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Lisa Black

Pediatricians can improve oral health by focusing on reducing or eliminating key risk factors for dental caries like a high sugar diet, frequent snacking, lack of a dental home, and tooth decay in the child’s caregivers and siblings.

More than 45% of all U.S. children experience dental caries – or tooth decay – by age 19, and disparities due to poverty, insurance and language barriers prevent many families from accessing proper care at a dentist’s office.

The American Academy of Pediatrics addresses this chronic and common childhood disease within an updated clinical report, “Maintaining and Improving the Oral Health of Young Children,” published in the January 2023 Pediatrics (published online Dec. 19).

“Pediatricians can help parents learn to prevent tooth decay in their children from the time they are infants, even before the first tiny teeth emerge,” said David M. Krol, MD, MPH, FAAP, lead author of the report, written by the Section on Oral Health. “Families can instill good habits early by never putting a child to bed with a bottle, avoiding sugary drinks and serving as role models by brushing and flossing regularly.”

The AAP advises that children drink only water between meals, preferably fluoridated tap water, and avoid juice intake before age 1. The intake of juice should be limited to, at most, 4 ounces per day in toddlers ages 1 through 3 years, and 4 to 6 ounces per day for children ages 4 through 6. For children ages 7 to 18 years, juice intake should be limited to 8 ounces or 1 cup of the recommended 2 to 2.5 cups of fruit servings per day.

Fluoride is also critically important to prevent dental caries, especially for those who do not have early or consistent ongoing dental care.

“Most bottled waters do not contain an adequate amount of fluoride,” said Kaitlin Whelan, MD, FAAP, co-author of the report. “Fluoride toothpastes and rinses are helpful, and the pediatrician or dentist can also apply fluoride varnish to the teeth two to four times annually, a practice that we know reduces substantially the risks of dental caries.”

The AAP also recommends that pediatricians:

  • Assess children’s oral health risks at health maintenance and other relevant visits.
  • Include anticipatory guidance for oral health as an integral part of comprehensive patient counseling.
  • Counsel parents, caregivers and patients on ways to cut back on sugary drinks and foods.
  • Encourage parents and caregivers to maintain their own good oral health and to brush a child’s teeth at least twice a day as soon as teeth erupt. Use a smear or a grain-of-rice-sized amount of fluoride toothpaste, increasing to a pea-sized amount when a child reaches age 3.
  • Advise parents and caregivers to assist in and monitor brushing until a child turns 10.

The AAP clinical report, “Fluoride Use in Caries Prevention in the Primary Care Setting,” provides more information on fluoride administration and supplementation decisions. Pediatricians are encouraged to build and maintain collaborative relationships with local dental providers and recommend that every child has a dental home by age 1.

“We have made strides in treating more children for tooth decay over the past decade,” Dr. Krol said. “But preventing decay is always the best way to go. I think the tooth fairy would agree.” offers an additional resource for parents: Good Oral Health Starts Early: AAP Policy Explained

For an embargoed copy of the clinical report or interview with an author, contact AAP Public Affairs.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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