What to expect when your baby starts teething

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GEHA | August 22, 2022

Children’s health

Everyday health

Dental

Your baby’s teeth are a big part of their health, so it is important to build a strong foundation for your child’s oral health now.

What is teething?

Teething is the process in which teeth grow through the gums in an infant’s mouth. Teething typically begins around 6 months of age, though some infants begin teething as early as 3 months while others don’t begin until after 12 months. By the time your child is 30 months old, all twenty of their baby teeth should be in place.

Signs and symptoms that your baby may be teething

There are several signs and symptoms your baby may experience as they begin the teething process. If you know what to look for, you may even notice certain symptoms that signal the teething process will soon begin.

Common teething signs and symptoms include:

• Face rash
• Flushed cheeks
• Sucking fingers
• Excessive drooling
• Disruption of eating and sleeping patterns
• Acting cranky, irritable and tearful
• Low-grade fever
• Tender, swollen and sore gums
• Gnawing, chewing and biting objects

How to comfort your teething baby and care for their new teeth

As your baby begins teething, you will want to find ways to comfort your baby and care for their new teeth. There are several methods you can attempt for both.

To comfort your teething baby, you can:

• Rub your baby’s gums. Wash your hands thoroughly, then massage or rub the sore area(s) with gentle finger pressure. You can also use clean and wet gauze instead of your finger.
• Keep their mouth cool. Cool or chilled food and objects can help soothe a baby’s sore gums. You can place a cold spoon or teething ring (not frozen) on your baby’s gums. If they are eating solids, you can use frozen bananas or berries. It is essential to watch your child closely when they have any substance in their mouth.
• Give your baby something to chew on. A firm, rubber teething ring may offer some pain relief.
• Try over-the-counter remedies. If nothing else is working and your baby seems especially upset, consider giving them infant’s acetaminophen or ibuprofen.

To keep your baby’s new teeth clean, you can:

• Run a soft, clean cloth over their gums twice a day. Once after the morning feeding and once before bed.
• Use a small, soft-bristled toothbrush to clean their teeth twice a day. A toothbrush should not be used until their first teeth appear.
• Use a smear of fluoride toothpaste no bigger than the size of a grain of rice. Once your child learns to spit (around ages 2 – 3) you can switch to a pea-sized dollop.
• Begin thinking about regular dental checkups. The American Dental Association and the American Academy of Pediatric Dentistry recommend scheduling a child’s first dental visit around their first birthday.

What not to do

There are a few things to avoid while your baby is teething. Certain ingredients and tools will harm your child a lot more than they will help. To keep your baby safe, follow these guidelines:

• Avoid teething medications containing benzocaine or lidocaine. These ingredients can be harmful, even fatal to your baby.
• Avoid teething necklaces, bracelets or anklets. While amber teething necklaces and other similar products may be trendy, they pose a huge risk for choking and strangulation.
• Avoid liquid-filled teething rings.
• Never give your child aspirin.
• Do not rub alcohol on your baby’s gums.
• Do not use homeopathic remedies.
• Never place anything frozen directly against your child’s gums or teeth. Instead, wrap the object in a towel or wait until it is cooler.

When to seek additional help

It is important to know that high fever, diarrhea and vomiting are not typical symptoms of teething and may be a sign that your child needs proper medical attention. If you notice your baby refusing food or bottles, it may also be time to contact their doctor. Click to access GEHA’s Find Care tool.

Disclaimer: This information contained herein is for informational and educational purposes only. This information is not a substitute for professional medical advice and if you have questions regarding a medical condition, regimen, or treatment you should always seek the advice of a qualified health care provider. Never disregard or delay seeking medical advice from a qualified medical professional because of information you have read herein.

Sources:

“Baby teething symptoms.” www.nhs.uk, National Health Service, 1 February 2019

“Teething: Tips for soothing sore gums.” mayoclinic.org, Mayo Clinic, 25 February 2022

“Teething.” medlineplus.gov, National Library of Medicine, 2 October 2020

“Teething: 4 to 7 months.” www.healthychildren.org, American Academy of Pediatrics, 6 October 2016

“Frequently asked questions (FAQ).” www.aapd.org, America’s Pediatric Dentists, n.d.

“Safely soothing teething pain and sensory needs in babies and older Children. ” www.fda.gov, U.S. Food and Drug Administration, n.d.

“Perinatal and infant oral health care.” www.aapd.org, America’s Pediatric Dentists, 2021

“Teething.” www.mouthhealthy.org, American Dental Association, n.d.

