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10. Teething and Tooth Care

Teething: 4 to 7 Months

​Teething usually starts during these months. The two front teeth (central incisors), either upper or lower, usually appear first, followed by the opposite front teeth. The first molars come in next, followed by the canines or eyeteeth.

The timing of teething: 

There is great variability in the timing of teething. If your child doesn’t show any teeth until later than this age period, don’t worry. The timing may be determined by heredity, and it doesn’t mean that anything is wrong.

How to ease your baby’s discomfort:

Teething occasionally may cause mild irritability, crying, a low-grade temperature (but not over 101 degrees Fahrenheit or 38.3 degrees Celsius), excessive drooling, and a desire to chew on something hard. More often, the gums around the new teeth will swell and be tender. Try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. (The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount. Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child’s pain, but the FDA has issued warnings against both due to potential side effects.​ If your child seems particularly miserable or has a fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius), it’s probably not because she’s teething, and you should consult your pediatrician.

How should you clean the new teeth? 

Simply brush them with a soft child’s toothbrush when you first start seeing her teeth. To prevent cavities, never let your baby fall asleep with a bottle, either at nap time or at night. By avoiding this situation, you’ll keep milk from pooling around the teeth and creating a breeding ground for decay.

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10. Teething and Tooth Care

Teething Necklaces and Beads: A Caution for Parents

​​​​​When parents see their baby suffering, they just want a solution. Teething necklaces and beads have become an increasing popular alternative treatment to ease teething pain. But, are they effective and safe? The answer is no.

The Food and Drug Administration (FDA) released an official warning in December 2018 after recieving reports of children choking on beads that break off and an 18-month-old being strangled to death by an amber necklace during a nap.

​Teething Necklaces: Watch Out For Faulty ClaimsTeething necklaces and bracelets are made of amber, wood, marble or silicone. They are marketed to relieve teething pain and sometimes are used to provide sensory stimulation to people with attention-deficit/hyperactivity disorder.
According to Dr. Andrew Weil, a world-renowned leader and pioneer in the field of integrative medicine, the use of these necklaces is not supported by modern science. Retailers claim that when warmed by the baby’s body temperature, the amber releases a pain-relieving substance that is then absorbed through the skin into the bloodstream. Additionally, promoters claim that they stimulate the thyroid gland (to control drooling) and improve the ability of the immune system to reduce inflammation in the ears, throat, stomach and respiratory system. However, there is currently no scientific research or evidence to back up these claims. 

Why These Teething Necklaces and Beads are Choking and Strangulation Hazards:

“The risk is two-fold — strangulation and choking,” said pediatrician Natasha Burgert, MD, FAAP. It occurs when the necklaces are worn around a child’s neck, especially when unsupervised (such as while sleeping) or if the child were to break the necklace and swallow the beads. However, those risks are not only for these teething necklaces.

The American Academy of Pediatrics (AAP) does not recommend that infants wear any jewelry. Suffocation is the leading cause of death for children under a year old and among the top five causes of death for children between the ages of 1 and 4.

Parents who choose to use these necklaces are advised to:

  • Always supervise your child when he or she is wearing the necklace or bracelet.
  • Have your child wear the necklace on a wrist or ankle and not around his or her neck.
  • Remember to remove the necklace or bracelet when your child is unattended, even if it is only for a short period of time!
  • Remove the necklace or bracelet while your child is sleeping (day or night).
  • Consider using alternate forms of teething pain relief (see suggestions below).
  • Talk to your child’s pediatrician if you have concerns or questions about your child’s health.

Safer Ways to Soothe a Teething Baby:

There are many teething-pain relievers that can soothe your baby’s sore gums safely. Here are a few worth trying:

  • Chew toys. Plastic and rubber toys are great for soothing aching gums.
  • Cold things. For help numbing and easing the ache and inflammation, try using damp washcloths that have been twisted and frozen (tie one end in a knot for better gnawing). Avoid teething rings that are frozen solid; they are too hard for children’s mouths.
  • Massage. A light, gentle rub or massage might give your little one a lot of relief. Remember to wash your hands, then massage the sore areas in your baby’s mouth with your finger or knuckle.
  • Medicine. When your baby is having a really tough time, ask your pediatrician about giving a dose of acetaminophen (Tylenol). Note: Numbing gels or creams that contain benzocaine are not recommended for infants.
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10. Teething and Tooth Care

How to Prevent Tooth Decay in Your Baby

Baby teeth are important. If baby teeth are lost too early, the teeth that are left may move and not leave any room for adult teeth to come in. Also, if tooth decay is not prevented, it can be costly to treat, cause pain, and lead to life-threatening infections. 

Tooth decay (called early childhood caries) is the most common chronic infectious disease of childhood. Tooth decay may also be called nursing caries or baby bottle tooth decay. 

