Teeth coming out baby

Teething Tots (for Parents) - Nemours KidsHealth

What Is Teething?

Teething is when teeth first come through a baby's gums. It can be a frustrating time for babies and their parents. Knowing what to expect during teething and how to make it a little less painful can help.

When Does Teething Start?

While teething can begin as early as 3 months, most likely you'll see the first tooth start pushing through your baby's gum line when your little one is between 4 and 7 months old.

The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. They're usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.

Next to break through are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child's teeth come in much slower than this, speak to your doctor.)

In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.

What Are the Signs of Teething?

As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may have brief periods of irritability, while some may seem cranky for weeks, with crying spells and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very fussy, talk to your doctor.

Although tender and swollen gums could cause your baby's temperature to be a little higher than normal, teething doesn't usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, something else is probably causing the fever and you should contact your doctor.

How Can I Make Teething Easier?

Here are some tips to keep in mind when your baby is teething:

Gently wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing.
Rub your baby's gums with a clean finger.
Give your baby something to chew on. Make sure it's big enough that it can't be swallowed or choked on and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid. Be sure to take it out of the freezer before it becomes rock hard — you don't want to bruise those already swollen gums — and be sure to wash it after each use.
Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, chill it in the refrigerator, but NOT the freezer. Also, never boil to sterilize it — extreme changes in temperature could cause the plastic to get damaged and leak chemicals.
Teething biscuits and frozen or cold food are only OK for kids who already eat solid foods. Don't use them if your child has not yet started solids. And make sure to watch your baby to make sure that no pieces break off or pose a choking hazard.
If your baby seems irritable, ask your doctor if it is OK to give a dose of acetaminophen or ibuprofen (for babies older than 6 months) to ease discomfort.
Never place an aspirin against the tooth, and don't rub alcohol on your baby's gums.
Never tie a teething ring around a baby's neck or any other body part — it could get caught on something and strangle the baby.
Don't use teething necklaces made of amber. These can lead to strangulation or choking if pieces break off.
Don't use teething gels and tablets because they may not be safe for babies.

How Should I Care for My Baby's Teeth?

The care and cleaning of your baby's teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay makes them fall out more quickly, leaving gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.

Daily dental care should begin even before your baby's first tooth comes in. Wipe your baby's gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!).

As soon as the first tooth appears, brush it with water and fluoridated toothpaste, using only a tiny amount.

It's OK to use a little more toothpaste once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don't let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.

By the time all your baby's teeth are in, try to brush them at least twice a day and especially after meals. It's also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You also can get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.

Another important tip for preventing tooth decay: Don't let your baby fall asleep with a bottle. The milk or juice can pool in a baby's mouth and cause tooth decay and plaque.

The American Dental Association (ADA) recommends that kids see a dentist by age 1, or within 6 months after the first tooth appears, to spot any potential problems and advise parents about preventive care.

Reviewed by: Larissa Hirsch, MD

Date reviewed: January 2018

Baby’s First Tooth: 7 Facts Parents Should Know

By: Dina DiMaggio, MD, FAAP & Julie Cernigliaro, DMD

1. Most babies will develop teeth between 6 and 12 months.

There is a wide range of variability of when a first tooth may appear—some babies may not have any teeth by their first birthday! Around 3 months of age, babies will begin exploring the world with their mouth and have increased saliva and start to put their hands in their mouth. Many parents question whether or not this means that their baby is teething, but a first tooth usually appears around 6 months old.

Typically, the first teeth to come in are almost always the lower front teeth (the lower central incisors), and most children will usually have all of their baby teeth by age 3.

2. Fluoride should be added to your child's diet at 6 months of age.

Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin them on solid foods (about 6 months of age). Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water. See FAQ: Fluoride and Children for more information.

3. Massaging sore gums, offering something cold, or acetaminophen, on an occasional rough night, can help soothe your baby's teething pain.

