Teeth under gums 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

Signs, Symptoms, Remedies, and FAQs St. Johns Pediatric Dentistry

Is your baby teething? What do you do? What can you expect? How will you survive? Whether it’s your first time with a teething baby or you just want to “get it right this time”, in our post, A Complete Guide to Teething, we’ll help you better navigate the very natural teething process. We’ll also help in nurturing your child as you, the parent or parents, explore this milestone together with baby.

We also compiled some amazing Inspirational Quotes About Becoming A Mother For The First Time you may be interested in.

In this post, we’ll discuss:

Chapter 1: Teething Process and Common Milestones
Chapter 2: Signs of Teething
Chapter 3: Teething Symptoms
Chapter 4: Teething Remedies
Chapter 5: Teething Toys
Chapter 6: Taking Care of Baby’s New Teeth
Chapter 7: Common Questions and Answers

Chapter 1: Teething Process and Common Milestones

Your baby is getting teeth! You may be wondering: How long does teething take? When will my baby’s teeth come in?

Baby’s primary teeth announce their joyous arrival over a period of about 18 – 24 months as they come through in stages. We’ll list these stages and time frames thoroughly, but note that every baby is a little different. Baby teeth may come in at different rates and sometimes teeth that normally come in after, emerge first. It’s all part of your baby’s unique and beautiful makeup that makes him/her so special.

6-10 Months

At 6-10 months you welcome baby’s first tooth as the lower front incisors (front teeth) come in. These are the two front teeth on the bottom that will give Baby the first experience of what it means to have teeth. Careful! Baby might get carried away with the new found freedom to chomp.

8-12 Months

At 8-12 months the upper front incisors emerge. Don’t be alarmed if these teeth erupt before the lowers.

9-13 Months

At 9-13 months, the upper lateral incisors join the party. “Lateral” means on the sides of, so these are the incisors that are on either side of the central incisors. Now Baby probably has four teeth across the top and two lower. But others aren’t far behind.

10 – 16 Months

At the 10-16 months, the lower lateral incisors erupt to balance the uppers and lowers.

13 -19 Months

At 13-19 months, Baby gets the first set of molars up top. These are the flat teeth that will help crush fibrous foods once the lowers join them. Baby may or may not have canines, the teeth right behind the two sets of incisors, at this time.

14 – 18 Months

Baby’s gets first lower molars.

16 – 22 Months

It’s time for Baby to get some upper teeth to help with piercing and tearing more substantial food. These are the two canines with their sharp fang-like points.

17 – 23 Months

2 Lower canines will soon follow the uppers.

23 – 31 Months

Baby adds some lower 2nd molars, the back most primary teeth.

25 – 33 Months

Upper 2nd molars emerge, and Baby’s set of primary teeth are complete!

All 20 primary teeth are very important for growth and development; they foster good nutrition by aiding in chewing, aid in speech development and don’t forget that beautiful picture perfect smile!

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Chapter 2: Signs Of Teething

When Baby starts teething, you’ll want to recognize the signs leading up to tooth eruption so that you can guide the process along, comfort baby and help reduce pain. Baby can’t tell you that something hurts, so you’ll be watching for the teething signs.

Excessive crying, especially at bed time

You were so happy when Baby first slept through the night. But now you may be going through it all over again — although you can expect it to be random nights and not consistent as it was just a couple months ago.

Chewing on hands, fingers, and toys… and everything

As the teeth try to emerge from one side, putting pressure on the opposite side can reduce the pressure and temporarily relieve pain. Baby will put anything in the mouth that can be accessed: bed rails, stair rails, furniture, remotes, shirts, toothbrushes, toilet paper, extension cords, pens, books. Anything that may be dangerous for Baby to chew on should be kept away. Small, sturdy devices like the remote control may seem okay at first sight aside from the icky germs, but they have batteries that could do serious harm if swallowed.

Fussiness

How would you act if you were in pain and no one understood? You might be a little irritable too. Baby may get upset with people, surroundings or things during this time and begin crying with no apparent cause.

Raised, red gums

As the teeth push through, the gums may become red, and swollen.

White specks under gums

When the teeth are just below the surface, you’ll see little white specks beneath a thin layer of gum tissue.

