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Teething (Primary Tooth Eruption)

Teething occurs when your child’s “baby” or “milk” (primary or deciduous) teeth break through the gum and start to grow in. Teething, or primary tooth eruption, usually begins around six months of age, but it is normal for teething to start at any time between three to 12 months of age.

The front teeth are the first to erupt at around six to eight months; the back teeth erupt between 18 and 24 months. Teething, sometimes referred to as “cutting teeth,” occurs until all 20 primary teeth are in place. This is normally around two and a half years of age.

Normal Teething Sequence

Exactly when and how teething begins seems to be hereditary, does not have anything to do with the baby’s health, and tends to occur earlier in females than in males. However, if primary tooth eruption has not begun by 15 or 18 months, consult a pediatric dentist. While teething or eruption patterns vary greatly from child to child, primary teeth typically emerge in a specific sequence. The general eruption pattern is:

  1. Two bottom front teeth (central incisors)
  2. Four upper front teeth (central and lateral incisors)
  3. Two lower lateral incisors
  4. First molars
  5. Four canines or eye teeth (on either side next to the upper and lower lateral incisors)
  6. Remaining molars on either side of the existing teeth

When a child is five or six years old, the primary teeth start falling out because the permanent (secondary) teeth are erupting underneath them, pushing them out. The eruption of permanent teeth occurs in the same approximate manner and sequence as primary teeth. By about age 14, children have 28 permanent teeth, and at about age 16, four additional teeth called wisdom teeth or third molars.

Teething Symptoms

Experts disagree about whether teething actually causes symptoms – like fussiness, coughing, fever and diarrhea – or whether it is just a coincidence that these common maladies occur at the same time as teeth are erupting. While some lucky parents report no apparent negative side effects, many others maintain that their teething babies do suffer discomfort.

If your child is showing discomfort during teething, the symptoms he/she may experience include:

  • Excessive drooling, which may lead to a rash on the face or chest
  • Gum swelling and sensitivity
  • Irritability or fussiness
  • Low-grade fever (rare)
  • Refusing food
  • Rubbing of ears and cheeks
  • Sleep problems
  • Urge to bite on hard objects

As a tooth erupts, a watery sac (eruption cyst) may develop. Eruption cysts are usually harmless and should be left alone. As a tooth pushes through the gum, it will eventually rupture the sac.

If symptoms develop during teething, they usually occur approximately four days before and up to three days after the tooth erupts.

Mild teething symptoms that gradually improve should not cause concern. However, contact your pediatrician if your baby’s symptoms are severe or persist. Fever, diarrhea, frequent ear pulling, coughs and severe diaper rashes are not normal teething symptoms. You should be especially concerned if your child has a rectal temperature of 101 degrees Fahrenheit or higher (100.4 degrees Fahrenheit or higher for babies younger than three months). When in doubt, consult with your pediatrician to determine whether your baby is showing signs of a problem that requires medical attention.

Alleviating Teething Symptoms

There are several ways you can bring your child relief from teething symptoms, including:

  • Use a cold, wet cloth for your baby to suck as a way to soothe gums. Clean the cloth after each use.
  • Consider a pacifier, teething ring or other teething accessories and toys your child can chew. Make sure the object is big enough so it can’t be swallowed or break into small pieces. Stay away from liquid-filled rubber teething rings, which can break or leak, and do not freeze them to the point that they are frozen solid, as this may only aggravate sensitive gums.
  • Gently rub your child’s gums with a clean finger, a small, cool spoon or a wet gauze pad.
  • If drool causes a rash on your child’s face or chest, wipe the drool away often with a soft cotton cloth, or gently dab petroleum jelly on the affected area.
  • If your child is eating solids, offer cold foods and liquids, like applesauce, pureed peaches or yogurt.
  • Give your baby a mild pain reliever that is labeled for his/her specific age, but NEVER without first consulting your pediatrician to see if it is all right to do so, and if so, what the right dosage should be.

Keep in mind that although many parents use topical gels and other teething remedies, many experts question how effective and safe these products really are. Before using any kind of medication or remedy, speak with your pediatrician about specific product safety, dosage and usage issues. If you are using medication to comfort your child, double check with your pediatrician to make sure there isn’t another cause for his/her symptoms, such as a viral or ear infection.

There are a number of palliative treatments to avoid when alleviating teething symptoms, including:

  • Do not use teething powder or aspirin on your baby’s gums. Breathing in small particles of either can cause lung problems. Aspirin should not be given to children because it has been associated with Reye’s syndrome, a rare but potentially life-threatening disease.
  • Do not cut gums to make it easier for teeth to erupt, as this may lead to infection.
  • Do not give your baby any type of alcohol, as this may be harmful. Read medicine labels carefully to avoid products that list alcohol as one of the first ingredients.
  • Do not tie teething rings around your baby’s neck as they may pose a strangling hazard.
  • Do not let your baby fall asleep with a bottle. The milk or juice can cause tooth decay and dental plaque.

When to Begin Tooth Brushing

It’s never too early to begin dental care. Even before your baby’s first tooth erupts, start using a warm, soft and clean washcloth or a moistened cotton swab to gently wipe the gums after every meal. This gets your child used to something in his/her mouth. As soon as the first tooth erupts, gently brush with a small, soft toothbrush and water. Do not use toothpaste – especially if it contains fluoride – until your child is two years old. At this time, apply only a pea-sized amount on the bristles. Teach your child proper tooth brushing techniques at around age three. To avoid a potentially harmful overdose of fluoride, never let your child swallow the toothpaste or eat it out of the tube.

When your child’s teeth have fully erupted, have him/her brush after every meal or at least twice a day. Start flossing, too. A good time to begin flossing is when two teeth are touching. Speak with your dentist for tips on flossing your baby’s teeth. Get your toddler in on the flossing habit by setting the example. Let him/her see how you brush and floss and have him/her follow along beside you in front of the bathroom mirror.

When to See the Dentist

The general rule is that children should see a dentist for the first time six months after eruption of the first tooth and no later than one year old. Taking your child to the dentist at a young age is a great way to give your child a healthy start on a lifetime of good oral hygiene habits.

Like adults, children should visit the dentist every six months. Some dentists may schedule visits every three months in order to build a comfort level or to treat any developing problems.