Children's Bone & Teeth Health

Children's Bone and Teeth Health: A Nutritional and Natural-Health Reference

1. Definition and Overview

Children's bone and teeth health encompasses the processes by which the skeletal system and dental structures develop, mineralise, and attain sufficient strength and density from birth through adolescence. The growth and development of the human skeleton requires an adequate supply of many different nutritional factors. Bones provide structural support, protect organs, and serve as the principal reservoir of minerals — primarily calcium and phosphorus — in the body. Teeth, though structurally distinct from bone, share overlapping developmental requirements for minerals and vitamins.

The maximum rate of bone mass accumulation is during early adolescence; as such, a focus on optimizing mineral nutrition in school-age children, defined here as approximately 5 to 15 years of age, is crucial to minimize the risk of bone loss that occurs later in life leading to osteoporosis and fractures. Bone mineral density (BMD) and bone mineral content (BMC) are the primary measurable indicators of skeletal health in children, typically assessed by dual-energy X-ray absorptiometry (DXA).

In recent years there has been interest in the role nutrition may play in bone growth at intakes above those required to prevent classical deficiencies, particularly in relation to optimising peak bone mass and minimising osteoporosis risk. There is evidence to suggest that peak bone mass and later fracture risk are influenced by the pattern of growth in childhood and by nutritional exposures in utero, in infancy and during childhood and adolescence.

Oral health is integral to general health and essential to well-being and quality of life. Dental tissues — enamel, dentin, cementum, and the supporting alveolar bone — form during a precisely timed developmental window; disruption at any point can result in permanent structural defects. Dental caries is a global disease with few populations exempt from its effects; in developing countries, as development increases so does dental caries, and children are at the forefront of the disease disadvantage.

2. Body Systems Involved

2.1 The Skeletal System

Bone is a dynamic, living tissue continuously shaped by the competing activity of osteoblasts (cells that build new bone matrix) and osteoclasts (cells that resorb bone). During childhood and adolescence this process favours net accretion. There is growing recognition of the role of diet and physical activity in modulating bone mineral density, bone mineral content, and remodelling, which in turn can impact bone health later in life; adequate nutrient composition could influence bone health and help to maximize peak bone mass, and therefore children's nutrition may have lifelong consequences.

Children have the highest needs for K vitamins, since bone formation and development are most intense during childhood and adolescence. The higher the bone mass acquired before the age of 20–25, the better the prognosis for good bone health later in life, as bone mass declines throughout adulthood.

2.2 The Dental System

Teeth develop in two distinct phases. Primary (deciduous) teeth begin mineralising in utero; permanent teeth begin forming before birth and continue mineralising through early childhood and adolescence. Enamel — the outer protective layer — is formed by ameloblasts and is the hardest mineralised tissue in the body. Developmental defects of enamel (DDE) represent an overarching category of enamel disturbances that occur during tooth development. Because enamel cannot regenerate after eruption, nutritional insults during tooth development can have permanent consequences.

Phospholipids, being a structural component of cell membranes, are involved in the mineralisation of teeth and bone. A balanced diet is as important to oral health as it is to overall health; an excess or deficiency of a particular nutrient can have various manifestations in the oral cavity; and awareness and adherence to the recommended intake of micro- and macro-nutrients can lead to the development and sustainment of a healthy oral cavity.

2.3 The Endocrine and Gastrointestinal Systems

Calcium absorption in the gut depends on vitamin D status and intestinal integrity. Intestinal health and body mass index in children play an important role in the absorption of vitamin D. Parathyroid hormone (PTH), calcitonin, oestrogen, and growth hormone further regulate bone turnover and mineral homeostasis throughout childhood.

3. Contributing and Associated Factors

3.1 Nutritional Deficiency

Classical nutrient deficiencies are associated with stunting (e.g., energy, protein, zinc), rickets (e.g., vitamin D), and other bone abnormalities (e.g., copper, zinc, vitamin C). Complications of rickets include failure to thrive, abnormally curved spine, bone deformities, dental defects, and seizures. Nutritional rickets remains a global public health problem, particularly in regions with limited sunlight exposure or food insecurity.