Usually teething doesn't cause children too much discomfort, however, many parents can tell when their baby is teething. Babies may show signs of discomfort in the area where the tooth is coming in, the gums around the tooth may be swollen and tender, and the baby may drool a lot more than usual.

Parents can help ease teething pain by massaging their baby's gums with clean fingers, offering solid, not liquid-filled, teething rings or a clean frozen or wet washcloth. If you offer a teething biscuit, make sure to watch your baby while they are eating it. Chunks can break off easily and can lead to choking. Also, these biscuits are not very nutritious and most contain sugar and salt.

A baby's body temperature may slightly rise when teething; however, according to a 2016 study in Pediatrics, a true fever (temperature over 100.4 degrees Fahrenheit or 38 degrees Celsius) is not associated with teething and is actually a sign of an illness or infection that may require treatment. If your baby is clearly uncomfortable, talk with your pediatrician about giving a weight-appropriate dose of acetaminophen (e.g., Tylenol) or if over 6 months, ibuprofen (e.g., Advil, Motrin). Make sure to ask your pediatrician for the right dose in milliliters (mL) based on your child's age and weight.

Many children, however, will have no problems at all when their teeth come in!

4. Do not use teething tablets, gels with benzocaine, homeopathic teething gels or tablets, or amber teething necklaces.

Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child's pain, but the FDA has issued warnings against both due to potential side effects.

In addition, amber teething necklaces are not recommended. Necklaces placed around an infant's neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace's effectiveness. See Teething Necklaces and Beads: A Caution for Parents for more information.

5. You should brush your child's teeth twice a day with fluoride toothpaste.

Once your child has a tooth, you should be brushing them twice a day with a smear of fluoride toothpaste the size of a grain of rice, especially after the last drink or food of the day. Remember not to put your baby to bed with a bottle—it can lead to tooth decay.

Once your child turns 3, the American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD)recommend that a pea-sized amount of fluoride toothpaste be used when brushing.

When your child is able, teach them to spit out the excess toothpaste. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until they are around 7 or 8 years old. When your child can write their name well, he or she also has the ability to brush well.

6. Ask your pediatrician about your baby's teeth and fluoride varnish.

During regular well-child visits, your pediatrician will check your baby's teeth and gums to ensure they are healthy and talk to you about how to keep them that way. The AAP and the United States Preventive Services Task Force also recommend that children receive fluoride varnish once they have teeth.

If your child does not yet have a dentist, ask your pediatrician if they can apply fluoride varnish to your baby's teeth. Once your child has a dentist, the varnish can be applied in the dental office. The earlier your child receives fluoride varnish the better to help prevent tooth decay.

7. Make your first dental appointment when the first tooth appears.

Try to make your baby's first dental appointment after the eruption of the first tooth and by his or her first birthday.

Both the AAP and the AAPD recommend that all children see a pediatric dentist and establish a "dental home" by age one. A pediatric dentist will make sure all teeth are developing normally and that there are no dental problems. They will also give you further advice on proper hygiene. If you don't have a pediatric dentist in your community, find a general dentist who is comfortable seeing young children.

Additional Information:

Brushing Up On Oral Health: Never Too Early to Start
How to Prevent Tooth Decay in Your Baby
Brush, Book, Bed: How to Structure Your Child's Nighttime Routine
Give Your Baby the Best Possible Start

About Dr. DiMaggio:

Dina DiMaggio, MD, FAAP, is a board certified pediatrician at Pediatric Associates of NYC and at NYU Langone Medical Center. She is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers, a comprehensive manual written by a team of medical, nutrition, and culinary experts. Follow her on Instagram @Pediatriciansguide.

About Dr. Cernigliaro:

Julie Cernigliaro, DMD, is a board certified pediatric dentist and the Associate Director of the Pediatric Dental Residency Program at Lutheran Medical Center in Brooklyn, NY. She holds a faculty position at NYU College of Dentistry and currently works in private practice at Happy Smile Pediatric Dentistry, PC in NYC.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Teething in a child: timing, care, ways to relieve pain

Children will definitely appreciate the parental contribution to maintaining dental health when they grow up. In order to help the baby from the very beginning, it is necessary to know the structural features, the stages of formation and the correct order of teething.