Healthy dental habits should begin early because tooth decay can develop as soon as the first tooth comes in. Here is information for parents and caregivers from the American Academy of Pediatrics (AAP) about causes of tooth decay, signs of tooth decay, and how to prevent tooth decay. 

Causes of Tooth Decay in Babies

Tooth decay develops when a baby’s mouth is infected by acid-producing bacteria. Parents and caregivers can pass bacteria to babies through saliva. For example, bacteria is spread by sharing saliva on spoons or cups, testing foods before feeding them to babies, and cleaning off a pacifier in the parent’s or caregiver’s mouth. 

Tooth decay also develops when the child’s teeth and gums are exposed to any liquid or food other than water for long periods or frequently throughout the day. Natural or added sugars in the liquid or food are changed to acid by bacteria in the mouth. This acid then dissolves the outer part of the teeth, causing them to decay. 

The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice (even when mixed with water), soft drinks (soda, pop), sugar water, or sugared drinks. It can also occur when children are allowed to frequently drink anything other than water from a sippy cup or bottle during the day or night. Milk should be served only with meals and not offered throughout the day, at nap time or at bedtime. Although extended and frequent breastfeeding alone does not cause tooth decay, all breastfeeding mothers should be aware of and follow oral hygiene, fluoride, preventive dental care, and healthy diet recommendations.

Signs of Tooth Decay in Babies

Tooth decay might first appear as white spots at the gum line on the upper front teeth. These spots are hard to see at first—even for a child’s doctor or dentist—without proper equipment. A child with tooth decay needs to be examined and treated early to stop the decay from spreading and to prevent further damage. 

How to Prevent Tooth Decay in Babies

Take the following steps to prevent tooth decay: 

  • Take good care of your own oral health even before your baby is born. It is important and OK to see a dentist for oral care while you are pregnant.
  • Whether you choose to breastfeed or bottle-feedit is important to take good care of your baby’s teeth.
    • Birth to 12 months: Keep your baby’s mouth clean by gently wiping the gums with a clean baby washcloth. Once you see the first teeth, gently brush using a soft baby toothbrush and a smear (grain of rice) of fluoride toothpaste.
    • 12 to 36 months: Brush your child’s teeth 2 times per day for 2 minutes. Use a smear of fluoride toothpaste until your child’s third birthday. The best times to brush are after breakfast and before bed.
  • Never put your child to bed with a bottle or food. This not only exposes your child’s teeth to sugars but can also put your child at risk for ear infections and choking.
  • Do not use a bottle or sippy cup as a pacifier or let your child walk around with or drink from one for long periods. If your child wants to have the bottle or sippy cup in between meals, fill it with only water.
  • Check to see if your water is fluoridated. Your child will benefit from drinking water with fluoride in it. If your tap water comes from a well or another non-fluoridated source, your child’s doctor or dentist may want to have a water sample tested for natural fluoride content. If your tap water does not have enough fluoride, your child’s doctor or dentist may prescribe a fluoride supplement. He or she may also apply fluoride varnish to your child’s teeth to protect them from decay.
  • Teach your child to drink from a regular cup as soon as possible, preferably by 12 to 15 months of age. Drinking from a cup is less likely to cause liquid to collect around the teeth. Also, a cup cannot be taken to bed.
  • If your child must have a bottle or sippy cup for long periods, fill it with water only. During car rides, offer only water if your child is thirsty.
  • Limit the amount of sweet or sticky foods your child eats, such as candy, gummies, cookies, Fruit Roll-Ups, or cookies. Sugar is in foods like crackers and chips too. These foods are especially bad if your child snacks on them a lot. They should be eaten only at mealtime. Teach your child to use his tongue to clean food immediately off the teeth.
  • Serve juice only during meals or not at all. The AAP does not recommend juice for babies younger than 6 months. If juice is given to babies between 6 to 12 months, it should be limited to 4 ounces per day and should be diluted with water (half water, half juice). For children 1 to 6 years, any juice served should be limited to 4 to 6 ounces per day.
  • Make an appointment to have your child see the dentist before the age of 1. If you have concerns, the dentist can see your child sooner. Find a pediatric dentist in your area on the American Academy of Pediatric Dentistry Web site or insurekidsnow.gov​. If no dentist is available to see your child by age 1, your pediatrician can look inside of your child’s mouth, apply fluoride varnish, and talk with you about how to keep her healthy.

Remember

Tooth decay can be prevented. Talk with your child’s doctor or dentist if you see any sign of decay in your child’s teeth or if you have questions about your child’s teeth. With the right care, your child can grow up to have healthy teeth for a lifetime of smiles. 

