental habits. With the proper coaching he’ll quickly adopt good oral hygiene as a part of his daily routine. However, while he may be an enthusiastic participant, he won’t yet have the control or concentration to brush his teeth all by himself. You’ll need to supervise and help him so that the brush removes all the plaque—the soft, sticky, bacteria-containing deposits that accumulate on the teeth, causing tooth decay. Also, keep an eye out for areas of brown or white spots which might be signs of early decay.

Toothbrushes & Toothpaste

By this age you should be helping your child brush her teeth two times a day with a child-sized toothbrush that has soft bristles. There are brushes designed to address the different needs of children at all ages, ensuring that you can select a toothbrush that is appropriate for your child. At this age you can start using a pea-size amount of fluoride toothpaste, which helps prevent cavities. If your child doesn’t like the taste of the toothpaste, try another flavor or use plain water. Also try to teach your child not to swallow it, although at this age they are often still too young to learn to rinse and spit. Swallowing too much fluoride toothpaste can make white or brown spots on your child’s adult teeth.

A Word on Toothbrushing

You’ll hear all kinds of advice on whether the best brushing motion is up and down, back and forth, or around in circles. The truth is that the direction really doesn’t matter. What’s important is to clean each tooth thoroughly, top and bottom, inside and out. This is where you’ll encounter resistance from your child, who probably will concentrate on only the front teeth that he can see. It may help to turn it into a game of “find the hidden teeth.” Incidentally, a child cannot brush his teeth without help until he’s older—about six to eight years old. So be sure to supervise or do the actual brushing if necessary.

Staying Away From Sugar 

Besides regular toothbrushing, your child’s diet will play a key role in his dental health. And, of course, sugar is the big villain. The longer and more frequently his teeth are exposed to sugar, the greater the risk of cavities. “Sticky sugar” foods such as sticky caramel, toffee, gum, and dried fruit—particularly when it stays in his mouth and bathes his teeth in sugar for hours—could do serious damage. Make sure to always brush your child’s teeth after a sugary food item. In addition, do not allow your child to have any sugar-containing liquid in a sippy cup for a prolonged period.

Establishing a "Dental Home"

During regular well-child visits, the pediatrician will check your child’s teeth and gums to ensure their health. If she notices problems, she may refer your child to a pediatric dentist or a general dentist with an interest in treating the dental needs of children. Both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend that all children establish a “dental home” by age one.

As part of her dental checkup the dentist will make sure all teeth are developing normally and that there are no dental problems and give you further advice on proper hygiene. She also may apply a topical fluoride solution to provide extra protection against cavities. If you live in an area where the water is not fluoridated, she may prescribe fluoride drops or chewable tablets for your toddler. For more guidance on fluoride supplements, talk to your pediatrician.


Last Updated
Adapted from Caring for Your Baby and Young Child: Birth to Age Five (Copyright © 2009 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.