“Fact sheets for families – teething.” cchp.ucsf.edu, University of California San Francisco, 2005

“How to help teething symptoms without medications.” www.healthychildren.org, American Academy of Pediatrics, 27 March 2014

“Baby teething pain.” www.healthychildren.org, American Academy of Pediatrics, 20 December 2018

“Managing discomfort caused by teething.” www.jcda.ca, Canadian Dental Association, 5 December 2013

Is my baby teething? Signs and symptoms of teething in babies – CHOC

Published on: June 15, 2021
Last updated: March 9, 2023

A CHOC pediatrician explains more about the signs of teething in babies, when to expect teething to begin, and offers suggestions to ease the process.

Link: https://health.choc.org/is-my-baby-teething-signs-and-symptoms-of-teething-in-babies/

Teething signs and symptoms vary among each baby, but parents can expect to see more drool and a desire to chew on objects, says Dr. Lori Openshaw a pediatrician in the CHOC Primary Care Network.

Discomfort, rosy cheeks, and excessive drool which can irritate the skin causing facial rashes, as well as loose stools can appear during this time, she says.

Some babies may not experience any pain, but others may have periods of pain and irritability. Some babies might be briefly unhappy, but others might seem to be cranky for weeks, with crying spells and disrupted sleeping and eating patterns. While teething can be uncomfortable, parents should call their pediatrician if their baby seems overly fussy, Dr. Openshaw says.

A teething baby’s temperature may rise slightly at this time due to tender and swollen gums, but teething doesn’t typically prompt a high fever or diarrhea. A fever at this time is likely caused by something different, and a call to the pediatrician is warranted, advises Dr. Openshaw.

When does teething time start? At what age does baby get their first tooth?

Baby teething age can vary, but most babies begin teething between ages 4 and 7 months. Early teething can begin in some babies as young as 3 months, and teething can begin as late as 12 to 14 months.

When and how teeth come in is different for every baby and may follow a timeline seen in their family history. Most of the time, a parent or caregiver will see the two front bottom teeth come in first, followed by the four front upper teeth, then the lower teeth on either side of the front lower teeth. Molars, the back teeth used to grind food, will break through next, followed by the canines. This period is sometimes called the “2-year-old molars.”

Most children have all 20 primary teeth by their third birthday.

How can I help a baby who is uncomfortable from teething?

Teething can be uncomfortable for babies – and thus, for parents too. Dr. Openshaw offers these tips to help make the transition easier:

• Gently wipe the baby’s face often with a cloth to remove drool and prevent rashes.
• Use a clean finger or wet washcloth wrapped around your finger to rub the baby’s gums.
• Teething rings or a baby-safe teething feeder may be used with ice or cold food for baby to gnaw on safely
• A simple teething aid is a wet washcloth placed in the freezer for 30 minutes. Just be sure to remove it from the freezer before it becomes too hard and wash it after each use.
• Chilling teething rings in the freezer or refrigerator can be helpful, however it is best to avoid products with liquids inside because they might break or leak. Also, avoid boiling rings to sterilize them because the high temperatures could damage the plastic and cause chemicals to leak.
• Give babies who are already eating solid foods cold foods in a baby-safe feeder, such as one made of mesh or silicone.
• Speak to a pediatrician about giving babies ages 6 months or older acetaminophen or ibuprofen to help with pain. This can be done on rare occasions but should not be given routinely.

Here are some things Dr. Openshaw advises parents not do when their baby is teething:

• Don’t use teething necklaces especially with small items such as amber. These can lead to strangulation and can also cause choking if pieces break.
• Don’t tie a teething ring around a baby’s neck or any other body part because it can lead to strangulation.
• Don’t use teething gels or tablets unless directed by your doctor because they may not be safe for babies.
• Never place an aspirin or any tablets against an emerging tooth or in baby’s mouth and do not rub alcohol on the baby’s gums.

How should I care for my baby’s teeth?   

Even before teeth emerge, parents can practice daily dental care with their baby. This is not necessary, however it can help prepare sensitive babies for having their mouths and gums touched during brushing when teeth do arrive and need brushing. To do this, just wipe a baby’s gums with a clean, damp washcloth on a daily or twice-daily basis.

Once the first tooth emerges, it’s time to start daily brushing with a tiny smear (the size of grain of rice) of fluoridated toothpaste. Even though the baby teeth will ultimately fall out to make way for adult teeth, caring for baby teeth is important for long-term dental health. In addition to starting important habits, daily brushing prevents decay in baby teeth, which would make them fall out more quickly and lead to crooked and crowded adult teeth.