3.2 Early Life Nutrition and Programming

Fetal and early life may be a critical period for the development and/or programming of metabolic systems, including the skeleton; there are increasing human data from cohort studies on the association between early life nutrition and bone development in children. Diet in utero has also been associated with subsequent bone mass from ages 6 to 16 years (but not fracture). Positive associations include milk, phosphorus, magnesium, potassium, protein, folate, calcium, and vitamin D, while fat intake is negative.

Breastfed children initially have lower bone mass than bottle-fed children, but longer-term studies suggest that they have higher bone mass (size-adjusted) by age 8 years, especially in children born at term. By the time of peak bone mass, both preterm and term breastfed children have higher bone mass indicating a different bone accrual trajectory curve. These children also have lower fracture risk.

3.3 Dietary Patterns in Infancy and Childhood

Early life nutrition affects peak bone mass attainment; in one prospective cohort study, children with high adherence to a "dairy and whole grains" pattern in infancy had higher bone mineral density at the age of 6 years. An infant dietary pattern characterised by high intakes of dairy and cheese, whole grains, and eggs is positively associated with bone development in childhood.

3.4 Physical Activity

Impact-loading through physical activity builds bone mass and enhances bone structure to improve its overall strength; evidence from cross-sectional, longitudinal, and randomised controlled trials supports the beneficial effects of weight-bearing physical activity. Researchers found that males and females who were most active as children had approximately 8–10% more adjusted BMC at the hip as young adults, suggesting that the effects of physical activity in youth have a greater influence than current adult physical activity.

The total physical activity associations, driven by high-impact physical activity, were evident even for children with below-average bone Z-scores who may be at genetic risk for future bone fragility; there was no statistical evidence that physical activity interacted with genetic risk score to influence bone Z-scores.

3.5 Sugar and Dietary Quality

Excess added sugars, particularly in the form of sugar-sweetened beverages, is a leading cause of tooth decay in U.S. children. Dental caries is a multi-factorial disease, and several risk factors and risk indicators influence its incidence and progression; the main risk factors for dental caries are reported to be diet, saliva, fluoride exposure and cariogenic bacteria, which are in contribution to the context of social, behavioural, and economic factors.

3.6 Genetic and Social Factors

Socio-behavioural and environmental factors play a significant role in oral disease and oral health. Genetic predisposition influences the set-point for peak bone mass, but as discussed in the physical activity section above, activity can meaningfully modify outcomes even in genetically at-risk children. Food access, socioeconomic status, cultural dietary practices, and sun exposure latitude also contribute significantly to both bone and dental outcomes.

3.7 Medication Exposure

The use of warfarin in children reduces bone density and the consumption of this medication is not recommended without careful clinical monitoring. Due to the transformation of food habits in developed countries over the last five decades, vitamin K and specifically vitamin K2 intakes among parents and their offspring have decreased significantly, resulting in serious health implications; the therapeutics used in pediatric practice — antibiotics and glucocorticoids — are also to blame for this situation.

4. Key Nutrients: Scientific Evidence

4.1 Calcium

Attention has primarily been paid to calcium intake, bioavailability, and turnover in school-age children as a marker of bone nutritional adequacy; calcium is the principal mineral contained in bone, and childhood, especially the early pubertal years, is the critical time period for calcification of the rapidly growing skeleton. As such, calcium nutrition is critical to bone mineralisation in children.

Calcium intake determines skeletal Ca retention during bone growth, thus contributing to peak bone mass (PBM) achieved in early adulthood. Calcium intake was a less important yet still significant predictor of total body bone mass. Inadequate Ca intake during the growth period may have a negative impact on bone maturity, and thus predispose a person to an increased risk of osteoporotic fractures later in life.

