Cutting teeth isn't one of those milestones a baby reaches all at once. Transitioning from that gummy grin to a mouthful of gleaming teeth is a rite of passage that can take your little one three years to complete. Whenever the first tooth peeks through, celebrate it by taking pictures and noting its arrival date in your child's baby book.
By the time your little one is 3, he'll have a mouthful of choppers that he can brush himself, a basic step on the road to self care. (Because he won't have the skills to do a good job, though, be sure to lend him a hand until he's at least 6 years old.)
The journey starts in the womb. While you were pregnant, your baby developed tooth buds, the foundation for baby teeth (also called milk teeth). Only one in 2,000 babies is born with teeth, though. The vast majority sprout their first tooth between 4 and 7 months of age.
If your baby's an early developer, you may see his first white cap (usually one of the bottom middle teeth) as early as 3 months. If he's a late bloomer you may have to wait until he's a year old or more. The last teeth to appear (the second molars, found in the very back of the mouth on the top and bottom) have usually begun coming into place by your baby's second birthday. By age 3, your child should have a full set of 20 baby teeth.
While some babies breeze through the teething process, many seem to struggle with it and experience discomfort. Among the symptoms your teething baby may exhibit:
- Drooling (which can lead to a facial rash)
- Gum swelling and sensitivity
- Irritability or fussiness
- Biting behavior
- Refusing food
- Sleep problems
Most babies get new teeth in this order: First the bottom two middle ones, then the top two middle ones, then the ones along the sides and back.
Baby teeth won't fall out until your child's permanent teeth are ready to come in, beginning around age 6.
You can't do anything to make teeth appear, but you can comfort your baby if you think the process troubles him. Give him something to chew on, such as a teething ring or a wet washcloth cooled in the refrigerator. He may also get some relief from eating cold foods, like applesauce or yogurt. Massaging his gums is another way to soothe his discomfort — after washing your hands, rub his gums gently but firmly with your finger. The pressure provides a welcome balance to the pressure your baby feels coming from the buried teeth below.
If none of this helps, your doctor may suggest giving your baby children's acetaminophen to ease the pain and inflammation. Rubbing the gums with a topical pain relief gel is also an option, but you may want to ask the doctor before trying it. If you use too much, it can numb the back of your baby's throat and weaken his gag reflex (which helps keep him from choking on his saliva).
Once your baby's teeth are in, it's up to you to keep them clean. For the first year, you won't really need to brush them, but you should clean his teeth and gums at least twice a day by wiping them with gauze or a wet washcloth.
Never put your baby to bed with a bottle(unless the bottle is filled with water). That's because the sugars in formula and breast milk will sit on his teeth all night and can lead to a condition known as baby-bottle tooth decay, or bottle rot. Another way to avoid this condition and reduce the risk of cavities is to transition your baby from a bottle to a cupby sometime around his first birthday, when he's coordinated enough to manage it. When your child drinks out of a sippy cup, he's more likely to finish his drink in a short time — and avoid the prolonged exposure to sugars that comes with sipping from a bottle all day long.
The 6-month well-baby checkup is a good time to ask your child's doctor whether your baby needs fluoride (these cavity-fighting drops are necessary only if the water supply in your area isn't fluoridated). You should also ask the doctor to examine your child's teeth. Your baby's first dentist visit should happen around the time he turns 1. If he hasn't sprouted his first tooth by then, talk to your doctor, who can let you know whether or not a visit to the dentist is necessary.
At about 18 months, your child may be ready to start learning to brush his teeth. You'll have to help, since he won't have the dexterity or concentration to successfully maneuver a toothbrush. Use a soft brush and — if you like — a small dollop (about the size of a pea) of non-fluoridated toothpaste. (The American Academy of Pediatric Dentistry recommends waiting to use fluoridated toothpaste until your child is 2 to 3 years old, and even then using only a pea-sized amount.)
You don't have to brush in a certain direction; just try to get any food particles out. If your child doesn't like the taste of the toothpaste, try another brand or skip it entirely. You don't really need to use toothpaste with your young child unless his diet includes lots of sugary foods — which you should avoid anyway. If he does indulge in sweets (at a birthday party, for example), be sure to brush his teeth soon after he eats.
When to be concerned
If by the end of the first year you still don't see any sign of a tooth, bring the matter up at your child's 12-month checkup. (Premature babies may be a few months behind in getting their teeth.)
If your child has all the signs of teething — heavy drooling, swollen gums — but also seems to be having unusual pain (crying inconsolably is a big clue), call his doctor. Teething shouldn't be an excruciating ordeal for a baby.
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