Common Questions about Tooth Development in Babies and Children

When do teeth first form?

Baby Teeth DevelopmentTeeth begin to form even before a baby is born. The first tooth usually erupts through the gum by the 6th to 7th month, but some children may not get their first tooth until after the age of 12 months. Usually, the lower teeth grow out before the upper teeth. By 18 months, babies usually have 12 teeth and by 3 years, all 20 of the primary teeth will have erupted.

When does teething start and what can be done?

Babies often have symptoms of drooling even a month or two before the first tooth erupts. While teething, they may be uncomfortable or more irritable. This can be soothed by offering them a government approved “one- piece teething ring” (cold is better). If a baby is still very uncomfortable, acetaminophen drops(Tylenol, Tempra)as directed, may help. Gels that are available for teething pain relief should not be used as they contain a freezing (anaesthetic) medication that if swallowed or goes into the throat area, may be dangerous for the child.

Does teething cause fever or other symptoms?

Many myths exist about what other symptoms teething can cause, ranging from high fever to a cold, to diarrhea. It is currently believed that these are not caused by teething. If indeed these symptoms are present, especially fever, they should not be assumed to be due to teething. Parents should consult their pediatrician for these symptoms even if the child is teething at the same time.

Why do babies get primary teeth?

Although primary or baby teeth are not permanent they do play an important role, as they are necessary for chewing and eating, provide space (and guide) permanent teeth into position and allow the jaw bones and muscles to develop normally. Also, some teeth especially the molars are not replaced until the teenage years and so they will serve a child for 10 years or more.

When should baby’s teeth be brushed and flossed?

Oral hygiene and care is essential. As soon a teeth develop they should be cleaned daily with a wet gauze or wash cloth. Review proper tooth brushing techniques with your dentist, and be sure that your child can brush properly before allowing him/her to brush on their own. As long as the spaces between the teeth are wide enough to allow the toothbrush access, flossing is not necessary. As soon as the spaces between the teeth are tight enough to allow it regular, daily flossing should also begin.

What about cavity prevention?

The development of dental caries depends more on how often a child consumes sugary foods rather than the exact amount. In children who still drink form the bottle one of the most important causes of caries is putting them to bed with a bottle. Both juice and milk contain sugar, which remains on the babies teeth over-night resulting in the formation of “Nursing Bottle Caries”, usually in the upper teeth. Modifying the diet to decrease the frequency of sugar consumption is very important. Bottle fed children, should never be put to bed with the bottle. If this is not possible, at least give them water at naptime or bed time. Also, baby’s pacifier should not be dipped in sweet liquids.

Are fluoride drops necessary?

Fluoride is the most effective measure against dental caries and depending on local fluoride levels in the drinking water, children may need additional supplementation. Your local municipality should be able to tell you the amount of fluoride in your drinking water. Knowing this, your doctor can then decide if and when supplementation is needed and how much. This is important as we do not want to give too much fluoride to children.

When can toothpaste be used?

When brushing teeth in older children, toothpaste (which contains fluoride) should be put sparingly on the toothbrush, the size of a pea and no larger; as again we want to avoid excessive fluoride ingestion. For the same reason, begin using toothpaste only when your child is old enough to understand not to swallow it.

When should baby visit the dentist?

The American Academy of Pediatric Dentistry currently recommends that the first dental visit be scheduled at 1 year of age or 6 months after the first tooth erupts….which-ever comes first. This gives the dentist the opportunity to examine for existing problems/caries, assess overall oral hygeine and health and look for any abnormalities in the dental development. The first visit, in general is a “Get to know one another visit”. Obviously if there is an injury to the teeth or if there are signs of discoloration or tooth decay a Pediatric dentist should be seen earlier.


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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.