An analysis of white women included in the third American National Health and Nutrition Examination Survey (n = 3,251) revealed that those who consumed low amounts of milk in childhood and adolescence had low bone density in adulthood and a higher risk of fractures. Low bone mass is a potential contributor to childhood fractures; a report on New Zealand children demonstrated that those who avoided cow's milk were at 1.7 times greater risk of fractures before puberty.

Intervention studies using calcium from supplements or food sources have often demonstrated increases in BMC and areal BMD of about 1–5% in children and adolescents. However, the clinical significance of these modest gains requires further long-term study, as some effects appear to diminish after supplementation is stopped. Vegetables with high calcium content have reduced calcium bioavailability due to the high concentration of oxalates.

A diet rich in calcium, phosphate, and protein might favour remineralisation and could thereby decrease the risk of caries; milk products contain lactose as a carbohydrate (the least cariogenic sugar) and high levels of calcium, phosphate, and casein, which may therefore favour oral health.

4.2 Vitamin D

The role of vitamin D on bone density in children is well established; in many cases, complications related to low bone mineral density have been observed in association with vitamin D deficiency. Vitamin D concentrations throughout fetal life are associated with BMC and bone growth in childhood, and adequate levels of vitamin D in childhood could have a positive effect on skeletal outcomes.

Studies have indicated that vitamin D can precisely influence bone mass accrual and can contribute to controlling calcium-phosphorus metabolism. An increasing body of evidence has shown that low vitamin D levels in children are widespread enough to regard as a considerable public health and global issue. However, the efficacy of vitamin D supplementation to enhance children's bone mineral density remains inconclusive.

A 2011 systematic review and meta-analysis published in the BMJ (Effects of vitamin D supplementation on bone density in healthy children) represents a landmark analysis of trial-level data. In non-cancer populations, vitamin D and calcium supplementation may increase BMD in children with low vitamin D levels.

A further systematic review examining infants and toddlers reported more nuanced findings: limited evidence suggests no relationship between consumption of 400 IU per day of vitamin D from supplements before age 12 months, compared with higher dosages of up to 1600 IU per day, and biomarkers of bone metabolism in children up to age 36 months; insufficient evidence is available to determine the relationship between 400 IU per day of vitamin D from supplements, compared with higher dosages, and bone mass, rickets, or fracture.

The role of sun exposure is important in increasing vitamin D levels in children; also, providing proper nutrition containing vitamin D has a beneficial effect in reducing the complications associated with vitamin D deficiency.

4.3 Phosphorus

Calcium, phosphorus, and vitamin D are essential for bone growth. The roles of phosphorus and magnesium are often inadequately appreciated in maintaining children's bone health. Phosphorus is a structural constituent of hydroxyapatite — the mineral phase of bone and tooth enamel — and reducing the intake of dairy products below the recommended daily doses can have a negative impact on bone not only due to the lack of calcium but also due to other micronutrients such as phosphorus, potassium, magnesium, or vitamins; diets are mainly composed of macronutrients and also of micronutrients like dietary calcium, phosphorus, and vitamin D, which together are essential factors in promoting bone health and preventing bone loss.

4.4 Magnesium

Optimising bone mass in school-age children requires attention to an overall healthy diet including adequate calcium, phosphorus, magnesium, and vitamin D. Magnesium is a cofactor for hundreds of enzymatic reactions and is required for the conversion of vitamin D to its active hormonal form. Although vitamin K, magnesium, and phosphorus are important for bone physiology, the clinical evidence supporting their supplementation is either limited or context-dependent. Most of the evidence base for magnesium in paediatric bone health derives from observational and adult studies; dedicated paediatric RCTs are sparse.

4.5 Vitamin K2 (Menaquinones)

Vitamin K2 activates proteins performing crucial biological functions that range from bone mineralisation and healthy teeth, through promoting cardiovascular health, to maintaining brain development, joint health, and optimal body weight. Vitamin K2 is important for many biological functions, including bone mineralisation, the inhibition of vascular stiffness, the improvement of endothelial function, the maintenance of strong teeth, and brain development.

