Teeth in infants age

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 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

Breastfeeding and dental caries

The medical community has long recognized breastfeeding as the best way to develop a child. The uniqueness of mother's milk makes it indispensable for the child's body. Undoubtedly, mothers should breastfeed their children in any situation, except for special medical contraindications.

It is impossible to overestimate the influence of breast milk on the development of a baby's teeth. It contains substances that increase the immunity of the oral cavity, and minerals that strengthen teeth. nine0003

Therefore, it is surprising for mothers to hear about the facts of the connection of early childhood caries with breastfeeding. And on this issue, the opinions of scientists differ: some of them confirm the increase in carious activity during prolonged breastfeeding, some refute it.

Early childhood caries is a rapid process of destruction of milk teeth in children under 2-3 years old. In a severe form, this is manifested by brown, dilapidated, painful teeth.

The front upper teeth are affected first, sometimes on the palatal surface, which goes unnoticed. Then the process can be detected on the lateral upper and lower teeth. Only the anterior teeth of the lower jaw are almost never involved in the process. Breastfeeding and tooth decay - what's the connection?

Before answering this question, we turn to the scientific facts about the mechanisms of development of caries:

Dental caries occurs when bacteria come into direct contact with food and drink, which the bacteria convert into acids. The baby receives these bacteria from the mother during the first year of life. nine0020
the process of the course of caries is a regular change of periods of "attack" and "repair". In itself, mother's milk is not the best food for bacteria, it is low in sugars. And it contains quite a lot of buffer substances that restore tooth enamel after a period of "attack" bacteria by acids.

each meal provokes an acid "attack" of bacteria on the teeth. It comes from any kind of food, both high and low in sugar. The process of "repairing" after an acid "attack" takes about two to three hours. If we eat earlier, the teeth do not have time to recover from previous exposure to acids and the decay process goes deeper. nine0020
caries in children worse at night. This is due to the slowing down of saliva production during sleep. Saliva is the main source of minerals for repairing teeth. Any food, drink and even breast milk taken before bed or during the night will stimulate the carious process.

In fact, breastfeeding poses minimal risk of tooth decay and is protective for most babies. Its reverse effect can be observed only if a rational feeding regimen is violated: nine0003

high feeding frequency;
frequent night feedings;
if the child's mouth is not cleaned after feeding.

What other dentists think about it

The American Academy of Pediatric Dentistry has a clear position on breastfeeding. They fully support breastfeeding. But they warn that the risk of developing tooth decay when breastfeeding is the same as when feeding with artificial mixtures. And it is recommended to avoid night feedings with the appearance of the first tooth in the child's mouth. nine0003

Here are some tips for caring for your child's oral health:

clean your baby's teeth and gums with a soft cloth or toothbrush after each feed;
Arrange for an initial pediatric dentist appointment as soon as the child is one year old;
teach your child to drink from a cup by the first year of life;
use preventive programs as advised by your dentist.

You can get the most out of breastfeeding and avoid cavities by following the advice of the experts:

breastfeed your baby for at least one year;
After the introduction of complementary foods, monitor the frequency of intake of sugary products. This is one of the most important things that will reduce the likelihood of developing caries.
monitor your child's sleep. According to the American Association of Pediatrics guidelines, babies should fall asleep on their own without motion sickness or feeding by 6-8 weeks of age, and sleep through the night by 6 months of age. nine0020
avoid long periods of feeding, especially if the baby falls asleep at the breast.

In general, parents need to understand the factors that lead to early childhood caries and ensure that breastfeeding is beneficial and not problematic.

Symptoms of teething in children under one year old and ways to alleviate them

In the first year of life, the child develops rapidly. He learns to sit, crawl, walk. And he also has something that indicates the general physiological development, the maturation of the digestive system. He is preparing to move from eating exclusively milk or formula to a new stage - to the use of semi-solid and solid foods and the appearance of first milk teeth .

The eruption of the first milk teeth is influenced by genetic characteristics, health, nutrition and other factors. Even the dependence of teething in infants on the region of residence has been established. So, in the northern regions of Russia, there is a frequent deviation from the average terms towards a later eruption of ^[1] .

On average, the first baby tooth appears at 6-7 months. Within three years, all 20 milk teeth will take their place in the dentition. In some babies, teething begins at 4-5 months, someone waits up to 10-12 months. All of this is within the normal range of ^[2] .

There are several theories explaining the process of teething ^[2] :

Hunter's theory - pushing a tooth out of the bone alveolus occurs due to the pressure of growing roots;
Yasvoin's theory - the appearance of a tooth above the gum provokes processes of differentiation in the tissue of the dental papilla;
Katz's theory - an increase in tissue pressure in the area of the bottom of the alveoli directs the tooth to the surface. nine0003

But none of them can fully explain this complex mechanism.

By the time the tooth erupts, there is resorption of the bone covering the crown of the tooth. The same processes are noted in the gum. During the growth of the tooth root, the bone is also rebuilt and the dental alveoli gradually deepen. At the same time, morphological changes occur in the tissues surrounding the tooth: increased blood flow, changes in vascular permeability, increased production of the main substance of the pulp and periodontium
"Can the physiological process of teething in infants be pathological?" Doctor of Medical Sciences, Professor, Chief Pediatrician of the Central Federal District of the Russian Federation, Honored Doctor of the Russian Federation Zakharova I. N. ^[2]

It is not surprising that the appearance of teeth causes discomfort in children at any age, but this process is especially difficult for babies.

