Pediatrics 8 min read August 21, 2023

Baby Teeth: More Valuable Than Fairy Coins

Written by Richard Dawson, DMD Reviewed by John Turke DMD Updated May 5, 2026

Reviewed by Richard Dawson, DMD — General & Implant Dentist, ICOI Fellow, Smile Science Dental Spa

Why Baby Teeth Matter More Than Most Parents Realize

A common misconception about primary (baby) teeth is that they are temporary placeholders that will fall out anyway, so treating decay in them is unnecessary. This view leads to avoidable pain, early tooth loss, and consequences that affect permanent teeth and jaw development for years. Baby teeth serve critical functions: they allow children to chew and eat a nutritious diet, they hold space in the jaw for the developing permanent teeth beneath them, they support speech development, and they affect a child’s self-confidence and social comfort.

Children have 20 primary teeth, and they begin appearing around 6 months of age. The last primary teeth, the second molars, are not lost until around age 10 to 12. The idea that baby teeth do not matter because they fall out ignores that many of these teeth are in the mouth for up to 11 years. A decayed and painful molar at age 5 is not “fine because it will fall out eventually.” It affects eating, sleep, school performance, and the child’s relationship with dental care for years.

Primary teeth are also not simply reservoirs of space. The roots of primary teeth guide the erupting permanent teeth into position. When a primary tooth is lost early from untreated decay, the teeth on either side drift into the open space, blocking the permanent tooth from erupting correctly. This is one of the most common causes of crowding and the need for orthodontic treatment. Preventing premature loss of primary teeth is genuine orthodontic prevention.

Early Childhood Caries: What Parents Should Know

Early childhood caries (ECC), sometimes called baby bottle tooth decay, is one of the most common chronic diseases in children worldwide. It begins in the primary teeth soon after they erupt and can progress rapidly in young children because primary tooth enamel is thinner and less mineralized than permanent enamel. The bacteria responsible are transmitted to children primarily from close caregivers through shared spoons, pacifier cleaning by mouth, and kissing.

The pattern of ECC typically starts on the smooth surfaces of upper front teeth and the biting surfaces of back teeth. Risk factors include putting a child to sleep with a bottle containing anything other than water, frequent juice or sweetened beverage consumption, night nursing beyond 12 months, and a mother or primary caregiver with high cavity activity (since they transmit the bacteria). Children in lower-income households and those with limited access to fluoridated water are disproportionately affected.

ECC is entirely preventable. The American Academy of Pediatric Dentistry recommends a child’s first dental visit by their first birthday or within 6 months of the first tooth erupting. This early visit focuses less on treatment and more on anticipatory guidance: discussing diet, bottle and breastfeeding habits, fluoride exposure, and cleaning routines for the parent and child. It also establishes a dental home before dental anxiety can develop from a first visit associated with pain or a problem. For guidance on what to bring to a first pediatric dental visit and what to expect, see our overview of what to look for in a pediatric dental provider.

Cleaning and Fluoride for Babies and Toddlers

Oral hygiene for children begins before the first tooth arrives. Wiping the gums with a clean, damp cloth after feedings removes bacterial biofilm and gets the infant accustomed to having their mouth touched. This habit makes the transition to toothbrushing much smoother when the first teeth appear.

Once the first tooth erupts, use a soft-bristled infant brush and a smear (rice-grain) of fluoride toothpaste twice daily. At this age, children will not spit effectively, so the small amount recommended for under-3s is designed to be safe if swallowed. Graduated to a pea-sized amount at age 3, with parental supervision for spitting. Many children cannot clean their own teeth effectively until age 7 to 8, when motor skills develop adequately; parents should brush for or after the child until then.

Fluoride exposure through water and toothpaste is important for primary teeth. Primary enamel is more soluble than permanent enamel, making fluoride’s protective and remineralization effects especially valuable early in life. In areas with unfluoridated water, or for children drinking primarily bottled water, a discussion with the dentist about whether supplemental fluoride is appropriate is worthwhile. Fluoride varnish applied at dental visits every 3 to 6 months for high-risk young children is a well-supported preventive intervention with a strong evidence base for reducing ECC rates.