Osteocalcin is a vitamin K-dependent protein (VKDP) synthesised by osteoblasts and is thought to be related to bone mineralisation. Vitamin K is necessary for the activation of osteocalcin. Moreover, vitamin K2 has been shown to inhibit resorption of bone by suppression of prostaglandin E2 synthesis in osteoclasts.

A 2025 meta-analysis published in Frontiers in Endocrinology found that vitamin K2 significantly increases osteocalcin (cOC), a vitamin K-dependent protein essential for the body to utilise calcium in bone tissue; increases were also recorded for bone-specific alkaline phosphatase (BAP), an enzyme that plays a crucial role in the mineralisation of bone; and the vitamin was associated with reduced levels of undercarboxylated (inactive) osteocalcin (ucOC); without adequate vitamin K, osteocalcin remains inactive and thus ineffective. The researchers noted that "these findings support its role in bone metabolism, though further long-term studies are needed to confirm clinical benefits, such as increased bone mineral density."

Low vitamin K status is much more frequent in newborns, due to both endogenous and exogenous insufficiencies; just after birth vitamin K stores are low, and since human milk is relatively poor in this nutrient, breastfed infants are at particular risk of a bleeding disorder called vitamin K deficiency bleeding. Evidence strength: emerging; most data on children are from observational studies or secondary outcomes of broader trials. Large paediatric RCTs specifically targeting bone endpoints are lacking.

4.6 Protein

Calcium, phosphorus, and protein are important components of bone; hence, adequate intake of these nutrients is required for normal bone development. Protein provides the collagen scaffold upon which mineral is deposited. Both under- and over-consumption of protein have been linked to altered bone metabolism in adult populations, though paediatric data are more limited. Classical nutrient deficiencies are associated with stunting (e.g., energy, protein, zinc) which indirectly affects skeletal growth.

4.7 Zinc

Zinc is essential for growth and regulation of the immune system. Zinc is also involved in bone metabolism. Multiple nutritional deficiencies, including vitamin D, iron, and zinc deficiency, are very common, especially in exclusively breastfed infants, and can be prevented by early education, regular follow-ups, and early supplementation.

The prevalence of zinc deficiency throughout childhood is estimated to be high, primarily related to the low consumption of foods high in bioavailable zinc; zinc deficiency is regarded as a major public health problem with multiple health consequences; zinc supplementation trials among zinc-deficient infants have demonstrated beneficial effects of zinc on growth, diarrhea, and pneumonia morbidity and mortality. Evidence in relation specifically to bone mineralisation in children is moderate-strength, largely from observational data; dedicated RCTs for bone endpoints are limited.

4.8 Fluoride

Fluoride has an important role in preventing caries, by acting in several ways: it increases dental mineralisation and bone density; it has bactericidal action on cariogenic bacteria; and it delays demineralisation and promotes enamel remineralisation when present in dental plaque and saliva.

Dental fluorosis, a condition associated with abnormal enamel development, was first noted in communities with high levels of naturally occurring fluoride in the drinking water. Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during odontogenesis, leading to enamel with lower mineral content and increased porosity. The evidence therefore establishes a U-shaped relationship with fluoride: insufficient exposure increases caries risk, whereas excessive systemic exposure during tooth development causes fluorosis.

Dental fluorosis affects children younger than 8 years, as the permanent tooth enamel is fully mineralised in older children, except for the third molars. Evidence does not support any detrimental effects on neurocognitive development at the currently recommended level of water fluoridation in the U.S. (0.7 ppm); in the United States, fluoride levels are carefully regulated to remain within safe limits, minimising the risk of adverse effects like fluorosis. Evidence strength: strong for caries prevention at recommended exposures (multiple systematic reviews and guidelines); strong for fluorosis at excess exposures; long-term neurological risk at environmental exposures above recommended levels remains an area of active research.

