Baby Teeth:

Frequently

Asked Questions

What to expect and how to

care for your baby's new teeth.

All content in the presentation, including

medical opinion and any other health-related

information, is for informational purposes only

and should not be considered to be a specific

diagnosis or treatment plan for any individual

situation. Use of this presentation and the

information contained herein does not create a

doctor-patient relationship. Always seek the

direct advice of your own dental pediatrician

in connection with any questions or issues you

may have regarding your own health or the

health of others.

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.

When can I expect my child's first

tooth to come in?

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.

My baby was born with a tooth. Does it

need to be pulled out?

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.

My child is 8 months old and still

doesn't have his first tooth. Is

something wrong?

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.

My 4-month-old is drooling and

chewing on his hand. Does this mean

he's teething?

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.

My baby has a fever and a touch of

diarrhea. Is that because he's

teething?

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.

What if my baby is pulling on his ear?

Is that due to teething?

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.

How can I make my baby feel better?

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 Tooth Care

Why do I have to worry about cleaning my child's

baby teeth? They're just going to fall out anyway.

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.

When can my baby start using fluoride

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.

When should I take my baby to the

dentist?

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.

My doctor told me that letting my 10-

month-old son go to sleep with his

bottle can cause tooth decay. But my

son likes to have milk at bedtime.

What can I do?

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.

Are pacifiers bad for baby teeth?

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.

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