Kids' dental care in Tennessee, from first tooth to braces
Children's dental care is mostly prevention, and prevention mostly works. Here's what to do at each age, the exact amount of toothpaste, why sealants are among the best deals in dentistry, what to ask before your child is sedated, what to do in the first minutes after a tooth is knocked out, and how TennCare and CoverKids pay for it.
Your child's first dental visit should come within six months of the first tooth and no later than the first birthday. Use a rice-grain smear of fluoride toothpaste under age 3 and a pea-sized amount from 3 to 6. Sealants on the back teeth prevent about 80% of cavities there, per the CDC. Get an orthodontic check by age 7. A knocked-out permanent tooth should be put back in right away or kept in milk on the way to the dentist; a knocked-out baby tooth should not be put back. TennCare covers children until 21 and CoverKids until 19.
How this page works: recommendations come from the American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA), the CDC, the International Association of Dental Traumatology (IADT), and the American Association of Orthodontists (AAO). Tennessee program figures come from the state Department of Health's fiscal-year 2025 oral health report. This page is general guidance; your child's dentist tailors it to your child's risk.
What to do at each age
A one-page timeline. Every child is different, so treat these as the defaults to ask about, not deadlines to panic over.
| Age | What to do | Why |
|---|---|---|
| First tooth to 12 months | First dental visit: within 6 months of the first tooth, no later than 12 months. Start brushing with a rice-grain smear of fluoride toothpaste. | The AAPD calls for a “dental home” by 12 months for a cavity-risk check and parent coaching. TennCare gives the same advice. |
| 12 months+ | Stop on-demand and overnight bottle-feeding and breastfeeding. No added sugar in food or drinks before age 2. | Both are AAPD recommendations to prevent early childhood cavities. |
| Ages 3–6 | Pea-sized amount of fluoride toothpaste; supervise brushing. Fluoride varnish if your child is at higher risk. | ADA toothpaste guidance; AAPD varnish guidance. |
| Around 6 | Ask about sealants when the first permanent molars come in. | Sealants prevent about 80% of cavities in back teeth (CDC). |
| By 7 | First orthodontic check-up. | The AAO recommends it by age 7. Most children don't need treatment then, but some problems are easier to address early. |
| Around 12 | Sealants on the second permanent molars. A mouthguard for contact sports. | The new molars are cavity-prone, and sports cause many dental injuries. |
| Late teens | Have wisdom teeth evaluated. | AAOMS recommends evaluation by young adulthood. See our wisdom-teeth guide. |
Pediatric dentist or family dentist?
Either can be your child's dental home. A pediatric dentist completes a specialty residency after dental school focused on children, including very young children, children with special health care needs, and behavior management. A family or general dentist treats all ages, and many see children comfortably.
A A pediatric dentist is worth seeking out when…
Your child is very young, has special health care needs, has significant anxiety, or has extensive decay that may need sedation. These are where the extra training matters most.
B A family dentist works well when…
Your child is cooperative and low-risk, and the convenience of one office for the whole family matters to you. You can always be referred to a pediatric specialist for a specific problem.
Whichever you choose, check the license on the Tennessee Department of Health's license verification site. Our guide to choosing a dentist has the questions to ask. On TennCare, Renaissance assigns your child a dental home, general or pediatric, and you can change it.
Prevention that actually works
Four things do most of the work in keeping children's teeth healthy, and none of them is expensive.
01 The right amount of fluoride toothpaste
The ADA's guidance: from the first tooth until age 3, a smear the size of a grain of rice; from 3 to 6, a pea-sized amount. More isn't better. Young children swallow toothpaste, and the small amount is what makes it safe.
02 Sealants
A thin protective coating painted onto the chewing surfaces of back teeth. The CDC reports sealants prevent 80% of cavities in back teeth, where 9 in 10 cavities occur, and that children ages 6–11 without sealants have almost 3 times more first-molar cavities than those with them. Yet about 60% of children that age don't have them. No drilling, no shots.
03 Fluoride varnish and fluoridated water
The AAPD recommends professional fluoride varnish for children at risk for early cavities. Many Tennessee health departments apply it too: the state's Nurse's Fluoride Varnish Program reached 12,159 at-risk children in FY2025, most of them under 6. Community water fluoridation adds protection, but it's changing in Tennessee: nine public water systems announced plans to stop fluoridating in FY2025. Check your town in our fluoride guide.
04 How often sugar shows up
The AAPD's advice focuses on frequency: avoid frequent sugary drinks and snacks, avoid added sugars before age 2, and don't put a child to bed with a bottle after 12 months. A sippy cup of juice sipped all day is harder on teeth than the same juice with a meal.
Free sealants at school in Tennessee
The Department of Health's School-Based Dental Prevention Program visits Title I schools with portable equipment for kindergarten through 8th grade, providing screenings, sealants, and referrals, and helping families apply for TennCare. In FY2025 it served 372 schools, screened 49,814 children, and placed 229,595 sealants. Watch for the consent form in your child's folder, and sign it.