An important thing to know about tooth care is that babies should never fall asleep with a bottle of milk or juice. Milk or juice can pool in baby’s mouth and cause tooth decay,  something called baby bottle tooth decay, Dr. Openshaw cautions. It can also lead to increased childhood ear infections.

By the time all baby teeth have emerged, parents should try to brush them at least twice a day and especially after meals. Once teeth start to touch, it’s time to start flossing.

When children are older – about age 3 – it’s OK to use a pea-sized amount of fluoridated toothpaste. Ensure the child spits out the toothpaste, as too much fluoride can be harmful.

The American Dental Association (ADA) recommends that children begin seeing a dentist by age 1, or within six months of a tooth’s first appearance.

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A child is teething: important information

One of the most difficult periods in the life of a parent and a child – the time, , when the first teeth are cut. Moreover, this is often a painful period for parents who are too worried.

Drop all fears. To reduce anxiety, read as much information as possible about what to do, how to relieve pain when teething.

AT WHAT AGE IS THE FIRST TEETH IN A CHILD

When a child’s teeth begin to cut, it is difficult to answer. This is an individual process and often it can deviate from the generally accepted norm. Some are already born with their first teeth, while others begin to grow at the age of about a year.

It is worth worrying if the teeth have not started cutting after a year – in this case, show the baby to the doctor.

Usually, the first teeth in peanuts begin to erupt at 6-9 months. It depends both on the genetic disposition, and on nutrition and climate. But there are also deviations. It is worth worrying if the teeth did not start cutting after a year – in this case, show the baby to the doctor. True, modern dentists say that it doesn’t matter at what age a child’s teeth begin to cut and this does not affect their future health. But it’s worth it to be safe. In total, babies up to three years old have a complete set of milk teeth – as many as 20 pieces.

What to eat to have strong teeth

IN WHAT SEQUENCE DO THE TEETH GROW IN CHILDREN

Teeth are cut in children in pairs and alternately – first on the lower jaw, then on the upper. The first “come out” are the 2 central incisors from below, at 10-12 months they are overtaken by the upper ones. They are the ones that cause the most discomfort and pain. Other teeth grow more quietly. From 11 to 15 months, the lower and upper lateral incisors appear. At 12-15 months, new teeth appear in the child’s mouth – the lower and upper molars. Up to 22 months, fangs grow, which slightly disrupt the coherence of the “dental life”, because at first the upper ones grow, and then the lower ones. And already up to 32 months, the child can boast of upper and lower second molars.

Teeth grow at intervals of about two months.

BABY IS TEETHING: SYMPTOMS

The signs of the appearance of the first teeth, like the process itself, are very individual. Some children suffer from pain and fever, while others go away without any symptoms. Of course, you can hope that your child is lucky and he will become the owner of a white-toothed smile without discomfort at all.

• The first sign that your little one is about to have their first tooth is redness, itching, and swelling of the gums. The child begins to pull everything into his mouth, trying to scratch them. Sometimes there may even be bruising.
• During teething, the child may have a fever. Make sure that it is not a symptom of any disease, because the time of the appearance of the first teeth in infants overlaps with the start of the introduction of complementary foods, which can cause infection. Temperatures below 38 ° C do not need to be brought down, but if it is higher, give the child an antipyretic.
• The growth of milk teeth sometimes causes indigestion. The child may have diarrhea. Make sure it’s not related to an infection.
• Tooth growth is sometimes manifested by a runny nose or cough. This may be due to profuse salivation and mucus running down the back of the throat.
• Abundant salivation is also a sign of the growth of the first teeth in infants. In this regard, the baby may develop a rash around the mouth and on the cheeks.
• Also, the child does not sleep well, cries, loses appetite. Yes, the growth of teeth in infants is in no way easier for either children or parents than infant colic.

TEETHING: HOW TO HELP THE BABY

As soon as the child’s first teeth begin to erupt, parents immediately receive a lot of advice from mothers, grandmothers, neighbors and many more people. No matter what you are told, there is no remedy that will help your teeth grow quickly and painlessly.

The least you can do to help your child is to do no harm. You should not give the baby during the period of teeth growth carrots, cookies, drying and other products with which he can scratch his gums. Just because a child puts everything in his mouth and tries to bite and chew on every hard object in your house does not mean that he needs to be given any food. Indeed, for example, he can easily break cookies and eventually choke on them.