4.9 Vitamin A

The bone mass increases that occur during the period of childhood are of great significance for maximising the peak bone mass in adults and preventing osteoporosis. Studies have reported that vitamin A can improve bone health in adults. The bone mass increases that occur during the period of childhood are of great significance for maximising the peak bone mass in adults and preventing osteoporosis; studies have reported that vitamin A can improve bone health in adults; however, limited studies have assessed such associations in children. Both deficiency and excess of vitamin A have been associated with adverse skeletal effects in animal and adult human studies. Evidence in children is preliminary and largely observational.

4.10 Omega-3 Fatty Acids

Studies have shown saturated fats and omega-6 fatty acids have an inflammatory effect on the periodontium; contrastingly, omega-3 fatty acids have demonstrated an anti-inflammatory effect. This suggests a theoretical mechanism by which omega-3 intake could benefit periodontal tissue health in children, but dedicated clinical trials in paediatric dental or bone health are limited. Evidence strength: preliminary; currently largely cell culture and adult observational data.

5. Traditional Uses

The following summarises historically documented traditional uses of natural substances in bone and teeth health. These are distinct from and should not be conflated with modern clinical evidence.

5.1 Sesame and Traditional Calcium-Rich Foods

In traditional Ayurvedic medicine and across many Asian and Middle Eastern culinary traditions, sesame seeds (Sesamum indicum) and sesame paste (tahini) have been used as food sources rich in calcium, particularly for growing children and pregnant women. This use pre-dates modern nutritional science by centuries. The traditional rationale was empirical — sesame seeds were observed to be dense and nourishing — though modern analysis confirms they contain substantial calcium. No formal clinical trials have evaluated sesame specifically for paediatric bone mineralisation outcomes.

5.2 Horsetail (Equisetum arvense)

Horsetail has a long history of use in European herbal traditions, particularly in German and British folk medicine, where it was employed in preparations aimed at strengthening bones, nails, and connective tissue. The plant is notably rich in silica (silicon dioxide). Silicon has been proposed in modern nutritional science as a trace element involved in bone collagen cross-linking, though the evidence from human studies in children is absent. The German Commission E has not formally approved horsetail for bone health indications; its approved use relates to irrigation therapy for urinary conditions. No clinical trials in children on bone or dental outcomes have been identified in authoritative databases.

5.3 Nettle (Urtica dioica)

Stinging nettle has been used across European, North African, and South Asian traditional medicine as a mineralising, nourishing plant food, consumed as a cooked green by children and adults alike. Traditional practitioners ascribed bone-strengthening properties to nettle, largely because of its content of calcium, magnesium, and vitamin K. The German Commission E approved nettle leaf for supportive therapy in rheumatic diseases and for irrigation of the urinary tract, but not specifically for paediatric bone health. No paediatric RCTs targeting skeletal outcomes have been identified.

5.4 Liquorice (Glycyrrhiza glabra) Root

In Traditional Chinese Medicine (TCM), liquorice root has been used as a harmonising herb in formulas intended to strengthen the body, including musculoskeletal health in children. Its use was typically as part of compound formulas rather than as a standalone intervention. Modern phytochemical research has identified isoflavone-like compounds in liquorice; however, no clinical evidence from paediatric populations specifically addressing bone or dental outcomes has been identified in the reviewed literature.

5.5 Dairy and Fermented Foods in Traditional Diets

Across most world cultures with access to livestock, dairy products — milk, fermented milk, cheese, and yogurt — have historically been central to children's diets precisely because of their perceived role in building "strong bones and teeth." This traditional knowledge is supported by modern nutritional science (see calcium section above). An infant dietary pattern characterised by high intakes of dairy and cheese, whole grains, and eggs is positively associated with bone development in childhood, consistent with traditional dietary wisdom.