When there's a cavity: options, including the black spot
Baby teeth do eventually fall out, but they hold space for permanent teeth, and a cavity in one can still cause pain, infection, and trouble eating, sleeping, and concentrating in school. “It's just a baby tooth” isn't a reason to skip treatment. There is more than one way to treat it, though.
| Option | What it is | Tradeoffs |
|---|---|---|
| Filling or crown | Removing the decay and restoring the tooth. Stainless steel crowns are common on badly decayed baby molars. | Requires numbing and cooperation, and sometimes sedation for young children. |
| Silver diamine fluoride (SDF) | A liquid brushed onto the cavity that can stop it from progressing. No drilling, no shots. | Permanently stains the decayed area black, so it's less suited to visible front teeth. Usually reapplied twice a year. FDA-cleared as a desensitizer; using it on cavities is off-label but endorsed by ADA and AAPD guidelines. |
| Watch and prevent | For very early lesions: fluoride, better brushing, and diet changes, then re-checking | Requires follow-up visits; only suitable for early, non-cavitated spots. |
SDF is widely used in Tennessee's school program: 13,120 children received 39,108 SDF treatments in FY2025. The ADA notes it can be “up to twenty times less costly” than some alternatives while stopping cavities at a similar rate, and that its use “requires diagnosis and monitoring by a dentist.” If a dentist suggests SDF, it's a legitimate option, especially for a young child where the alternative is sedation. Ask how the black staining will look.
Sedation and general anesthesia: what to ask
Most children's dental care needs nothing more than numbing and a patient dentist. When a very young child needs extensive work, sedation or general anesthesia may be the safest way to do it in one visit. It's a real medical decision, and Tennessee regulates it.
01 Tennessee's permit rule for children
Under Tennessee Board of Dentistry Rule 0460-02-.07, a dentist treating a child 13 or under with any sedation beyond nitrous oxide, including an anti-anxiety dose, must hold the state's comprehensive conscious sedation permit (or the deep sedation/general anesthesia permit for deeper levels). The office needs its own facility permit and inspection, and the permit requires current advanced life-support certification (pediatric advanced life support, PALS, for pediatric dentists).
02 The FDA warning, in proportion
In 2016–2017, the FDA added warnings to general anesthetic and sedation drug labels: repeated or lengthy use (more than three hours) in children under 3 may affect brain development. A consensus statement from anesthesia and medical societies cautioned parents against delaying needed procedures because of it, and urged weighing the risks and benefits of each one. Practically: ask whether the work can be done in one shorter session, or whether some of it can safely wait.
- Which Tennessee sedation permit do you hold, and is this office permitted for it?
- Who monitors my child's breathing and oxygen while you work: you, or a separate trained person?
- How long will it take, and could it be split, shortened, or partly treated with SDF instead?
- What are the fasting instructions, and what happens if my child is sick that day?
- Should this be done in a hospital or surgery center instead of the office, given my child's health?
Knocked-out and broken teeth: the first minutes
Children fall, and teeth take the hit. What you do in the first minutes matters most when a permanent (adult) tooth is knocked out, and the advice is the opposite for baby teeth.
! Permanent tooth knocked out: act now
From the International Association of Dental Traumatology's guidelines:
1. Keep your child calm. Find the tooth and pick it up by the crown (the white part). Don't touch the root.
2. If it's dirty, rinse it gently in milk, saline, or your child's saliva.
3. Put it back in the socket right away, if you can, and have your child bite on gauze or a cloth to hold it.
4. If you can't, store it in milk (best), saline, or saliva. Water is poor but better than letting it dry.
5. See a dentist immediately. The root's cells start dying quickly once it's dry; every minute counts.
B Baby tooth knocked out: don't put it back
Knocked-out baby teeth are not replanted. Doing so can injure the permanent tooth developing underneath. Control the bleeding with gauze, keep the tooth to show the dentist, and call your child's dentist the same day to check for other injuries.
Broken or pushed-in teeth: find any fragments, keep them in milk or water, and call the dentist.
Go to the ER first if…
There's a possible head injury (loss of consciousness, vomiting, confusion), trouble breathing, or bleeding you can't control. Teeth come second. For everything else, our emergency dental helper walks you through ER vs. emergency dentist vs. first aid.
Paying for kids' dental care in Tennessee
More Tennessee children have dental coverage than parents realize.
| Coverage | Ages | What's covered | Cost to you |
|---|---|---|---|
| TennCare | Under 21 | Exams, X-rays, cleanings, fluoride, sealants, fillings, crowns, root canals, extractions, gum care, sedation, and braces for a handicapping malocclusion (with prior approval) | $0 |
| CoverKids (CHIP) | Under 19 | The same service list | Low copays none for routine preventive care |
| Private insurance | Varies | Preventive care usually at ~100%. Children's dental is an essential health benefit under the Affordable Care Act, so it's offered with or alongside Marketplace plans. | Per plan |
| School sealant program | K–8, Title I schools | Screenings, sealants, SDF, and referrals | Ask your school |
On TennCare or CoverKids, call Renaissance at 866-864-2526 to find or change your child's dentist; TennCare members reported that pediatric access is better than adult access. Rides to appointments are covered; book at least two business days ahead. Not enrolled? Apply through TennCare Connect at 855-259-0701. Families who earn too much for TennCare may qualify for CoverKids. Details are in our TennCare dental guide.