Also, give up the “grandmother’s” methods: do not put your child’s fingers in his mouth and press on his gums. This is usually done to speed up the growth of teeth and relieve pain. But, firstly, from such manipulations, the teeth definitely will not grow faster. Secondly, even if you reduce the discomfort, you will not be able to constantly keep your hands in the baby’s mouth, and what’s the point of a few minutes of pressure? And third, are you sure your hands are clean enough?

Give up “grandmother’s” methods: do not put your fingers in your child’s mouth and press on the gums.

If teeth are being cut, you can help your child by buying him special teethers. This is a children’s toy that is offered to babies during teething so that they gnaw it and scratch their gums with it. It is better to choose teethers with water inside. Before giving a toy to a child, put it in the refrigerator – this will cool the water and while biting, the coolness will help to relieve discomfort in the gums a little.

WHETHER THE FIRST TEETH SHOULD BE BRUSHED

The very first teeth of the baby do not need to be brushed. Yes, and how do you imagine it? It is necessary to start accustoming a child to this ritual from the age of two. Until this time, keep an eye on the hygiene of the baby: teach him to rinse his mouth with water, do not let him keep food in his cheeks. It is also important for the child to drink clean water – this is how bacteria and food debris are washed off. And adjust the humidity level in the house, otherwise the baby’s mouth will dry out, and without saliva, an infection can multiply in it.

If you have problems with your teeth, see a doctor. The first scheduled inspection is carried out at the age of one year. And then the baby should be shown to the dentist once every 12 months.

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Teeth in children – Teething in a child: order, timing, symptoms, pattern of growth

Temporary teeth

Milk teeth are a natural mechanism that helps a child to move from mother’s breast milk or formula for artificial feeding to regular solid food. Another function of temporary teeth is to ensure the normal anatomical development of the jaw apparatus and the correct distribution of the masticatory load for the formation of facial muscles. With the appearance of the first milk teeth in an infant, the sucking reflex begins to fade, the swallowing mechanism changes and the chewing function begins to form.

As the teeth begin to grow, the child begins to pronounce the first conscious sounds. The active development of speech is an essential component of the system of social adaptation and mental development of the baby.

Today’s children differ from previous generations in many ways, including the fact that their milk teeth begin to grow 1-2 months earlier. Global acceleration also has negative consequences: the hard tissues of the first teeth do not have enough time to mineralize, and they are largely susceptible to caries.

In healthy babies, temporary teeth begin to erupt at 6-7 months, the lower central incisors appear first (Fig. 1). The milk bite in children consists of 20 teeth, it is fully formed by 2-2.5 years and serves until the appearance of molars.

Figure 1. Baby teeth eruption calendar. Source: MedPortal

Later teething and growth patterns may be associated with some negative factors:

• severe toxicosis in the mother during pregnancy,
• Rhesus conflict in mother and child,
• baby prematurity,
• complicated childbirth,
• viral and bacterial infections in the first months of life,
• rickets,
• artificial feeding.

Science knows cases when children were born with already erupted lower incisors, the reason for this phenomenon is still unknown. It is also interesting to note that the first child has teeth earlier than younger siblings, and girls begin to erupt milk teeth earlier than boys.

Permanent teeth

At older kindergarten age, milk teeth fall out one by one, and permanent ones begin to grow in their place. This process is simultaneous: the weak roots of temporary teeth are absorbed, because the growing molar presses on them from the gums.

At this point, gaps (three) are formed between the milk teeth. This is due to the fact that the child’s jaw grows with age, and the new permanent teeth are larger than the temporary ones, and they need more space. Parents should carefully monitor this process: with an insufficient gap between the milk teeth, the permanent ones can grow crooked and spoil the bite. Pediatric dentists can put a special plate to increase the distance between the teeth.

The order of eruption of milk and molars is different. At 4-6 years old, the first molars begin to grow, and parents often mistake them for milk ones. These teeth do not fall out along with the temporary teeth, and the central and lateral incisors grow after them.

All permanent teeth (except wisdom teeth) are fully grown by 12-13 years of age, but full root formation ends at 18 years of age or a little earlier. Four wisdom teeth begin to grow after the age of 17, but in some people they may not erupt, which does not affect chewing function.

Signs of teething

The appearance of the first milk teeth is a normal physiological process, and, according to dentists, it should not be accompanied by any pathological symptoms. Indigestion, convulsions, vomiting during this period usually occur against the background of acute respiratory viral infections or existing chronic diseases.