Teeth development before eruption

The health of your baby's teeth should be taken care of long before they erupt. It is useful for expectant mothers to know that the rudiments of milk teeth are formed already at the 7-8th week of intrauterine development, and permanent ones at the end of 4 months. Not just teething timing, but even level enamel mineralization both milk and molars depends on how the pregnancy proceeds. Therefore, it is so critical that a woman receives all the vitamins, microelements and is as healthy as possible.

But not only food is important. The results of the research showed that in the presence of industrial harmful substances in the environment of the expectant mother during pregnancy and numerous stressful situations, the formation of all dental tissues is disrupted in the child and the timing of the appearance of milk teeth is shifted. Among children born to women with high blood pressure, late eruption of temporary teeth was noted in 56. 7%. Approximately one third of the examined children born to mothers with heart defects revealed late eruption of temporary teeth, as well as deviations in the pairing and sequence of their eruption. The duration of pregnancy also plays a role. There is a pronounced dependence of the timing of the eruption of the first teeth on the degree of prematurity: the earlier the baby was born, the later the first teeth erupt ^{[1, 2]} .

Why baby teeth are needed

Nature has conceived the correct order and timing of teething in children. Evolutionarily, this is due to the need to form the bite and jaw bones for chewing and speech. Over the years, the bones grow, and the milk teeth, which at the beginning of their appearance fit snugly against each other, diverge by the age of 6-7, forming wide, natural interdental spaces for this period - tremas and diastemas.

There are only 20 teeth in the milk bite. This is due to the fact that they must be correctly placed in the small children's jaw of the first years of a baby's life, and excludes crowding of teeth that provokes dental diseases. The last of the milk teeth are replaced at the age of 10-12 years. However, they are very important for the physiological formation of the jawbones and permanent occlusion.

Proper growth and health of milk teeth help:

rebuild the body from lactophoric to a mixed type of nutrition;
reserve space for the normal positioning of future molars;
form a mixed bite.

There is an erroneous opinion that milk teeth in case of infection with caries can not be treated, but immediately removed. But modern dentists are against such tactics. Early removal is fraught with displacement of neighboring milk teeth and the appearance of problems already with an adult bite. Therefore, it is so important to maintain the presence and health of all milk teeth until the moment when permanent teeth erupt on their own ^[3] .

The structure of milk teeth

Temporary teeth have thinner enamel, and their internal pulp cavity is larger compared to permanent ones. All this makes the tooth lighter, which helps with the eruption of permanent teeth, but at the same time accelerates the development of caries and pulpitis. However, there are bonuses: by the time the molars begin to erupt, which will remain with the child until the end of life, the roots of milk teeth even dissolve to ensure their rapid and relatively painless loss.

Terms of eruption of milk teeth

Teething is a genetically programmed event that occurs at a certain period. Physiological teething is characterized by three main features: certain timing, pairing and sequence of teething. Galaktionova M. Yu.

Children's milk teething rates differ depending on their ethnicity. But as studies show, in general, the world is experiencing a reduction in the time from birth to the moment when the first tooth appears. This is due, according to most researchers, to the global acceleration of human development ^[1] . How and when milk teeth erupt is one of the indicators of a child's physical development.

Causes of violation of the order and timing of teething in children can be:

heredity;
climatic conditions;
nature of feeding;
certain diseases, such as rickets.

The eruption rates for milk teeth according to the American Dental Association are presented in the table.

Baby teeth	Upper jaw eruption / month	Lower jaw eruption / month
Center cutter	8-12	6-10
Lateral cutter	9-13	10-16
Fang	16-22	17-23
First molar	13-19	14-18
Second molar	25-33	23-31

The specified periods are average indicators, varying depending on individual and family characteristics ^[4,5] . But the sequence of appearance of teeth is essential, and it is better to track and record it. From a physiological point of view, the correct order of eruption of milk teeth in children is important for bite formation .

