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The Whole Tooth

baby teeth

Shannon Greer

I could tell it was coming. Forewarned by my son Roy's excessive drooling and nighttime fussiness, I put myself on Tooth Patrol. While cuddling with him each morning, I'd slide my index finger along his gums, as baby-smooth as the rest of him, in anticipation of that first jagged little milestone. One day, a couple of weeks into his seventh month, I finally felt something hard. Right there, on the bottom: a tooth!

The tooth buds actually start forming as early as six weeks in utero. When you eat a well-rounded diet and take prenatal vitamins during pregnancy to help your baby's body grow healthy and strong, you're doing the same for his future smile, says Jeannie Beauchamp, D.D.S., a pediatric dentist in Clarksville, Tennessee. After a baby is born, his tooth buds are busy developing into teeth, which gradually emerge through the jaw and eventually to the gum's surface.

Having teeth changes your little one's interaction with her environment. Suddenly, you've got a biter on your hands—and soon after that, a chewer. This new territory brings lots of questions about tooth development and teething discomfort. With the help of our pediatric dental experts, we've rounded up answers to your biggest tooth concerns.

So when will the first tooth make its debut?

The event could happen around the same time that my son's arrived, at about 6 months. But it varies from kid to kid. I have a friend who fretted over her daughter's gummy mouth, only to have her pediatrician quip at the baby's 1-year checkup, "How many people do you know who never got any teeth?" Four months later, her first tooth finally broke through.

As that initial baby tooth gets close to coming in, the gum above it might become swollen and start to tighten and get whitish. This is when your baby may let you know that something big is getting ready to take place. Perhaps a day or even weeks later, the first tooth will appear. Its roots will keep growing for another entire year, and 19 more teeth will complete the same process at their own pace until your child has a mouthful of them.

Which tooth will it be?

You'll probably first see a front bottom tooth (central incisor). "But the symmetry of primary teeth is what's most important—they should come in in pairs, one after the other," says Parents advisor Burton Edelstein, D.D.S., M.P.H., chair of social and behavioral sciences at Columbia University's College of Dental Medicine, in New York City. So it's fine if your baby first sprouts an incisor on the side. Just keep a lookout for its mate on the opposite side of the mouth, says Dr. Edelstein. If it doesn't show up within a few months, check in with your pediatric dentist or pediatrician to rule out other problems, such as an extra tooth or even a growth—both of which are, thankfully, rare.

When will my child's molars come in?

The four front top and bottom teeth are generally followed by the first molars at about 12 months, leaving gaps in the middle of the gum lines. These will eventually be filled by the pointy canine teeth. Finally, you'll see those far-back second molars, aptly nicknamed the 2-year molars. Once your 3-year-old has all her baby teeth, she's ready to chomp on crunchier foods, and you'll have a few years to prepare for exciting round two: when the Tooth becomes the Loose Tooth.

What's the best way to soothe teething pain?

"It breaks your heart to see your child uncomfortable," says Dr. Beauchamp. "The best remedies are cold and pressure: Cold slightly numbs the area, and pressure provides a counter sensation that feels good. Wet a washcloth, stick it in the freezer for 30 to 60 minutes, and let your child chew on it." Or you can chill some teething rings.

Are there any remedies to stay away from?

"A lot of parents ask me if rubbing whiskey on their baby's gums will help," says Dr. Beauchamp. "I'm sure their mother or grandmother did this, but it really isn't advisable." Another popular remedy is homeopathic teething tablets. However, last October the FDA issued a consumer-safety alert for a popular brand, Hyland's, because the tablets contained inconsistent amounts of one of the active ingredients, an herb called belladonna. Although homeopathic products typically hold only minute amounts of their active ingredients, in large doses belladonna can cause hallucinations, difficulty breathing, increased heart rate, and other problems. Hyland's released a voluntary recall of the tablets and as of press time was addressing the concerns and planning to release a new version with child-resistant packaging in early 2011.

Are there any health consequences if a child gets teeth late?

Teeth or no teeth, he should be able to take in all the nutrition he needs, even if that means eating softer, easier-to-chew foods, says John Liu, D.D.S., president of the American Academy of Pediatric Dentistry and a pediatric dentist in Issaquah, Washington. "Every child's teeth have their own schedule, but it's natural for parents to worry," says Dr. Liu.

Can teeth ever come in too early?

"Rarely, a baby may have teeth at birth—but they won't have finished forming so they won't be very strong," says Dr. Liu. "We usually remove these teeth before the child leaves the hospital because they're irritating to a breastfeeding mom. Even more important, they tend to be floppy, and we worry that they could fall out and the baby might choke on one. These early teeth are easily removed with some topical anesthetic, a piece of gauze, and the pediatric dentist's fingers."

Why do some kids have a harder time with teething than others?

"When a tooth is getting ready to pop through, it stretches the gum area as tight as a drum," says Dr. Liu. "To some children, that tightness is interpreted by their brain as being painful. For others, it's just like an itch they have to scratch. Different kids just have a different perception of what is and what isn't pain."

My child keeps pulling on his ears. Does this mean his molars are coming in?

"Not necessarily. At about 4 months, children first discover their ears—and after that, some simply like to play with them," says Linda Ciampa, R.N., a nurse at Milford Regional Medical Center, in Massachusetts. "It's also possible that your child could have an illness, such as an ear infection. To play it safe, feel for swollen ridges on the gum line, and take his temperature. If your child has a fever, you should call your pediatrician."

Is it okay to give acetaminophen or ibuprofen to stop pain?

"Ibuprofen should only be used for babies older than 6 months. After that, either medication is fine when given in the correct dose and administered judiciously—but parents should first ask themselves if their child really needs the drug," advises Dr. Liu. "I recommend picking the one your child has done well with and sticking with it. Ibuprofen isn't necessarily more effective because it's known to relieve inflammation as well as pain. What's happening in your child's mouth is primarily irritation."

Can teething cause a fever? How about a diaper rash or diarrhea?

Although some moms swear that their baby has had one or all of these symptoms while teething, it's probably just a coincidence. "There's absolutely no scientific evidence linking fever, diaper rash, or diarrhea with teething," says Dr. Liu.

Nothing seems to make my child's pain go away. Is there anything I can do?

"Teething is a normal physiological experience that takes time to adjust to," says Courtney Chinn, D.D.S., assistant professor at Columbia University's College of Dental Medicine. "Molars are the largest baby teeth, but they cause the least discomfort. That's because by the time a child's last primary teeth come in, she's absorbed in her activities and learning language skills. For now, try to distract her; love and hugs are the best remedies."

Originally published in the April 2011 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.