Parents think of teething as the few days of swelling, discomfort, and irritability before a baby's tooth erupts, but tooth development actually begins before birth. Primary or "baby" teeth form below the gum line around the sixth week of pregnancy, and they're covered by hard enamel during the third to fourth month. Permanent or "adult" teeth also begin developing at this time. During pregnancy, you can get your child's teeth off to a healthy start by following your doctor's advice and eating a well-balanced diet, including calcium-rich foods such as yogurt and dark leafy greens. And once your baby sprouts these little teeth, you'll need to take good care of them. Here are some frequently asked questions about baby teeth.
Teething can begin as early as 4 months of age, but most babies don't get their first tooth until 6 months. Teeth usually come in pairs. The bottom front two teeth typically show up first, followed by the top ones (both sets are called central incisors). Then the side front teeth (lateral incisors) fill in, followed by the molars and then the canines, which are the pointy teeth next to the front teeth. The back molars erupt last. Your baby should have a full set of primary teeth by age 3; permanent teeth won't begin to replace them until the child is 4 to 6 years old.
It's rare, but some children already have a tooth when they're born, usually a bottom front tooth. It may be a real baby tooth or an extra tooth in the set that has grown over the baby tooth and permanent tooth underneath it. This extra tooth will fall out when the baby tooth erupts. But sometimes these teeth -- real or extra -- need to be removed, to avoid the risk of choking if they're loose, for example, so a tooth doesn't get in the way of breastfeeding.
Don't worry. The first tooth can come in anytime between 4 and 12 months. If a tooth hasn't come in by 1 year, there's probably still no reason to worry if your child is growing fine otherwise -- he may just be a late bloomer. In rare instances, lack of teeth is a sign of metabolic disorder, but if that were the case, a child would have other growth problems as well.
It's possible, but drooling and chewing aren't always signs of teething. Your baby is on the young side for teething, and at 4 months, it's natural for a baby to put objects into his mouth to explore them. Also at this age he's beginning to produce more saliva than he can swallow, which causes drooling. But if you notice that your child is also cranky and fussy, and he tends to chew or gnaw on the breast or bottle more than suck, that sounds like teething. Besides increased drooling, chewing, and crankiness, another common teething symptom is loss of appetite. Gum swelling and the resulting sensitivity to hot and cold foods will make eating uncomfortable for your baby, and can also interfere with sleeping.
In addition, when teeth are coming through, the gums will look swollen and bumpy, and they may be lighter or darker in color. Sometimes a bluish-red blister (called a hematoma) appears on the gum line where the tooth is coming in, and it may bleed a little when the tooth breaks the surface. Call your doctor if the blister lasts for more than a week without the tooth poking through.
Some doctors don't buy into the idea that these symptoms are related to teething, but other pediatricians, myself included, see a connection. The usual scenario is that a parent will bring in an irritable 6-month-old who has a low-grade fever (less than 100.5 degrees) and some mild diarrhea. The child is also drooling and chewing on his fingers or anything else near his mouth. An exam doesn't show any problem, and the parent is sent home with instructions for managing the fever. Then, two or three days later, a new tooth appears -- and soon after that the fever and diarrhea disappear. Be aware, though, that we sometimes blame these symptoms on teething when they may actually be the result of an infection. A good guideline is that whatever problem you think is due to teething should pass with treatment within 24 hours. If it doesn't your baby may actually be sick with something else and should be seen by a doctor.
It's often hard to tell why a baby is pulling at his ear. Sometimes it's because there's too much wax in there, or he could have an ear infection. Some babies pull on their ear when they're sleepy. I usually tell parents to look at what else is going on at the same time. If your baby is casually scratching or rubbing at his ear but seems happy and playful, with only intermittent bouts of fussiness, then the problem may simply be teething -- a reaction to the tingling of the tooth nerves. But if your child has a moderate to high fever (higher than 101 degrees), gets more irritable when lying down or being fed, and has recently had a cold with congestion, an ear infection is the more likely cause.
The worst part of teething for you is seeing and hearing your baby in pain. But rest assured, things will get easier with each new tooth. Teething is most painful for the first two to four teeth, because it's a new experience for the baby.
