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Teething

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Teething describes the process of tooth eruption through the gums of the mouth.

Teething usually begins between the 4th and 7th month of life. Further tooth eruption occurs periodically until all 20 teeth of infancy and childhood, or deciduous teeth, are in place. All the deciduous teeth are normally in place by the 30th month of life.

These teeth include 4 incisors, 2 canines, and 4 molars in each jaw for the total of 20. The 2 lower incisors usually erupt first followed by the 2 lower incisors, upper lateral incisors, lower molar, upper molar, lower canine, upper canine, lower lateral molar, and finally the upper lateral molar. Note that some children do not show any teeth until much later than 8 months, and this is perfectly normal.

The signs of teething are:

• Drooling
• Irritability
• Gum swelling and sensitivity
• Sleeping problems
• Refusing food
• Biting on hard objects
• Low grade fevers (but NOT over 100 degrees)

The discomfort that results from teething is due to the pressure exerted on the tissue in the mouth, called the periodontal membrane, as the teeth erupt. This discomfort may be eased by a cool object such as a firm rubber teething ring or a cold apple. Gently rubbing the gums with a cool,wet washcloth may also provide comfort.

The gums should not be cut to facilitate the eruption of teeth since infection can result. Teething powders and aspirin should also be avoided. Medications such as children’s Tylenol or over-the-counter teething medications containing a topical anesthetic can be helpful.

Note: Teething has NOT been shown to cause a high-grade fever. If your child develops a fever greater than 100 degrees, look for other signs of illness.

An old folk tale links a baby's mental development to how early teething starts. Does this mean that your 5-month-old, who has already begun cutting her second tooth, is going to be the next Einstein? The truth is, teething is not related to mental development, so parents need not worry even if their baby hasn't begun teething in the first year. Teething can start as early as 3 months and continue until a child's third birthday.

Typically between the ages of 4 and 7 months, you will notice your child's first tooth pushing through the gumline. The first teeth to appear are usually the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About 1 month later, the lower lateral incisors will appear. Next to break through the gumline are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most children have all 20 of their primary teeth by the third birthday. (This is a general rule; if your child experiences significant delay, speak to your child's doctor.)

Development of baby teeth

Both baby teeth (deciduous or milk teeth) and permanent teeth have fairly well-defined times of eruption. The ages listed are the normal ages that a baby tooth emerges.

Easing Teething
Whenever your child does begin teething, it generally will be a painless process marked by increased drooling and the desire to chew on things. Here's our doctors' advice to parents:

• Wipe your baby's face often with a cloth to remove the drool. This keeps rashes from developing.
• Give your baby something hard to chew on. Make sure it's big enough so that she can't swallow it. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid - just be sure to wash it after each use. Teething rings are also good, but avoid the ones with liquid inside. If they break, the liquid may not be safe. If you use a plastic teething ring, be sure to take it out of the freezer before it becomes rock-hard - you don't want to bruise those already-swollen gums!
• Never tie a teething ring around a baby's neck, since it could get caught on something and strangle the baby.
• If your baby seems irritable, give her acetaminophen (such as Tylenol ). If your child is under 6 months, consult your child's doctor.
• Teething, as a rule, does not cause high fever, diarrhea, or sleep problems. If your baby does develop a fever during the teething phase, it is probably due to something else and your child's doctor should be contacted.

Baby Teeth Hygiene
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 can hasten this process and leave 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.

Beginning daily dental care as soon as your child's first tooth appears will show your child the importance of oral hygiene. Brush your child's teeth gently with a soft child's toothbrush, or wipe the teeth with gauze at the end of the day. Another important tip: don't let your baby fall asleep with a bottle, since the milk or juice that can pool in her mouth can cause tooth decay and plaque.

The American Academy of Pediatrics recommends regular dental checkups after age 3 or when all 20 primary teeth come in. Before that time, your child's doctor or pediatrician can check your child's dental health.

The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.

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Copyright © 2002 The Perkins Pediatric Clinic, LLC
Last modified: 01/30/07