Teething aid

The appearance of milk teeth is not an easy process not only for the children themselves, but also for their parents. The most common teething symptoms:

swelling and redness of the gums;
excessive salivation;
itching and urge to keep hands, toys in mouth;
capriciousness of a child;
sleep disorder;
refusal to breast, bottle or complementary foods;
temperature increase;
stool disorders;
runny nose.

The following will help you get through this period as comfortably as possible:

special teething rings that relieve itching, especially with a cooling effect;
local anesthetic dental gels;
antipyretic and analgesic preparations;

Gentle silicone fingertip massage to soothe and relieve your baby ^[6]

Baby Teeth Care

Once the first tooth has erupted, don't put off going to the dentist. Schedule a visit (at least once every 3-4 months). And after the first birthday, it is also desirable to be observed by an orthodontist. If there are no problems, visits to him should be repeated once a year ^[7,8]

Proper care at home is important.

Milk teeth are suitable for an ultra-soft toothbrush with a small head.
Children's mouth rinses are used from about 4 years old or from the time the child can spit.
Parents should supervise the brushing of preschool children's teeth and, if necessary, help and clean missed areas.
Adults should teach their children to rinse their mouth after meals from a very young age.
Until the child has learned to spit on his own, toothpaste should not contain fluorides.
A bathroom timer or a favorite song helps you stick to the 2-minute brushing time.
Solid food should be included in the diet daily in sufficient quantities to properly form the bite and stimulate the gums.

These simple tips help keep baby teeth healthy from the very beginning until they are naturally replaced by permanent teeth.

List of sources

Izmestieva OV, Galaktionova M. Yu., Manashev GG Characteristics of exogenous and endogenous factors affecting the eruption of temporary teeth in children. 2012 // https://cyberleninka.ru/article/n/harakteristika-ekzogennyh-i-endogennyh-faktorov-vliyayuschih-na-prorezyvanie-vremennyh-zubov-u-detey (date of access: 21.02.2020)
Galaktionova M. Yu., Izmest'eva OV Timing of eruption of temporary teeth and the nature of feeding children in the first year of life. 2012 // https://cyberleninka.ru/article/n/sroki-prorezyvaniya-vremennyh-zubov-i-harakter-vskarmlivaniya-detey-pervogo-goda-zhizni (date of access: 02/21/2020)
Iordanishvili AK, Korovin NV, Serikov AA Anatomical and topometric characteristics of the jaws during eruption and retention of wisdom teeth. 2017 //https://cyberleninka.ru/article/n/anatomo-topometricheskie-harakteristiki-chelyustey-pri-prorezyvanii-i-retentsii-zubov-mudrosti (Accessed: 02/21/2020)
Bimbas ES, Saipeeva MM, Shishmareva AS Timing of eruption of permanent teeth in children of primary school age. 2016 //https://cyberleninka.ru/article/n/sroki-prorezyvaniya-postoyannyh-zubov-u-detey-mladshego-shkolnogo-vozrasta (date of access: 02/21/2020)
Shilova N., Berzina S., Brinkmane A., Dulevska I., Umbraszko S., Briede I. Timing and sequence of eruption of primary teeth and factors influencing them. 2017 // https://cyberleninka.ru/article/n/sroki-i-posledovatelnost-prorezyvaniya-molochnyh-zubov-i-vliyayuschie-na-nih-faktory (date of access: 02/21/2020)
Bogdanova NA, Zueva TE How to help a child with teething? A new look at an old problem. 2019 // https://cyberleninka.ru/article/n/kak-pomoch-rebenku-pri-prorezyvanii-zubov-novyy-vzglyad-na-staruyu-problemu (date of access: 02/21/2020)
Ayupova FS Tactics of treatment of children with anomalies in the eruption of permanent posterior teeth. 2013 // https://cyberleninka.ru/article/n/taktika-lecheniya-detey-s-anomaliyami-prorezyvaniya-postoyannyh-bokovyh-zubov (date of access: 21.02.2020)
Gatalsky VV Control of the mesiodistal size of the dentition as one of the aspects of the prevention of dental anomalies. 2005 // https://cyberleninka.ru/article/n/kontrol-meziodistalnogo-razmera-zubnogo-ryada-kak-odin-iz-aspektov-profilaktiki-zubochelyustnyh-anomaliy (date of access: 21.02.2020)