While your child is teething, excessive drooling can cause irritation around his mouth. Applying a little petroleum jelly there and on his lips can protect the skin. A frozen teething ring is very good for numbing the pain of teething and satisfying baby's need to chew and rub his gums. (Avoid the type of ring with stuff floating inside -- a vigorously chewing infant might gnaw through and swallow or choke on the little objects.) Even something as simple as a wet washcloth that your baby can chew on will provide relief. An age-appropriate dose of liquid infant pain reducer can also help. Ibuprofen is a good idea for nighttime because it lasts six to eight hours. But since acetaminophen is easier on a baby's stomach, it's a good daytime option. If you're going to use a topical teething ointment, which you may want to reapply often, make sure to follow the package instructions so you don't give your baby too much.
Baby teeth are actually very important. They help children chew food, speak clearly, and retain the space for the permanent teeth. If baby teeth aren't cared for properly, they can decay, leading to a gum infection called gingivitis that can affect the spacing and the health of the permanent teeth. Moreover, children who learn to take care of their baby teeth tend to have good dental habits as adults.
You can start oral care even before your child's teeth come in. Wipe her gums once a day with a warm, wet washcloth or a dampened piece of gauze wrapped around your finger. Once the first couple of teeth come in, you can continue using wet gauze to clean the baby teeth (now twice a day), but also introduce a very soft baby toothbrush. Rub it across baby's teeth to help her get used to the feeling. You probably won't need to use the brush to actually clean her teeth until she's eating only table foods (and has a significant number of teeth), at around 18 months. However, if your toddler has eaten sticky, sugary foods, you should get rid of the residue by gently cleaning her teeth with a wet toothbrush and some baking soda. Once your baby is about 2, you can begin using a pea-sized amount of toothpaste.
Wait until at least age 3, when your child is old enough not to swallow the toothpaste -- and then use only a tiny amount. Ingesting too much fluoride can result in tooth staining or surface irregularities called fluorosis. Fluoride is important for strengthening enamel and preventing tooth decay. Before your baby is old enough to use toothpaste containing it, he should get enough fluoride from drinking tap water. Most municipal water supplies have added it just for this purpose. But since the content of local water supplies varies, the American Dental Association (ADA) recommends fluoride supplements for children, once they're 6 months old, who live in communities that don't have optimally fluoridated drinking water or who drink only bottled water. Ask your pediatrician or dentist about fluoride supplements if you're concerned.
The ADA recommends that a baby have his first dental exam at age 1, but the American Academy of Pediatrics suggests that the first visit can wait until age 3, when all the baby teeth are in, as long as you practice good dental care with your child at home. In the meantime, your pediatrician will check your baby's teeth at well-baby visits and can refer you to a dentist if he sees any problems. At a first dental appointment, your child's teeth will be examined to make sure they're developing normally, and the dentist will discuss basic oral care with you. She may also apply a topical fluoride solution to your child's teeth to provide extra protection against cavities.
The reason your doctor warned against giving your son a bedtime bottle is because this practice can cause baby bottle tooth decay (BBTD), the leading dental problem for children under 3. BBTD occurs when a child's teeth are exposed to sugary liquids, such as formula or milk and fruit juices, for a long time, leading to tooth decay. Putting a baby to bed with a bottle, which he can suck on for hours and fall asleep with, is the major cause. If decay occurs and is left untreated, it can lead to pain, infection, early loss of baby teeth, crooked permanent teeth, and increased risk of decay in permanent teeth. To prevent BBTD, you should obviously not put your baby to bed with a bottle. The American Academy of Pediatric Dentistry also recommends not letting your child walk around with a bottle in his mouth between meals. And introduce your child to a cup by age 1; drinking from a cup doesn't cause beverages to pool around the teeth, and a cup cannot be taken to bed. In the meantime, if your child wants a bottle for comfort between regular feedings, during naps, or at bedtime, give him one filled with water. And if you see any signs of cavities -- unusual red or swollen areas in your child's mouth, or any dark spot on a tooth -- consult your doctor right away.
Not if they're used for a limited time. I usually recommend that parents choose the square, orthodontic type of pacifier (look for the word "orthodontic" on the packaging), because it maintains a more natural alignment between the upper and bottom teeth. Pacifiers with nipples that resemble those found on a baby bottle tend to promote malalignment (buckteeth) if used beyond 3 years. A child shouldn't use any kind of pacifier beyond about age 4, because it could cause problems with permanent teeth. Also, never dip a pacifier in a sweet liquid, because that can cause tooth decay, or honey, which can cause botulism poisoning in children under age 1.
The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.