Questions people actually ask us
In the words patients use — because the worry behind the question is usually the real question.
Within six months of the first tooth coming in, and no later than the first birthday. That's the American Academy of Pediatric Dentistry's recommendation, and TennCare gives the same advice. The first visit is mostly a cavity-risk check and coaching for parents, and it's short.
The ADA recommends a smear of fluoride toothpaste the size of a grain of rice from the first tooth until age 3, and a pea-sized amount from ages 3 to 6. Supervise brushing so young children spit rather than swallow.
Yes, for most children. The CDC reports sealants prevent 80% of cavities in back teeth, where 9 in 10 cavities occur, and children ages 6 to 11 without sealants have almost three times more first-molar cavities. Sealants are painted on with no drilling or shots. TennCare and CoverKids cover them, and Tennessee's school program places them free at participating Title I schools.
Silver diamine fluoride (SDF) is a liquid brushed onto a cavity that can stop it from progressing, with no drilling or shots. It permanently stains the decayed part of the tooth black, which is why it's used less on visible front teeth. The ADA's guideline supports it, and it's often a good option for young children who would otherwise need sedation. It's usually reapplied twice a year.
Sedation is regulated in Tennessee: a dentist sedating a child 13 or under beyond nitrous oxide must hold the state's comprehensive conscious sedation permit or higher, in a permitted, inspected office. The FDA warns that repeated or lengthy (over three hours) anesthesia in children under 3 may affect brain development, while medical societies caution against delaying needed care. Ask about the permit, who monitors breathing, and whether the procedure can be shortened.
If it's a permanent tooth, hold it by the crown, rinse gently in milk, saline, or saliva if dirty, and put it back in the socket immediately if you can; otherwise store it in milk and see a dentist right away. If it's a baby tooth, don't put it back, because that can damage the permanent tooth underneath. Call the dentist the same day. Go to the ER first for any head injury or uncontrolled bleeding.
The American Association of Orthodontists recommends a first orthodontic check-up by age 7. Most children don't need treatment then, but some bite and jaw problems are easier to address early. TennCare covers braces for children under 21 only when a handicapping malocclusion is diagnosed and approved in advance.
Yes. TennCare covers comprehensive, medically necessary dental care for children until age 21 at no cost, including checkups, cleanings, fluoride, sealants, fillings, crowns, root canals, extractions, sedation, and braces for severe bite problems. CoverKids covers children until 19 with low copays and none for routine preventive care. Call Renaissance at 866-864-2526 to find a dentist.
Sources & method
- AAPD — Policy on Early Childhood Caries: Consequences and Preventive Strategies (revised 2025) — aapd.org: dental home within 6 months of the first tooth and by 12 months; bottle and breastfeeding after 12 months; added sugars before 2; fluoride varnish for at-risk children.
- ADA — Toothpastes — ada.org: rice-grain smear under 3, pea-sized amount 3–6. ADA — Silver Diamine Fluoride — ada.org: FDA clearance status, effectiveness, staining, 2018 ADA guideline, 2017 AAPD guideline, cost comparison, and the requirement for dentist diagnosis and monitoring.
- CDC — Vital Signs: Dental Sealants Prevent Cavities — archive.cdc.gov: 80% of back-tooth cavities prevented; nearly three times more first-molar cavities without sealants; about 60% of children 6–11 without sealants.
- Tennessee Department of Health, Oral Health Services Annual Report FY2025 — PDF: school program reach, SDF treatments, Nurse's Fluoride Varnish Program, and fluoridation changes. School Based Dental Prevention Program — tn.gov.
- IADT guidelines: 2. Avulsion of permanent teeth — Fouad AF et al., Dental Traumatology 2020;36(4):331–342, endorsed by the AAPD — aapd.org PDF: first-aid steps and storage media. Smiles for Life — Avulsion of Primary Teeth — smilesforlifeoralhealth.org: avulsed primary teeth are not replanted.
- American Association of Orthodontists — Orthodontics for Children — aaoinfo.org: first orthodontic check-up by age 7.
- FDA label changes for general anesthetic and sedation drugs in young children (December 2016 communication; April 2017 approval), as summarized by the American Society of Anesthesiologists, including the multi-society caution against delaying needed procedures.
- Tennessee Board of Dentistry Rule 0460-02-.07 — Justia Regulations: sedation permits, the rule for children 13 and under, PALS, and facility permits. TennCare — Dental Services — tn.gov: children's and CoverKids coverage and first-visit advice; Tenn. Comp. R. & Regs. 1200-13-14-.04: orthodontic rules; January 2026 advisory council minutes: pediatric access.
Method in one line: every recommendation is attributed to the professional body that issued it (AAPD, ADA, CDC, IADT, AAO, FDA) and every Tennessee figure to the state report it came from, with years attached, so parents can check the source behind each line.