How do you brush a baby's first tooth with fluoride?

What does the evidence say about brushing a baby's first tooth?

1. The first visible tooth starts the brushing routine, even if it arrives earlier or later than expected. Use a small soft brush twice a day, including after the final feed when practical. Gum wiping alone is no longer the whole oral-care routine. 1
2. AAP guidance uses a smear the size of a grain of rice before age three and a pea-sized amount from age three. The small quantity matters because infants cannot reliably spit. Adults should dispense the toothpaste rather than allowing a child to suck from the tube. 2
3. Long contact with sugary liquids can affect newly erupted teeth. Avoid putting a baby to bed with a bottle. Pair brushing with consistent feeding and bedtime habits instead of relying on toothpaste while milk or sweet drinks continually bathe the teeth. 3
4. Fluoride varnish is applied by a clinician and is separate from home toothpaste. Oral fluoride drops or tablets also have a different purpose; a pediatrician or dentist should consider water fluoride and cavity risk before recommending them. 2
5. Early enamel damage may be painless and can appear as a white or brown change. Brushing supports the daily routine, but a persistent mark or visible hole deserves a dental assessment rather than vigorous scrubbing or additional paste. 4

A simple tooth-care routine

• Before teeth appear, gently wipe gums with a clean damp cloth.
• From the first tooth, brush twice daily with a rice-sized smear.
• At the dental visit, review water fluoride and the need for varnish.