What to expect and how to care for your baby's new teeth. 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. Pediatric dentistry specializes in beautifying smiles and helping special need children for overall dental care. Pediatric dental care for all children ages 1-18.

1. Baby Teeth:
Frequently
Asked Questions

2. What to expect and how to
care for your baby's new teeth.

3. 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.

4. 
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.

5. 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.

6.  When
can I expect my child's first
tooth to come in?

7. 
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).

8. 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.

9.  My
baby was born with a tooth. Does it
need to be pulled out?

10. 
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.

11.  My
child is 8 months old and still
doesn't have his first tooth. Is
something wrong?

12. 
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.

13.  My
4-month-old is drooling and
chewing on his hand. Does this mean
he's teething?

14. 
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.

15. 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.

16. 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.

17.  My
baby has a fever and a touch of
diarrhea. Is that because he's
teething?

18. 
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.

19. 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.

20.  What
if my baby is pulling on his ear?
Is that due to teething?

21. 
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,

22. 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.

23.  How
can I make my baby feel better?

24. 
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.

25. 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.)

26. Even something as simple as a wet washcloth that your
baby can chew on will provide relief. An ageappropriate 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.

27. Baby Tooth
Care

28. 
Why do I have to worry about cleaning my child's
baby teeth? They're just going to fall out anyway.

29. 
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.

30. 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.

31. 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 peasized amount of toothpaste.

32.  When
can my baby start using fluoride
toothpaste?

33. 
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.

34. 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.

35.  When
should I take my baby to the
dentist?

36. 
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 wellbaby visits and can refer you to a dentist if he sees any
problems.

37. 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.

38.  My
doctor told me that letting my 10month-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?

39. 
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

40. 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;

41. 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.

42.  Are
pacifiers bad for baby teeth?

43. 
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.

44. 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.

45. Dental Care For All
Children
Ages 1-18
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