6. Dietary and Lifestyle Factors

6.1 Overall Dietary Quality and Pattern

Optimising bone mass in this age group requires attention to an overall healthy diet including adequate calcium, phosphorus, magnesium, and vitamin D. Special concerns may exist related to children who follow a restricted diet such as a vegan diet, those with intolerance or allergies to dairy, and those with chronic health conditions including young adolescents with eating disorders.

Previous studies on childhood nutrition and skeletal health mainly focused on individual nutrients, which does not consider the cumulative effects of nutrients. Other nutrients, including vitamin D, vitamin K, magnesium, zinc, and fluoride, are also involved in bone metabolism; many of these nutrients are intercorrelated and act in a synergistic way.

6.2 Sugar and Frequency of Eating

Of the studies reviewed for a WHO-informing systematic review, 42 out of 50 of those in children reported at least one positive association between sugars and caries. There is evidence of moderate quality showing that caries is lower when free-sugars intake is less than 10% of energy.

In longitudinal studies, the consumption of 100% juice (daily), candy (more than once a week), and soft drinks and sweet drinks (at bedtime) were highly associated with caries in children. There is evidence that sugar consumption before bedtime increases the risk of caries, which is due to the reduced saliva flow and sustained low plaque pH.

In some longitudinal studies, daily consumption of water and dairy products was reported to be protective against dental caries.

6.3 Physical Activity Type and Volume

In a review of school-based exercise interventions, all 17 studies utilised jumping exercises, and 15 of the 17 studies found at least one significant increase in measures of BMD and/or BMC. School-based exercise interventions that provide high-impact jumping activities with ground reaction forces of at least 3.5 times body weight are effective in increasing BMD and/or BMC in children and adolescents.

Gunter and colleagues reported that 7- to 9-year-old children in their intervention group had 7.9% more BMC at the spine and 8.4% more BMC at the hip than the control group after a 7-month jumping intervention; Meyer and colleagues reported that 6–7 and 11–12 year-olds in their intervention group had 4.7% more bone mineral density at the spine and 5.4% more BMD at the hip than the control group after a 9-month multi-component intervention including daily physical education with at least 10 min of jumping or strength training.

Subgroup analysis revealed that physical exercise significantly increased whole-body BMD in both male and female adolescents, but the effect was more pronounced in boys than in girls.

Among physical activities, gymnastics has been shown to be particularly osteogenic for bone development in children because it is a high-impact activity and involves the subject at an early age during growth. However, intense athletic activity in growing and maturing gymnasts is often associated with inadequate dietary intake, which leads to relatively low fat mass and consequently possible alteration of endocrine function. Two major systematic reviews showed that prepubertal gymnasts have higher BMD and BMC than age-matched untrained controls; therefore, gymnastics activities seem to be one of the most effective exercises for improving bone mineral gain in growing and maturing children.

6.4 Sunlight Exposure

The role of the sun is important in increasing vitamin D levels in children; also, providing proper nutrition containing vitamin D has a beneficial effect in reducing the complications associated with vitamin D deficiency. Children with limited outdoor activity or who live at high latitudes are particularly susceptible to vitamin D insufficiency, which in turn impairs calcium absorption and bone mineralisation.

6.5 Breastfeeding and Introduction of Complementary Foods

The American Academy of Pediatrics (AAP) recommends starting vitamin D supplementation soon after birth for all breastfed infants to prevent rickets and ensure adequate bone development. During early childhood, minerals and vitamins are essential for growth; after weaning, a varied diet is essential to obtain adequate micronutrient intake.

6.6 Fluoride Exposure Management

The position of the Canadian Dental Association was that, apart from fluoride in water, the main source of fluoride should be fluoridated toothpaste, and that supplements should not be used in children younger than three years of age. The USPSTF reported adequate evidence of an association between early childhood intake of fluoride supplements and risk of fluorosis; their findings are based on a commissioned systematic review; exposure to systemic fluoride was estimated to increase enamel fluorosis, with odds ratios ranging from 1.3 to 15.6 in observational studies. These findings underscore the importance of age-appropriate, weight-adjusted fluoride intake.

References

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