The Best Baby Teething Advice from Experts

Babies start teething around 4-6 months.

So when exactly do babies start teething? Babies start showing signs of teething around 4-6 months: producing more saliva and putting their fingers in their mouths. (The drooling is usually unrelated to teething and stops once teeth come in; they help to dam up the drool so it gets swallowed.)

Infants typically get their first tooth between ages 5 and 12 months, but some take longer. The bottom incisors emerge first, followed by the top incisors. A toddler usually has a full set of teeth by around 2 years of age, explains Edward Kulich, M.D., of New York, NY. Any child who is without teeth by then should see a pediatrician, who may recommend a dental visit with X-rays. There are a few very rare medical conditions where the body fails to form teeth.

But some infants can be born with teeth.

It's understandable if the idea of a newborn with little chompers freaks you out, especially if you plan on nursing. (Yee-ouch!) Natal teeth (which are present at birth) and neonatal teeth (which show up during the first month) may be unusual but aren't usually a cause for concern. "I get worried calls from parents who see teeth within a week or so after their baby is home," says Megan Chin, D.D.S., attending pediatric dentist at Mount Sinai Hospital, in New York City. She tells them it's likely caused by a genetic blip that occurs in about one of every 1,000 to 3,000 babies.

If your baby is born with any pearly whites, it's important to visit a pediatric dentist, who may recommend smoothing sharp edges. You wouldn't want to remove them unless absolutely necessary, since they are typically your child's primary teeth, not an extra set, Dr. Chin notes. The exception: If a tooth is excessively loose because the root hasn't fully formed, the dentist may suggest extracting it to prevent your baby from choking if it falls out on its own.

Sometimes what looks like a tooth isn't actually a tooth.

Small, round, white cysts called Epstein pearls that form on the gums or the roof of the mouth may appear in as many as four out of five newborns. They're actually harmless pockets of skin cells, and you should leave them alone, says Elliott Maser, D.D.S., clinical associate professor of pediatric dentistry at the University of Pennsylvania. They'll either dissolve on their own from friction while your baby is feeding, or incoming primary teeth will push them out within a few weeks. They're too small to be a choking hazard.

Know the difference between teething and cranky.

Parents know firsthand that teething can make a baby cranky and even cause a mild fever. However, any temperature above 101 degrees is likely from an infection rather than teething.

"If an infant has a temperature, excessive irritability, decreased eating, increased sleeping, or other symptoms such as vomiting, a cough, or a rash, it is unlikely that teething is the culprit," says Dr. Kulich. "If your infant is experiencing such symptoms, or the irritability is excessive, you should touch base with your pediatrician."

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Teething Timeline

Saying no to solid foods is normal.

The average age when babies start teething is about 6 months. At this time your little one may begin to refuse to eat solid foods, instead preferring to chew on things. If she's also drooling a lot, teething may be the issue. Check in the mouth to be sure there are no white spots, which could indicate thrush—an overgrowth of yeast in the mouth that requires a trip to the doctor.

Otherwise, continue to offer solids once a day and try different textures of foods and types of spoons (those with a coating like a teething ring may be preferable to her). If you go more than 3 to 4 weeks without success or if at any time she starts refusing liquids a visit to her doctor is recommended.

Nighttime can be a nightmare.

Many parents notice an increase in teething symptoms and discomfort during evening hours, but there's no specific medical reason for this. "It seems worse at night because they are tired, and during the day they are awake and playing and have things to distract them from the pain," says Gaurav Gupta, M.D., pediatrics expert at JustAnswer.com.

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Drooling may cause painful rashes.

If your little one drools so much that the constant contact with saliva is irritating his lips and skin, there are things you can do to help soothe him. "Apply some Vaseline (white petroleum jelly) to reduce the contact of the saliva with the tender skin. Also, do not rub the saliva off the chin—just pat-dry gently to avoid a friction-induced, worsening rash," Dr. Gupta says.

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You can relieve pain with the right meds.

Ouch! Teething can be uncomfortable as little teeth poke their way through sensitive gums. "I recommend giving an appropriate dose of acetaminophen along with a cool teething ring," says Tanya Remer Altmann, M.D., of Los Angeles, co-editor of Caring for Your Baby and Young Child. "Popsicles work well for toddlers and are a fun treat!

"For infants over 6 months of age, an appropriate amount of acetaminophen or ibuprofen can be used as needed for pain. Which one? Whichever you have in your medicine cabinet or whichever your child prefers since most uncomfortable toddlers seem to have a preference for flavor."

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Or opt for natural soothers.

There haven't been many studies on what remedies (natural or otherwise) are truly effective for the pain associated with teething, says Michael McKenna, M.D., a pediatrician at Indiana University School of Medicine. "For most infants, nonmedicinal therapies such as chewing on cool washcloths, frozen teething rings, and other such items is usually enough to ease the pain. If you feel your baby needs something more, acetaminophen usually does the trick, and if it doesn't you should discuss with your doctor—something more than teething may be going on."

Never give your infant alcohol of any kind, even topically. Also, while some people tout the benefits of clove oil, it can burn your baby's gums and skin, so avoid this as well.

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Fevers can be associated with teething.

"Teething fever" is a surprisingly controversial topic. "Recent research points seem to confirm that some symptoms, including fever around 101 degrees Fahrenheit, may be associated with teething," Dr. Michael McKenna says. "However, it is important to note that there was no association with high fevers (those greater than 102 degrees Fahrenheit), and that around a third of teething infants had no symptoms. Whether your child is teething, it is still a good idea to call your child's doctor for further advice."

Cavities and plaque are serious.

