Teething

The Development of Teeth
What symptoms can I expect when my child is teething?
What will I see when my child is teething?
How can I make my teething child more comfortable?
How should I take care of my child’s teeth once they come in?
Additional Information
References

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Teething can be a stressful time for both babies and parents, with sleepless nights and cranky days. But once they come in, teeth play an important role in both eating and speaking.

The Development of Teeth

By about the sixth week of pregnancy, your baby’s teeth are already beginning to develop. These teeth, however, usually don’t erupt through the gums into the mouth until several months after the baby is born.

The teeth usually begin to erupt some time between 4 and 7 months of life. Some babies get their first tooth earlier than this, and some not until later. Generally the first teeth to come in are the front lower teeth, called the mandibular central incisors. About 4 to 8 weeks later, the front top teeth come in, called the maxillary central incisors. These are followed by the teeth on the sides and in the back of the mouth, called the lateral incisors, canines, and molars. By the time a child is 30 to 36 months old, all 20 primary teeth (also called “baby” teeth) have usually come in.

The teeth on the right and left sides of the mouth typically appear at about the same time. A baby may have two teeth erupt into the mouth at the same time, or one closely followed by another. Both sex and race can affect when teeth come in. Girls frequently get their teeth earlier than boys, and black children often have teeth come in earlier than white children.

When kids get to be about 6 years old, the permanent teeth begin to come in, and the baby teeth start to fall out.

What symptoms can I expect when my child is teething?

Some children go through the process of teething without any fussiness, pain, or discomfort. Other infants, however, become cranky, have difficulty sleeping, and eat less than usual.

It is known that teething infants may have sore, swollen gums, which can cause them to be cranky and have increased saliva production. Other symptoms are more controversial. For years experts believed that teething could cause diarrhea and fever. In fact, more than 100 years ago, teething was considered a cause of major medical problems such as seizures, paralysis, and even death.

Recent studies have found that some symptoms traditionally thought to be due to teething are likely caused by another process. In other words, infants with diarrhea or fever who happen to be teething may have another cause for their symptoms. Therefore, if a teething infant has a temperature of 100o or higher, is inconsolable, or has persistent diarrhea, parents should call the doctor, rather than just assuming the symptoms are due to teething. The doctor may want to see your child in the office, or may be able to offer some advice over the phone. You should also go to the doctor if your child is refusing to drink or seems uncomfortable without any signs of teeth coming in. Some viruses can give infants lesions in the mouth which can be uncomfortable.

While symptoms like diarrhea and fever are controversial, ones like crankiness, drooling, and mouthing of objects are well agreed upon. Infants’ mouths are important not only for eating, but also for comfort and for exploring their environments. When teeth are coming in, and a baby senses discomfort in a body part that usually brings enjoyable experiences, it can be stressful. Understandably, this can cause an infant to be crankier than usual.

Babies may have discomfort when one tooth comes in, but be fine when another erupts. The eruption of the first tooth and the molars often are the most uncomfortable. When any tooth comes in, infants often seem comfortable some times, and uncomfortable at others. Babies who are teething often drool large amounts and chew on whatever they can get their hands on, including their fingers themselves.

What will I see when my child is teething?

One of the first signs that teething is starting is an increase in the amount of drool coming out of your baby’s mouth. In addition to making a mess on your child’s clothing, your clothing, and your furniture, the excess saliva can also cause a rash on your baby’s face. You will likely begin to notice that your child is frequently putting anything in her hands into her mouth, in addition to chewing on her fingers.

If you feel your child’s gums with a clean finger, you may be able to feel the tooth just under the surface of the gum. As it starts to come in, you will be able to see it poking through the gums, into the mouth.

Sometimes parents notice a water-filled sac, called an eruption cyst, where the tooth is coming in. This sac bursts when the tooth comes through the gums, and is harmless. No medicine or treatment is needed for these cysts.

How can I make my teething child more comfortable?

There is no “cure” for teething, but there are ways to make your child more comfortable. Babies often help themselves feel better by chewing on their fingers and other objects. The pressure that they put on their gums can help with some of the discomfort they feel. Similarly, you can put gentle pressure on her gums – just make sure your finger is clean first. Some parents prefer using a wet gauze pad, or a cooled spoon.

Alternately, you can provide your child with something safe to chew on. A wet washcloth can be put in the freezer for 30 minutes, so that it is cool, but not hard and frozen. If a washcloth is given to chew on, make sure that it isn’t fraying, and that it is washed after each use. In the same way, a terry cloth toy can be used instead of a washcloth.

There are many teething rings on the market, but you should be careful about which one you choose. It’s best if the teething ring is made of nontoxic materials, and does not have liquid inside, in case it breaks. The rings can be put in the refrigerator, or very briefly in the freezer. They shouldn’t be left too long in the freezer or they can become too hard, which can cause more pain on already tender gums. Teething rings, or anything else mouthed by your child, should be washed after each use.

Whether a teething ring is used or another object is chewed on, it is important to make sure that the object is big enough so that the child cannot get the whole thing in her mouth. Additionally, there should be no small parts that can come off, and it should not be able to be break apart, in order to avoid being a choking risk. Teething rings and other objects should never be tied around a child’s neck – this can pose a risk of strangulation.

Kids who are teething who are old enough to eat solids may benefit from cool foods, such as cold applesauce. Again, watch out for choking hazards, like carrots or chunks of crackers.

For kids who are still uncomfortable after trying these methods, an occasional dose of acetaminophen can help. But before giving any medication, make sure to talk to your doctor to see if it would be appropriate for your baby.

There are some topical gels sold over the counter which aim to numb the gums. If these gels are swallowed or if too much is used, they can interfere with your child’s gag reflex. This means that your baby could be at an increased risk of getting food down into her lungs, which can cause complications, such as pneumonia and difficulty breathing. Just as with any other medication, there is also a risk of an allergic reaction. These gels should only be used after you have discussed them with your child’s doctor.

Since your child is likely to be drooling quite a bit, make sure to gently wipe the drool off of her face frequently. This can help avoid rashes which can result from saliva being on the skin.

There are many “treatments” for teething discussed among parents which can be dangerous and must be avoided. Babies should never be given whiskey, nor should anything be tied around their necks. Medications such as Nyquil and Robitussin should never be given to infants, and Benadryl should not be given for teething. If you have any question about the safety of a treatment you have heard about, make sure to talk to your child’s doctor.

How should I take care of my child’s teeth once they come in?

Once your child’s teeth start coming in, it is important to begin cleaning them. You can use a soft toothbrush with water to gently clean the new teeth. Toothpaste shouldn’t be used until kids are 2 years old, and even then, its use should be closely supervised in order to avoid swallowing.

You should take your child to see a pediatric dentist by the time she is 1 year old, or sooner if you have questions or concerns. Some experts feel that kids should go to the dentist as soon as the first tooth appears. Others feel that babies should be seen within 6 months of the first tooth coming in. Early visits allow for identification of risk factors for cavities and other dental problems. The dentist can give advice and guidance about the care of the baby’s teeth, and can help deal with issues such as thumb-sucking and pacifier use.

One of the best ways you can encourage good dental hygiene and a healthy smile in your child is to practice it yourself – kids learn a lot by watching you!