The AAP recommends that: 

  • All infants receive oral health risk assessments during well-child visits starting at 6 months of age and periodic fluoride varnish application from the time the first tooth erupts through 5 years of age.
  • All children should be referred to a dentist as early as 6 months of age to establish a dental home. If a dentist is not available, talk with your pediatrician about how to maintain your child’s oral health and find a dental home.
  • All children in their early toddler years should have a thorough initial dental examination and regular dental care whenever possible.
  • Parents should limit food and drink exposure over the course of the day to 3 meals and 2 snacks (with healthy food choices and limited juice). More frequent exposure to sugars in foods and drinks makes it more likely that children will develop decay.
  • Parents should brush their children’s teeth with fluoride toothpaste as soon as they can see the first tooth coming in (erupting).  
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10. Teething and Tooth Care

How to Help Teething Symptoms without Medications

Teething Toys

​Find something for your little gnawer that’s cool to touch but tough to chew on—a wet washcloth chilled in the freezer for 15 to 30 minutes, a frozen banana or berries if you’ve introduced solids, solid (not liquid-filled) teething rings chilled in the fridge or freezer (take them out before they are rock hard), a frozen bagel, your finger, or a “lovey”-type toy.

If Your Baby is Older than 6 to 9 Months:

Offer a slow-flow sippy cup of cool water to suck on and drink for comfort. Of note, plastic teething rings with liquids have been given a bad name in the past few years due to recalls— potential bacteria growing in liquid and the possibility of a baby cutting through the ring and into the liquid.

As many parents try to avoid plastics (due to presence of phthalates/BPA), use the washcloth method or a cotton sock rolled up tightly to gnaw on. Silicone and latex chewy toys may be a safer bet.

Fingers

Let your baby gnaw on your fingers (if his or her teeth haven’t come through), or rub your baby’s gums with your clean fingers for comfort.

Massage

If you’re breastfeeding and your baby isn’t interested in a teething toy but more interested in chewing on your nipples (eeeeeek) or your arms, especially around the time of feeding, massage your baby’s gums with your fingers dipped in cool water prior to starting a feeding.

Clean teething toys, washcloths, or socks after each use. And know that it’s absolutely fine to let your baby chew all day if he or she enjoys it. Still, nothing about gnawing means pain.

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10. Teething and Tooth Care

Drooling and Your Baby

​Drooling and blowing bubbles is common in babies during the phase of development when getting what they need is centered on the mouth. This becomes especially apparent at 3 to 6 months of age. The increased flow of saliva that often signals the appearance of a new tooth seems to soothe tender gums; however, if your baby appears to be drooling excessively and looks ill, she may be having trouble swallowing, which requires medical attention.

The Role of Saliva

Drooling fulfills several important functions for your baby.

  • Softens and moistens food once solids are part of your baby’s diet
  • Keeps your baby’s mouth moist
  • Makes it easier for your baby him to swallow
  • Washes away food residues
  • Protects your baby’s teeth

Saliva also contains ptyalin, a digestive enzyme that changes starch into sugar. A natural antacid in saliva neutralizes stomach acid and aids digestion. Saliva also protects against tooth decay.

Warning!

If your child is suddenly drooling, can’t speak, and is having trouble breathing, she may be choking on food or a foreign object. Call 911 or your local emergency number, and while you’re waiting for help, follow the first aid procedures related to choking.Choking First Aid Chart

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10. Teething and Tooth Care

Baby’s First Tooth: 7 Facts Parents Should Know

​​​​​

1.  Most babies will develop teeth between 6 and 12 months.

There is a wide range of variability of when a first tooth may appear—some babies may not have any teeth by their first birthday! Around 3 months of age, babies will begin exploring the world with their mouth and have increased saliva and start to put their hands in their mouth. Many parents question whether or not this means that their baby is teething, but a first tooth usually appears around 6 months old. Typically, the first teeth to come in are almost always the lower front teeth (the lower central incisors), and most children will usually have all of their baby teeth by age 3.

2.  Fluoride should be added to your child’s diet at 6 months of age.

Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin him or her on solid foods (about 6 months of age). Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water. 

3.  Massaging sore gums, offering something cold, or acetaminophen, on an occasional rough night, can help soothe your baby’s teething pain.

Usually teething doesn’t cause children too much discomfort, however, many parents can tell when their baby is teething. Babies may show signs of discomfort in the area where the tooth is coming in, the gums around the tooth may be swollen and tender, and the baby may drool a lot more than usual.

Parents can help ease teething pain by massaging their baby’s gums with clean fingers, offering solid, not liquid-filled, teething rings, or a clean frozen or wet washcloth. If you offer a teething biscuit, make sure to watch your baby while he or she is eating it. Chunks can break off easily and can lead to choking. Also, these biscuits are not very nutritious and most contain sugar and salt.