Start Your Child’s Dental Journey the Right Way.

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When to Treat Cavities in Baby Teeth

Cavities in primary teeth should be treated when they are identified, not watched until the tooth is due to fall out. The timeline for natural loss is relevant, but it does not change the fact that an untreated cavity continues to grow and carries risk of pain, abscess, and damage to the underlying permanent tooth bud.

Small cavities in primary teeth are filled similarly to adult fillings, typically with tooth-colored composite or a stainless steel crown for larger restorations in back teeth. Stainless steel crowns, though visually distinctive, are the most durable and cost-effective restoration for heavily decayed primary molars that need to last several more years. Tooth-colored crowns made of zirconia are now available for primary teeth and are increasingly popular for front teeth where appearance matters to the child or parent.

When a cavity has reached the pulp of a primary tooth, pulp therapy (a baby root canal, called a pulpotomy or pulpectomy depending on extent) is performed to relieve infection and maintain the tooth for its remaining functional years. If the tooth is not treatable, extraction is performed and a space maintainer is placed to hold the gap until the permanent tooth erupts. Space maintainers are simple appliances, either fixed or removable, that prevent adjacent teeth from drifting and collapsing the arch space. Skipping the space maintainer after early primary tooth loss is a common oversight that contributes to crowding and the need for orthodontic treatment later.

Frequently Asked Questions

Here are quick answers to common questions about baby teeth, when to start dental visits, and caring for primary teeth.

When should my child first see a dentist?
Current guidance from the American Academy of Pediatric Dentistry recommends a child’s first dental visit by their first birthday, or within 6 months of the first tooth appearing. This early visit is primarily educational: the provider examines the erupting teeth, discusses diet and feeding habits, demonstrates brushing technique for the parent, assesses fluoride exposure, and applies fluoride varnish if appropriate. Establishing a dental home early creates a comfortable baseline experience before any anxiety-producing treatments are ever needed.
Do baby teeth need to be filled if they are going to fall out anyway?
Yes, in most cases. Untreated cavities in primary teeth cause pain, can abscess, may damage the developing permanent tooth beneath, and when lost prematurely allow adjacent teeth to drift and block the permanent tooth from erupting correctly. The age at which a tooth will naturally be lost is one factor in deciding treatment urgency, but it is rarely a reason to leave active decay untreated. A small cavity in a 5-year-old’s first primary molar that won’t naturally exfoliate until age 9 or 10 needs treatment.
How do I clean a baby’s gums before teeth appear?
Wipe the gums with a clean, damp washcloth or a silicone finger brush after each feeding. This removes milk or formula residue and early bacterial film and gets the infant used to having their mouth touched, which makes the transition to toothbrushing much easier. Once the first tooth erupts, transition to a soft-bristled infant toothbrush and a smear of fluoride toothpaste.
Is it okay to let a baby fall asleep with a bottle?
Allowing a baby to sleep with a bottle containing milk, formula, juice, or anything sweet is one of the strongest risk factors for early childhood caries. As the child sleeps, pooled liquid bathes the teeth in fermentable carbohydrates for hours with minimal salivary buffering. If a bottle at bedtime is part of your routine, transition to water in the bottle by 12 months. Breastfeeding on demand through the night beyond 12 months also carries caries risk if the teeth are not cleaned before sleep and the child falls asleep at the breast routinely.
What is a space maintainer and does my child need one?
A space maintainer is a simple dental appliance placed after a primary tooth is lost prematurely due to decay or extraction. It holds the gap open so the permanent tooth can erupt into the correct position rather than being blocked by adjacent teeth that have drifted in. Not all early primary tooth losses require a space maintainer: the need depends on which tooth was lost, the child’s age, and how close the permanent replacement is to erupting. Your dentist will advise whether one is appropriate after any early tooth loss.