Ear-tugging

Ear tugging can suggest an ear infection, but teething babies can also experience deferred pain or pain that resonates out from its source. This may be the case, particularly with back teeth because the nerves of the back teeth branch out to the middle ear.

A sore jaw can become a sore middle/inner ear for which tugging on the ear can provide some temporary relief. You don’t want to ignore an ear infection, so if Baby is tugging on an ear, has a fever and seems uncomfortable when lying down, you’ll want to have Baby’s doctor check him/her out. This could be an ear infection.

Drooling

Excess saliva may be produced during this time as the body trying to soothe the inflamed area. Streams of drool down the cheeks and chin can be a sign that baby is teething.

No outward signs at all

A select few, lucky parents claim that there were no signs at all. No teeth one day and then there they are — not all at once of course. This may happen with some or all of the teeth.

Resources:

Keeping Track of Baby Teeth by Ilana Wiles

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Chapter 3: Teething Symptoms

In the signs section, we talked about what you may notice about your child’s appearance and behavior. Now let’s discuss symptoms that baby is experiencing.

Warning: Baby may not be his/her usual, adorable and playful self at least not all of the time.

Pain

Erupting teeth sounds painful, and it is. The gums are very sore, and the sharp edges of teeth are pushing up out of the jaw and through the skin. The ears may feel stuffy, swollen and painful. The jaw aches and the gums feel swollen and sensitive.

Sore gums

Baby’s discomfort may not be at the level of pain, but Baby will almost undoubtedly have sore gums as the teeth push up through the skin.

Insomnia

Baby is so tired and wants to sleep, but the discomfort may prevent sleeping, so Baby stays awake. Apparently, not sleeping for extended periods of time would be damaging to Baby’s and your health, so we’ll discuss remedies in the next section.

Fever

Fevers are our bodies’ natural way of fighting illness. It is possible for your child to have a very low-grade fever when teething, but anything higher than that should be investigated by baby’s pediatrician to rule out any other illness.

Irritability

Because Baby may not be getting great sleep and is in pain, he/she feels irritable and may cry more often and get upset by little inconveniences more easily. But know it will pass. Baby will be adorable and cheerful most of the time

Resources:

Teething Pain by Dr. Greene
How To Handle Teething and Sleep by Nicole Johnson
What to Do When Your Kids Chew on Everything by Katelyn Fagen

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Chapter 4: Teething Remedies

While teething is a very natural process, some babies simply experience worse symptoms than others. As with all of Baby’s milestones, it’s helpful to have a caring adult around to support Baby through the process. Here are some remedies to help Baby through the process.

To Help Baby Sleep

Pain relievers

Give Children’s Motrin or Tylenol, make sure the dose is approved by the pediatrician. Read the label carefully and stop immediately and call the pediatrician if Baby has any reactions. These medicines should be reserved for bedtime because you can only have so many doses per day. If Baby wakes after 4-6 hours and appears to be in pain again, a 2^nd dose is usually okay, but not any sooner.

Cold wash cloth

Soak a clean washcloth in cold water, wring and let Baby chew on it. The cold will help numb the pain long enough for Baby to fall asleep.

Teething tablets

Teething tablets have been used in the past by many parents to help ease teething pain however their safety has been questioned recently by the FDA causing some brands (Hylands) to be recalled. It is not recommended for use at this time, and we urge parents to look into these products thoroughly before considering their use.

Read:
FDA confirms elevated levels of belladonna in certain homeopathic teething products

The FDA has also warned the public regarding the use of Benzocaine, a local anesthetic that can be found in over-the-counter (OTC) products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase. Especially in children under 2 years old, there is a higher risk for a rare but serious—and sometimes fatal—condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the bloodstream is reduced.

Read: Benzocaine and Babies: Not a Good Mix

To Help Relieve Teething Pain During the Day

Silicone teethers

Teethers should be firm to add pressure to the gums but have a slight give to allow the gums and new teeth to subtly sink in.

Teething biscuits

Hard biscuits specifically made for teething can help baby cut teeth while eating a healthy snack.

