Oral hygiene may be started even before eruption of the first tooth. Twice-a-day cleaning of the gums using the washrag used for cleaning the face and hands after eating is effective and simple. Fluoride has been shown to be extremely effective in reducing the development and severity of cavities. Since fluoride amounts vary by water source, check with the child’s pediatrician or dentist regarding any supplementation that may be necessary. Fluoride recommendations will be based upon fluoride concentration in water consumed and the age of the child. An excess of fluoride may cause fluorosis — permanent staining of the teeth. Children’s teeth seem most vulnerable during the first three years of life. For this reason, fluoridated toothpaste is rarely necessary for children less than 3 years of age. Maternal fluoride supplementation during pregnancy has not been shown to benefit fetal dental integrity or protect the child’s baby or permanent teeth from cavity formation. Infants and children should never take a bottle to their crib or bed. Breast milk, cow’s milk, soymilk, and juice all can be associated with cavity formation. Ingestion of sticky fruit (such as raisins) or other foods heavily laden with sugar (such as candy) is also associated with an increase in cavity formation.