Brush your child's teeth twice a day from the first tooth, with fluoride toothpaste in an amount that suits their age: a smear the size of the child's little fingernail for the smallest and a pea-sized amount from around age three. Spit, do not rinse. Help with the brushing until the child is about ten, because their fine motor skills are not up to it before then. The evening brush is the most important, and nothing to eat or drink except water afterwards.
A quarter to seven in the evening, the one-year-old turns his head away and clamps his jaw shut, the four-year-old has brushed by herself for ten seconds and says she is done. Toothbrushing is the point in the bedtime routine that most often goes wrong, and it is also the one that matters most for the child's teeth for the rest of their life. Milk teeth get cavities, and cavities hurt. Here is what applies about fluoride and amount, and above all how to get it done.
Fluoride and amount by age
| Age | Amount of toothpaste | Who brushes |
|---|---|---|
| First tooth to about 2 years | A smear the size of the child's little fingernail | You, with the child on your lap or lying down |
| About 3 to 5 years | A pea-sized amount | The child starts, you finish |
| 6 to 9 years | A pea-sized amount, toothpaste for the age | The child brushes, you check and go over it again |
| From about 10 years | As an adult | The child, with reminders in the teenage years |
How to brush properly
- Twice a day, after breakfast and last thing before bed. The evening matters most, because saliva decreases at night and the bacteria get to work undisturbed.
- Two minutes once the child has many teeth. An hourglass or a song the child recognises helps.
- All surfaces: the outside, the inside and the chewing surfaces. The back molars get forgotten, and that is where the cavities appear.
- Along the gum line with small movements, not hard. A soft brush in a child's size, or an electric toothbrush from around age three if the child will accept it.
- Spit, do not rinse. The fluoride should stay on the teeth. That feels odd to many adults who learned the opposite.
- Nothing more to eat or drink after the evening brush. Water is fine. A bottle of välling (Swedish milk cereal drink) in bed after brushing is the most common cause of cavities in small children.
How to get it done with a child who refuses
- Position: small children are best lying on your lap with their head against your stomach, so you can see into the mouth and the child cannot back away. It feels heavy-handed but it is quick.
- Two brushes: one the child holds and chews on, one you brush with. The child gets to brush your teeth afterwards.
- The mirror: many children from age two find it more fun to watch themselves.
- A song or counting: the same song every time, brushing is over when the song ends. Predictability reduces the protests.
- Keep it dull and short. No negotiations, no ten-minute discussions. Brush, done, book.
- The same order every evening: bath, pyjamas, teeth, book. Teeth before the book, so the book is the reward.
- Hold firm. A child who has screamed at toothbrushing for three weeks usually stops once they notice it happens every evening anyway. It is no fun, but it is shorter than a cavity.
Dummies, night feeds and squash: what causes cavities
Cavities in milk teeth are almost always caused by sugar sitting on the teeth for a long time, especially at night. Välling or juice in a bottle at bedtime, breastfeeding many times a night once the teeth have come through without brushing afterwards, squash in a sippy cup during the day, and grazing all afternoon are the usual culprits. Water between meals, not squash. Sweets on one occasion, not spread out. A dummy is not harmful to the teeth in itself in the first years, but never dip it in anything sweet, and do not lick it clean yourself, because then you transfer your bacteria to the child's mouth. Milk teeth need to last until the child is six to twelve, it is not the case that they will be replaced soon anyway.
The dentist
Dental care for children is free of charge in Sweden. Folktandvården calls children in for a first check-up, often around age three, and the routines differ slightly between regions and clinics. In Region Stockholm there is also early contact with dental care for the very smallest, and BVC (the child health clinic every family is enrolled in) brings up teeth at its visits. If you want help earlier, for example with a child who refuses to brush or has brown spots on the front teeth, call Folktandvården directly. They have a patience with small children that is worth seeing.
When to contact the dentist
| Contact dental care | Carry on brushing at home |
|---|---|
| White or brown spots on the teeth that do not go away | A little discolouration from food that brushes off |
| The child complains of pain in a tooth or with cold and hot food | Slightly sore gums when a new tooth is coming through |
| A tooth that has been knocked and become loose, dark or moved | A milk tooth that is loose at the right age, from about six |
| Swollen, bleeding gums that do not improve within a week | A little blood when brushing in the first days with a new brush |
| The child refuses completely for several weeks and you cannot get in | Protests that are fading |
How we do it with our families
Toothbrushing is one of the points that is always on the note when the nanny takes the evening, with exactly how you do it: on the lap or in front of the mirror, which song, which toothpaste. Sanna, who does the evening shifts with a family in Kungsholmen, brushes the one-year-old on her lap while big sister brushes by herself in front of the mirror and then has her teeth gone over to the same song. It takes four minutes for both, and no välling afterwards, because the parents have been clear about that. It is the same nanny every Tuesday and Thursday, so the children know there is no negotiating with her either.
This text is general information and does not replace advice from BVC, your vårdcentral (local health centre) or 1177 (the national healthcare helpline). If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows how things usually are and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Teething in babies · Bedtime routine for children · Sugar and children · Frequently asked questions
Frequently asked questions
When should we start brushing?
When the first tooth comes through, usually at six to eight months. Twice a day, morning and evening, with a small soft toothbrush and a very small amount of fluoride toothpaste. What matters most is that the routine is there from the start, so that brushing is as natural as a nappy change.
How much toothpaste should children have?
For the smallest, a smear the size of the child's little fingernail, and from around age three a pea-sized amount. The fluoride content of the toothpaste should suit the age, and it is stated on the packaging. The child should spit but not rinse, so the fluoride stays on. Ask Folktandvården or the pharmacy if you are unsure which toothpaste is right.
How long should we help?
Until the child is about ten. Children do not have the fine motor skills to brush properly on their own before then, however much they want to. Let the child brush first and then go over the teeth yourself, every time. That applies even when they protest, and especially in the evening.
The child refuses, what do we do?
Hold firm that it has to be done but be flexible about how: brush on your lap, in front of the mirror, with a song, with the child brushing you first, with their own brush in hand. Keep it short and calm. A child who is screaming still gets brushed quickly anyway, because cavities do not care about moods. It gets better, usually within a few weeks.
When does the child start going to the dentist?
Folktandvården calls children in for a first check-up, often around age three, and in Stockholm there is also earlier contact for the smallest via BVC and dental care. Dental care for children and young people is free of charge. If you have questions about fluoride, dummies or night feeds before then, ask BVC or call your nearest Folktandvården clinic.