It's easy to be lax about brushing and flossing when there are more immediate battles to fight, but dental hygiene now is crucial. Kids rely on teeth for eating—a vital job for a growing body—and some kids are more prone to plaque buildup, which leads to cavities. Plus, primaries serve as important placeholders for permanent teeth.

Start a hygiene routine early: Even before he gets a tooth, clean your infant's gums with wet gauze pads or a very small toothbrush. Your toddler can help brush as soon as he can hold a toothbrush. But make sure you're taking your turn too. "Children don't have the dexterity in their hands to do a thorough job until they're about 8 or 9," Dr. Maser says. Remember not to put your infant or toddler to sleep with a bottle of juice, milk, or sweetened liquid.

And don't forget the floss, which you should start using when your child has two baby teeth that touch. One study in the Journal of Dental Research found that when kids ages 4 to 13 had their teeth flossed every school day for almost two years, their risk of cavities dropped 40 percent. If you use plastic flossers, be sure to wipe debris off the string before moving to the next tooth in order to avoid redepositing whatever gunk you just took out, Dr. Bowden says.

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Baby teeth need a baby amount of fluoride.

As soon as you see teeth sprout, start gently brushing them with a soft brush and kid-friendly fluoride toothpaste. For children under age 3, use a smear the size of a rice kernel. Some training toothpastes don't have fluoride—which has been proven to help prevent decay in young children—because young children can't spit it out. But ingesting a small amount isn't harmful. "A child would have to swallow tubes and tubes of toothpaste per day for it to be dangerous," Dr. Maser says. In fact, a little swig may be helpful: "The developing permanent teeth also need fluoride, and the only way for them to get it is through the bloodstream."

It's okay if your toddler doesn't have any teeth yet.

If your kid is walking and talking but still flashing a gummy grin, relax. Six to 12 months is the typical age for the first tooth to arrive, but as many as one third of children get teeth earlier or later. Mostly likely, the delay is just a genetic quirk. It's very possible that you or your partner were late to get teeth too, says Ogbonna Bowden, D.D.S., a dentist in Chicago who created the Smiles of Tomorrow mobile unit that provides free dental services for kids.

Chompers or no chompers, your kid should still have a 1-year checkup with a pediatric dentist. And you don't need to delay starting solid food either. Just cut everything into small pieces and keep it on the soft side—nothing you can't mash between your thumb and first finger, Dr. Bowden says. All toddlers gum their food until they get their molars anyway. "Their little gums are very tough," he says.

Crooked smiles are no biggie.

"Small jaw, big teeth or big jaw, small teeth—don't worry about anything yet," Dr. Bowden says. Once your child's teeth are all in, your dentist will have a better idea of how much space there is (or isn't) in her mouth and how her jaw is growing before deciding on the next steps. Your dentist may recommend a consultation with an orthodontist to discuss an appliance like a palatal expander, but usually the advice is just to be patient. The rare exception is if a crooked baby tooth is damaging teeth around it, Dr. Chin says. Otherwise, think of your child's imperfect smile as one more unique characteristic to love.

Shark teeth aren't so scary.

When permanent teeth come in behind or in front of baby teeth, it can look like you're watching the Discovery Channel. "I see this occur in about 35 percent of my patients," Dr. Chin says. "It's caused by various reasons. In essence, the permanent tooth buds aren't in the right position underneath to push out the primary teeth." The result can be two neat rows of teeth, or just a few rogue extras.

When so-called shark teeth emerge, your child's baby teeth will probably be loose already, and they'll fall out on their own within a few weeks. Her tongue may also push the adult teeth forward, which loosens the baby teeth, Dr. Maser says. If nothing happens after a few weeks, though, call your dentist to decide what to do next; she may want to extract the remaining primary teeth.

Preschoolers can have a loof toof too.

Most kids start losing teeth around age 6, but just as there's a wide range for when teeth arrive, the same goes for their departure. If you notice a wiggly incisor while brushing your 4-year-old's teeth, don't worry, says Dr. Bowden. Kids whose teeth came in early are also more likely to lose them on the sooner side. Just don't try to pull one out yourself, because you might use too much force, Dr. Chin says. Instead, encourage your child to wiggle it with his tongue or a clean finger until it comes out on its own.

When an accident happens, see your dentist.

Considering how often kids collide—with each other, toys, walls, the sidewalk—it's surprising more primary teeth don't get knocked loose or out. But if either happens to your child, your dentist may want an X-ray to assess the damage. Sometimes a tooth that has just moved a bit will move back, Dr. Maser says. But if it seems like the tooth is broken at the gum or below the gum, the tooth may need to be pulled. Whatever you do, if a baby tooth comes out after an accident, don't try to push it back in or you could damage the permanent tooth underneath. Instead, bring it—or whatever broken pieces you can find—with you. This can help the dentist determine the best next steps.

A "dead" tooth probably isn't.

Sometimes a collision causes a tooth to turn a corpse-like gray. "The discoloration is kind of like a bruise; it doesn't mean the tooth is dying," Dr. Chin says. Blood supply in the tooth's pulp or nerve leaks into the rest of the tooth, which causes the color. It's worth having it checked by your dentist, but if there's no pain or swelling, she'll probably leave it as is.

If your child has discoloration along with pain and swelling, that could be a sign of an abscess, an infection, or a large cavity. He'll probably need a pulpotomy (where the pulp tissue is removed from the tooth) or a pulpectomy (where the tissue is removed from both tooth and root). This will normally be determined by an X-ray. "It's like a baby root canal," Dr. Maser says. The dentist will remove the top portion of the nerve in the pulp or the entire nerve and then put medicine and a special material in its place that allows it to heal, which may also help lighten the tooth. The goal is always to save a tooth. "Mother Nature created primary teeth for a reason," he says.

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