Freezer pops

Puree and freeze fruit juice, pump and freeze breast milk or freeze chamomile tea into little handheld pops. You can buy molds that are shaped like a pacifier, so Baby can easily hold it. Remember that fruit juice is loaded with sugar and can damage baby’s teeth, so use juice sparingly.

Cold foods

Snacks like soothing cold yogurt and even ice cream (in small amounts).

Resources:

FDA: Homeopathic Teething Remedies Toxic by Edzard Ernst, MD
10 Natural Teething Remedies by Amy Antoinette

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Chapter 5: Teething Toys

Baby’s teething and you’re on a mission to reduce the pain and keep Baby cheerful and bright. What do you do? You buy more Baby toys, of course. Teething toys can be a life saver for Baby and Mommy during this time. When Baby has clean and appropriate toys to chew on, Baby is less likely to chew on other dirty and dangerous household objects like keys and cabinets.

As Baby gets teeth, he/she’ll want to explore different textures so let’s talk about some amazing options.

Silicone bracelets – Since baby wears the bracelet, it never gets lost.
Wooden teething rings with cloth handles – Baby learns to grip and hold cloth while chewing on soft wood and leaving hundreds of cute, little bite marks that you’re so happy are not on the coffee table instead.
Teething necklaces with bunched cloth – It’s easy for baby to twist the necklace around to find the perfect spot to gnaw.
Teething necklaces with wooden rings – Wood is often one of Baby’s favorite substances to gnaw on. And if the wood becomes unsatisfying, Baby can just chew on the cloth necklace itself.
Squeeze toys – Baby will love to chew and make squeaky sounds with baby-safe squeeze toys. But don’t let Baby confuse his/her toys with puppy’s.
Amber necklaces – Necklaces made from real amber beads give Baby yet another texture to explore. Some people claim these are extremely effective, but always be cautious with putting something around Baby’s neck that could potentially be a strangulation hazard. Also be sure each bead is individually wrapped so there is no way one can break off and potentially be a choking hazard as well.

Resources:

Tackling Teething: Our Favorite Teething Toys by Life Anchored

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Chapter 6: Caring For Baby Teeth

Congrats, Proud Parent! Baby now has teeth, so what do you do? Let’s discuss how to care for Baby teeth, but first, we’ll share some statistics you need to know.

According to the CDC:

More than 40 percent of children have caries by the time they reach kindergarten.
Kids who get cavities in their primary teeth are more likely to get cavities in their permanent teeth.
20% of children 6-8 have cavities that go untreated.

Think that the primary teeth aren’t really that important since your child loses them anyway? You may be surprised to find that if a child loses a primary tooth too early, then the permanent tooth that replaces it will often come in maligned, which means that your child is more likely to need braces. Not to mention, primary teeth with decay can lead to pain, fevers, abscess, and even life-threatening infections if left untreated.

A child who learns early to care for teeth is more likely to have better overall health into adulthood with a reduced risk of diabetes, stroke, cancer, Alzheimer’s, kidney problems, infertility… and the list goes on.

Now, let’s talk about protecting those teeth.

Ages 0-1

Even before the teeth arrive, Baby will still have bacteria in the mouth that multiplies. These bacteria are usually transmitted from family members, especially mom, so it is of the utmost importance for mom to also have a healthy oral environment. As the teeth begin to emerge, these bacteria will begin their colonization and attack of those new teeth. Always wipe the gums with a clean, moist washcloth or folded gauze after each feeding.

Ages 1-2

By age 1, some of Baby’s teeth have fully emerged. It’s time to switch to a soft baby brush and no more than a rice-grain size speck of fluoride toothpaste. Brush teeth twice a day. Baby should not be left to brush his/her own teeth; they need to be closely supervised to assure that he/she isn’t swallowing too much toothpaste.

Ages 3+

At this point, your child likely wants to be cleaning his/her own teeth independently. You can encourage this positive behavior by having them brush and you finish the process after. Children do not have the manual dexterity to effectively brush all surfaces of their teeth until about age 8-9. This is a task that should be shared with parents to ensure proper oral hygiene is being maintained.

A pea size amount of toothpaste is all they need at this stage. Brushing should be firm but gentle with a soft-bristle brush. Flossing should begin as soon as you cannot see space between each tooth.