A baby’s body temperature may slightly rise when teething; however, according to a 2016 study in Pediatrics, a true fever (temperature over 100.4 degrees Fahrenheit or 38 degrees Celsius) is not associated with teething and is actually a sign of an illness or infection that may require treatment. If your baby is clearly uncomfortable, talk with your pediatrician about giving a weight-appropriate dose of acetaminophen (e.g., Tylenol) or if over 6 months, ibuprofen (e.g., Advil, Motrin). Make sure to ask your pediatrician for the right dose in milliliters (mL) based on your child’s age and weight.

Many children, however, will have no problems at all when their teeth come in!

4.  Do not use teething tablets, gels with benzocaine, homeopathic teething gels or tablets, or amber teething necklaces.

Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child’s pain, but the FDA has issued warnings against both due to potential side effects.

In addition, amber teething necklaces are not recommended. Necklaces placed around an infant’s neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace’s effectiveness.

5.  You should brush your child’s teeth twice a day with fluoride toothpaste.

Once your child has a tooth, you should be brushing them twice a day with a smear of fluoride toothpaste the size of a grain of rice, especially after the last drink or food of the day. Remember not to put your baby to bed with a bottle—it can lead to tooth decay.

Once your child turns 3, the American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD)recommend that a pea-sized amount of fluoride toothpaste be used when brushing. When your child is able, teach him or her to spit out the excess toothpaste. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until he or she is around 7 or 8 years old. When your child can write his or her name well, he or she also has the ability to brush well.

6.  Ask your pediatrician about your baby’s teeth and fluoride varnish.

During regular well-child visits, your pediatrician will check your baby’s teeth and gums to ensure they are healthy and talk to you about how to keep them that way.  The AAP and the United States Preventive Services Task Force also recommend that children receive fluoride varnish once they have teeth. If your child does not yet have a dentist, ask your pediatrician if he or she can apply fluoride varnish to your baby’s teeth. Once your child has a dentist, the varnish can be applied in the dental office. The earlier your child receives fluoride varnish the better to help prevent tooth decay.

7.  Make your first dental appointment when the first tooth appears.

Try to make your baby’s first dental appointment after the eruption of the first tooth and by his or her first birthday.

Both the AAP and the AAPD recommend that all children see a pediatric dentist and establish a “dental home” by age one. A pediatric dentist will make sure all teeth are developing normally and that there are no dental problems. He or she will also give you further advice on proper hygiene. If you don’t have a pediatric dentist in your community, find a general dentist who is comfortable seeing young children.

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10. Teething and Tooth Care

Baby Teething Pain

Baby Teething Pain - HealthyChildren.org

​Discomfort from teething, which may begin as early as 3 months, can wake a baby. The gums around the emerging teeth may be swollen and tender.

How to Ease Your Baby’s Teething Pain:

Chew toys

  • Plastic and rubber toys are great for soothing aching gums. Note: Teething necklaces and bracelets are made of amber, wood, marble or silicone are choking and strangulation hazards; the Food and Drug Administration (FDA) warns against them.  

Cold things

  • For help numbing and easing the ache and inflammation, try using damp washcloths that have been twisted and frozen (tie one end in a knot for better gnawing). Avoid teething rings that are frozen solid; they are too hard for children’s mouths.

Massage

  • A light, gentle rub or massage might give your little one a lot of relief. Remember to wash your hands, then massage the sore areas in your baby’s mouth with your finger or knuckle.

Medication

  • Pain relievers intended to be rubbed on a baby’s gums aren’t very helpful; a teething baby drools so much that the medication is quickly washed away. In addition, pediatricians warn that such medications can numb the back of the throat and interfere with your baby’s ability to swallow. If your baby is clearly uncomfortable, talk to your pediatrician about giving a dose of acetaminophen (Tylenol). Note: Numbing gels or creams that contain benzocaine are not recommended for infants.

Side Effects of Teething:

Fever, vomiting, diarrhea

  • When your baby’s teeth are coming through, she may also have a very slight increase in temperature. But if her temperature reaches 100.4°F (38°C) or above, it’s not because of teething. If your baby has symptoms such as fever, vomiting, or diarrhea while teething, consult your pediatrician to find out whether she has a medical condition requiring treatment.

Keep Usual Bedtime Routine:

If your teething baby is irritable, try to make her comfortable, but keep to your usual bedtime routine. Changing the routine, even for a few nights, may only lead to sleep troubles.

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10. Teething and Tooth Care

Teething and Tooth Care

Teething usually starts between four to seven months. The two front teeth (central incisors), either upper or lower, usually appear first, followed by the opposite front teeth. The first molars come in next, followed by the canines or eyeteeth.