General signs of the beginning of the growth of temporary teeth:

• redness and swelling of the gums,
• itching of the gums, due to which the baby puts toys and any hard objects in his mouth,
• possible appearance of a small hematoma at the site of the future tooth,
• profuse salivation and consequent irritation and rash on the chin and around the mouth,
• poor appetite,
• slight increase in temperature,
• tearfulness, sleep disturbance.

An increase in the distance between the teeth indicates that the change of milk teeth to permanent teeth will soon begin. In general, the symptoms of eruption of molars and temporary teeth are similar: the child may be naughty, eat poorly, his gums swell slightly and turn red. If you experience severe pain, you should consult with a pediatric dentist.

Painful teething: advice to parents

When a baby is teething, he especially needs the affection and attention of his parents. You need to try to distract the child from discomfort, play with him, walk more, read books.

Help relieve pain and discomfort:

• Massage gums. It can be done with your finger, after thoroughly washing your hands. You can wrap your finger with a sterile bandage – its slightly rough surface relieves itching well.
• Teethers. The older generation will definitely remember that during the eruption of the first milk teeth, children were given something hard to gnaw on – peeled carrots, drying, crackers, bread crusts. Now pharmacies sell special teethers – toys made of medical plastic (Fig. 2). They are absolutely safe for the child, and he is happy to hold bright objects with his gums.
• Special gels and ointments. The choice of pharmacy products is very wide: gels with a cooling effect relieve swelling of the gums, have an anti-inflammatory effect. Great care should be taken with gels that contain an anesthetic, for example, in the USA, such products are not allowed to be used for children, as they can cause heart rhythm disturbances and convulsions. Before buying such drugs, you should definitely consult a pediatrician.
• Folk remedies. A decoction of chamomile, lemon balm, sage infusion are used as a compress or rinse. Also, to relieve inflammation, you can lubricate the gums with a mixture of olive and clove oil. But it must be remembered that any herbal remedy can be a strong allergen, and it should be used with caution and only after consulting a doctor.

Figure 2. Teether. Source: freepik.com

How to care for milk teeth

Hygienic care of milk teeth should be started at the first signs of eruption. To do this, use a special silicone nozzle on the finger or brush for the first teeth. When brushing your teeth, you should follow simple rules:

• Brush your teeth in the morning and in the evening,
• Hold the brush or nozzle at a 45 degree angle,
• Teeth must be brushed on both sides, touching the gums,
• Up to 1.5 years it is better to do without toothpaste.

If a child develops cavities in their milk teeth, they must be treated to avoid severe pain and various complications, including fistulas and loss of future permanent teeth (video 1).

Video 1. Why is it so important to treat milk teeth? Tips for parents. Source: Russian Union of Pediatricians.

Should milk teeth be pulled out when they are loose

Usually milk teeth do not require extraction and fall out on their own. Do not rush them and try to immediately remove a slightly loose tooth. The first teeth are needed to guide the growth of the molars and the proper development of the jaw. However, if the tooth is already ready to fall out and interferes with the child, its loss can be accelerated. When preparing for a tooth loss, follow a few simple tips:

• have the child gradually loosen the tooth with the tongue;
• do not allow him to get into his mouth with his hands – this way you can easily infect the infection, and you can press too hard on the tooth with your finger;
• Baby teeth that fall out usually don’t bleed much, but if there is blood, ask the child to bite on wet gauze to help the blood clot quickly.

Severely decayed milk teeth can be extracted by a dentist, but in this case, if the permanent teeth are far from erupting, the help of an orthodontist will be needed to maintain chewing efficiency. Most often, chewing molars are removed, which are more difficult to reach with a toothbrush.

Teething abnormalities

Parents should carefully monitor the process of changing milk teeth to permanent teeth, since any violations in eruption threaten malocclusion, an unsightly smile and serious problems in adulthood.

Main disturbances in the process of eruption of molars:

• growth retardation due to hereditary factors or intrauterine developmental defects that do not allow the formation of the rudiments of permanent teeth;
• pain at the initial stage of eruption due to the absence of a reliable protective layer;
• late loss of milk teeth when they interfere with the growth of permanent ones;
• Loss of newly grown permanent teeth due to systemic pathologies or inflammatory gum disease.

All these violations require a mandatory visit to a pediatric dentist and strict adherence to his recommendations.

Conclusion

The erroneous belief that milk teeth do not require special care and attention, since they will fall out anyway and be replaced by permanent ones, threatens with big problems in the future.