Symptoms of teething in a child

The appearance of milk teeth is a natural physiological process, however, a number of children develop a symptom complex, which, according to the International Classification of Diseases, is classified as teething syndrome (ICD code - K00.7). Numerous surveys of young children say that the most common symptoms accompanying the appearance of teeth are:

increased salivation — processes in the oral cavity are activated;
irritability - the child experiences severe discomfort and cannot report it otherwise than by changing behavior;
sleep disturbance - the pain is so severe that the baby cannot sleep or often wakes up during the night;
itching of the gums - children try to compensate for it by trying to bite the breast or nipple, by trying to keep hands, toys, clothes in their mouths. nine0003

Such harbingers of the appearance of a tooth occur in 35-60% of children. But some babies may have non-specific symptoms ^[2] :

On average, symptoms appear 5-8 days before the appearance of a tooth. When teething several teeth at the same time, this, as a rule, increases the discomfort.

Even if the child's symptoms are very similar to those of teething, a specialist consultation is necessary. Be sure to consult a doctor if diarrhea or fever persists for a long time. nine0003

Ways to alleviate discomfort

To ease teething in a baby, it is necessary:

provide additional attention and care from parents;
if the child is breastfed, breastfeed more frequently as this has a slight sedative effect;
purchase several silicone teethers that can be cooled and offered to the baby during the day; nine0003
massage the gums with a finger wrapped in a clean gauze pad or with a special silicone nozzle;
blot drool in time with a clean tissue to avoid irritation of the skin around the mouth;
if necessary and in agreement with the doctor, use medicines.

Today, there are pharmacological and non-pharmacological methods of therapy for the eruption of temporary teeth. nine0003

Topical preparations

Pediatricians prescribe gels and ointments as symptomatic relief for severe discomfort associated with teething.

Such teething gels and ointments with proven effectiveness are divided into 3 groups ^[1] :

Preparations with analgesic effect based on anesthetic (lidocaine, choline, benzocaine). Sometimes lidocaine-based preparations include anti-inflammatory or antiseptic components, providing a combined effect of the gel. nine0003
Medicines based on anti-inflammatory or antiseptic agents.
Preparations based on extracts of medicinal plants. They use extracts of Roman chamomile, boswellia, aloe, marshmallow, Indian ivy, medicinal rhubarb, calendula and other components of plant origin.

Homeopathic teething products are also produced, but their effectiveness has not been scientifically proven ^[1] .

Systemic drugs

In severe pain syndrome, hyperthermia, non-steroidal anti-inflammatory drugs are used, which reduce body temperature and have a systemic analgesic effect. The pediatrician should select the dosage and the drug suitable for the child.

Distractions

These include the gum massage described above and baby teethers that help your baby temporarily relieve gum itching. nine0003

Inspection of erupted teeth

Swelling and redness of the gums gradually subside as the infant's teeth erupt and grow, but should be monitored. Normally, the teeth should be evenly located in the dentition, not have whitish or colored spots, irregularities on the enamel.

Violation of the timing, pairing and sequence of eruption of milk teeth can serve as a marker of various diseases and disorders. For example, rickets or hypothyroidism ^[2] . It is important to record the date of appearance of each tooth and its location in the mouth. It is convenient to do this with photos saved in a separate folder on your smartphone. nine0003

Erupted Tooth Care Instructions

To brush babies' teeth, use special silicone fingertips with soft bristles. Toothpaste should be labeled as suitable for young children and free of substances that are harmful if swallowed: high concentrations of fluoride, parabens, sodium lauryl sulfate.

As soon as the first tooth shows above the gum line, it needs special care . Enamel has not yet fully formed, it is very thin, so children's caries develops rapidly. Only 10% of children manage to avoid caries and adults practically fail ^[5] . Therefore, do not postpone the preventive fight against it.

To maintain the health of milk teeth, some of which will remain with the child until the age of 10-12, it is important to visit the dentist regularly once every 3-4 months. After a year, you need to visit an orthodontist to make sure that the bite develops correctly.

List of sources

1. Zaplatnikov A. L., Kasyanova A. N., Maykova I. D. Teething syndrome in infants: a new look at an old problem 2018 // https://www.rmj.ru /articles/pediatriya/Sindrom_prorezyvaniya_zubov_u_mladencev_novyy_vzglyad_na_staruyu_problemu/ (Accessed 05/28/2020). nine0003

2. Zakharova IN, Kholodova IN, Dmitrieva Yu. A., Morozova NV, Mozzhukhina MV, Kholodov DI Can the physiological process of teething in infants be pathological? 2016 // https://cyberleninka.ru/article/n/mozhet-li-fiziologicheskiy-protsess-prorezyvaniya-zubov-u-mladentsev-byt-patologicheskim (date of access: 05/28/2020).

3. Kleschenko E. I., Zhdanova I. A., Lukisha A. N., Krakovets I. V., Smychkova E. V., Kartavtseva A. V. Symptoms of teething in infants: condition or disease? 2017 // https://cyberleninka.ru/article/n/simptomy-prorezyvaniya-zubov-u-mladentsev-sostoyanie-ili-bolezn (date of access: 05/28/2020).