Most importantly, the American Academy of Pediatric Dentistry and American Academy of Pediatrics both recommend your child find a Dental Home within 6 months of their first tooth emerging and no later than age 1. This way, a Pediatric Dentist can give you individualized anticipatory guidance based on your child’s specific needs. The Pediatric Dentist can be your go-to person for any questions regarding oral care, products, growth, and development questions as well as a contact point for any dental trauma that your child may encounter.

Resources:

Tips for Healthy Baby Teeth Care by Hollie Schultz
Is Taking Care of Baby Teeth Important by Chrystal Johnson
Dental Health from Baby Teeth to Braces by Jo Frost
10 Benefits of Clean Teeth and a Healthy Mouth by Rachel Hall
No Fooling: Baby Teeth Really Do Deserve Special Care by Dentistry & You

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Chapter 7: Common Questions and Answers

My baby boy is only 2 months old. Can he really be teething?

Yes. Each baby is unique and perfectly designed. While most babies begin teething at around 6 months, many babies start teething well before or after the normal teething age. Baby’s teeth will come through on his/her own timeline… not ours.

When should Baby first go to the dentist?

The American Dental Association recommends that Baby visits the dentist within 6 months of the first tooth arriving. This will typically mean that Baby sees the dentist before the 1^st birthday, but don’t wait too long if Baby is an early teether.

What’s the difference between a regular (general) dentist and pediatric dentist?

A general dentist is trained to handle patients of all ages. A pediatric dentist has had 2-3 years of additional training to specialize in children’s dental needs. Because of this, techniques, facilities, and staff will all be designed around helping children to feel calm and comfortable when they see the dentist.

Seeing a pediatric dentist can be a fun and joyful experience at a pediatric dentist while children who visit a general dentist may not have the same experience, not because the people aren’t friendly and professional, but only because everything is not centered around children’s needs. Even if you love your dentist, it may be better for Baby to see a pediatric dentist.

I feel like I’m getting conflicting information about dental care, will a pediatric dentist answer my questions?

Absolutely! That’s what we’re here for. Ask away. We love to answer questions, and we are dedicated to the health of our patients. We are overjoyed to help dispel myths and provide clarity to children’s dental care. It’s what we love to do.

Resources:

American Dental Association

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 feeding exclusively on milk or formula to a new stage - to the use of semi-solid and solid foods and the appearance of the 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 this is the range of the norm ^[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.

But none of them can fully explain this complex mechanism.

By the time of tooth eruption, the area of bone covering the crown of the tooth has been resorbed. 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 in the tissues surrounding the tooth occur: 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 wakes up frequently 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.

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.

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 mild sedative effect;
purchase several silicone teethers that can be cooled and offered to the baby during the day;
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.

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] :

Anesthetic-based analgesics (lidocaine, choline, benzocaine). Sometimes lidocaine-based preparations include anti-inflammatory or antiseptic components, providing a combined effect of the gel.
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 case of 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 itchy gums.

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.

Erupted Tooth Care Instructions

To clean baby's 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., Maikova 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).

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).

4. Kiselnikova L.P., Drobotko L.N. Eruption of temporary teeth in children // https://cyberleninka. ru/article/n/prorezyvanie-vremennyh-zubov-u-detey 2017 (date of access: May 28, 2020).

5. 90 percent of children and 100 percent of adults suffer from caries, Komsomolskaya Pravda, 09/04/2016 // URL: https://www.kp.ru/daily/26429.7/3300802/ (date of access: 07/21/2020).

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

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 only the timing of teething, but even the level of mineralization of enamel of 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 milk 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 a thinner enamel, and the inner cavity of the pulp 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 disorder and timing of teething in children can be:

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

Standards for eruption of 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 indicated 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

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 are:

swelling and redness of the gums;
excessive salivation;
itching and urge to hold hands, toys;
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 your 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.

The milk teeth are suitable for an ultra-soft toothbrush with a small head.
Children's mouth rinses are used from about 4 years of age 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 mouths after meals from an early 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 Anatomo-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 E. S., Saipeeva M. M., Shishmareva A. S. Terms 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 milk 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.
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