Timing of teething - Articles

Author:

Marbery Gedrean

| Checked by: Shteba Victoria Petrovna | Last edited: October 18, 2020.

Most parents are very concerned about how teething (and gums) affects their babies in everyday life. Although we cannot fully predict exactly how each baby will react to their first tooth. However, we can learn about teething symptoms and how to soothe your baby during this difficult time. In general, the more we know about teething, the better we can help our babies get through it. Let's figure it out.

Timing of teething

One of the most common questions parents ask is, "How long does it take for babies to teeth?". It is useful to know both the time frame for the appearance of the first tooth and the time frame in which all teeth erupt. In general, teething is an ongoing process that occurs between the ages of 6 and 24 months. Although your baby has twenty milk teeth that will appear within two years, teething, fortunately, only causes pain and irritation at the time when the tooth is about to break through the gum. It is not known exactly how long it will take for a tooth to fully erupt, but on average experts say it can erupt within 1-7 days per tooth. However, teething symptoms usually only last a couple of days, so if a baby experiences discomfort for an extended period of time, it's safe to assume it's not teething.

Teething history

Most babies erupt their first teeth between 6 and 7 months of age, but this may happen sooner or later. Generally, your baby's teeth are likely to appear in the following timeline windows:

6-7 months

During this time, the first teeth begin to erupt. The first teeth to erupt are usually the lower central incisors, which are the two middle teeth at the bottom. Children at this age become more active. They begin to grab and pull objects towards them, transfer objects from one hand to the other, and may even begin to crawl. It's important to keep an eye on small objects within your baby's reach, as he'll want to put everything in his mouth during teething!

8 to 13 months

Between 8 and 12 months your baby will have upper central incisors. In addition, sometime between 9 and 13 months they will have upper and lower teeth next to their upper central incisors (these are called lower and upper lateral incisors). In addition to teething, it is important to understand that other important milestones in gross motor development are also achieved during this developmental window. Most babies are able to sit up, stand up unassisted, take their first steps, pick up and throw objects, roll a ball, and grasp objects.

13 to 20 months

Typically, between 13 and 16 months of age, your baby's first molars appear at the bottom and top at about the same time. Shortly thereafter, their fangs will appear in both the top and bottom rows, between about 16 and 20 months.

From 20 to 30 months

At the final stage of teething, the back teeth or second molars appear in the bottom row of the baby. While most teething symptoms appear the same in both toddlers and babies, there are some differences as your baby grows older. First of all, your baby can now tell you about their discomfort and pain, unlike non-verbal babies. On the other hand, many toddlers will not show any signs of discomfort and will not complain of pain at all during the passage of molars. For other babies, the pain can be significantly worse because their first molars are larger than their other molars. They may even complain of a headache or jaw pain!

Toys that can help

Teethers are teething toys that help to greatly relieve the symptoms of teething in children, while keeping them occupied during play. Because teething babies are always looking for something they can chew on, teething toys are specifically designed to soothe gums and temporarily ease teething.

“6 months? But my 3 month old is teething right now!”

Some babies start teething early at 6 months - and usually it's a little thing you don't have to worry about!

Many babies begin to drool more often and explore their world by bringing their hand to their mouth to chew at about 3-4 months. This is completely normal and is often accompanied by teething after some time.

If you suspect that your little bundle of joy, which can be much less joyful during gum pain attacks, is teething, look for symptoms such as: