Teeth part 2- Teething

Teething

Sometime between birth and 3, your child will cut about 20 teeth. Exactly when and in which order varies from child to child. On average, the first tooth appears at around 6 months. I have known children who were born with teeth and others who did not get one tooth until they were a year old. Some children get two at a time, first the bottom front then a week later, the upper front and so on (as is the suggested schedule). Others get one tooth then nothing for a month or more and some babies will get one tooth after another for a period of time. Any milestones for teething have to be very general.

Teeth that are present at birth (called “natal teeth”) are generally extra teeth and the doctor may recommend that they be removed.  If not, they should be taken care of and cleaned.

Symptoms

During teething, babies may not feel good. Some may run a fever and some may lose their appetite. Diarrhea is not uncommon during teething. You might see increased drooling, swollen gums and even a rash around the cheek area. Your baby may seem irritable and may be restless. You might even see the baby pulling on an ear.  One problem is that these are all also signs of other illnesses. It is easy to blame everything on teething but it may not be. I was guilty of this. My daughter had cut two teeth when she exhibited a fever and was cranky. I said “teething” but three days later she broke out with a rash so I took her to the doctor. She had Roseola, a childhood illness like measles, which was contagious. She did not get any more teeth for another month.

What to do

It is called “cutting teeth” because the teeth are literally cutting through the gums. This is often not a pleasant experience for baby and therefore not a pleasant experience for anyone who lives with him. There are some things that may help. Chewing on soft things, cold and massaging the gums may help. Cold, clean (but not frozen) teething rings may help. Allowing the baby to suck on a cold wet cloth may help for a while. Massaging the gum with your finger may help but be careful because those teeth are sharp when they start to poke through.  Remember that tooth decay is caused by bacteria so be sure everything that goes in the mouth (and that may be everything that goes into baby’s hand) should be clean.

What not to do

Teething biscuits are NOT recommended because they stick to the teeth and promote tooth decay. Frozen teethers could damage your baby’s gums so cold is good, frozen is not. There are a number of numbing gels and creams that provide some relief but care should be taken when using these and you should consult your pediatrician regarding the latest guidelines on their use.  There are some concerns about one of the main ingredients in these gels (benzocaine) so be careful about using these. 

Note that this post follows the post on care of the teeth. That is because care of the teeth should begin before the teeth start coming in. Below is a rough timeline of teething courtesy of Health Link BC.

Teeth part 1

HEALTHY TEETH START IN INFANCY

 

 

HEALTHY TEETH START IN INFANCY

Healthy teeth are important for your appearance but also for your health. Recent studies have shown that children miss as much school for tooth problems as for Asthma. Anybody who has had a toothache knows that it is not a pleasant experience. And those of you who have never had a cavity are either very lucky or know how to take care of your teeth.  Tooth health has been connected to other health issues as well, including heart trouble. 

Baby teeth

Tooth care should begin before the first tooth appears. Many people think that “milk teeth” are not important because they will come out eventually. This is not true. “Milk teeth” are important. Baby teeth are used to learn to chew and process food. Much of a child’s growth occurs in the first five years which includes much of the structure of the face and jaw. Missing teeth will impact that growth.  They play a role in learning how to speak both because they are used in speaking and they are important in face development.  Perhaps, most important, baby teeth hold space open for the permanent teeth when they come in. If baby teeth are missing, the mouth may not have room for permanent teeth. 

Another issue is that decay in baby teeth, especially if severe, can cause decay in permanent teeth. First of all, the decay can actually go up to the growing teeth and children with severe bottle mouth have had already decayed teeth grow in. Secondly, It is thought that tooth decay is caused by bacteria, which will be present in the mouth when the permanent teeth grow in, so one must take care of baby teeth.

Cleaning the mouth and teeth

When do you start cleaning your baby’s teeth.  You should start before the first tooth comes in.  Aside from keeping your baby’s mouth clean, starting early makes caring for teeth an easy routine. If you try to start cleaning the mouth of an 18 month old you will find resistance.  From the start clean your baby’s gums twice a day, after the morning feeding and before bedtime at night. Here is how.

1.      Lay baby on your lap with head towards you, face up.

2.      Use a soft wash cloth

3.      Use only water, no toothpaste of any kind

4.      Place wet cloth over your finger and gently rub the inside and outside of the upper and lower gums. Some theories recommend that you start at the outside and rub to the center on one side then go to the outside of the other side and rub towards the center. Do the outside then on the inside of the upper before going to the lower gum.

When the first teeth appear (usually between 5 and 7 months) it may be time to start using a small soft toothbrush specifically made for infants. The toothbrush should be replaced every 2 months (as should yours). The pediatric dental association recommends that NO fluoride be used until a child is over 2 years old. It is not necessary to use toothpaste at all until then (plain water will clean the teeth) but if you want to introduce toothpaste be sure to get one especially made for infants.

Bottle mouth

In addition to cleaning the teeth, there are other preventative measures that you should take. Most people have heard of “bottle mouth”. This is decay in the front teeth due to extended sucking on a bottle containing milk or juice.  This is particularly a danger when babies take a bottle to bed. Breast fed babies do not get bottle mouth from breast feeding because it is a rare mother who will let baby “nibble” on the breast for long enough to cause the problem but it is not impossible. Use the bottle only for feeding and remove it when feeding is over. Do not let the baby keep the bottle in the mouth when sleeping. Remove it from the crib. The worst offender is juice bottles but milk also contains sugars and will decay teeth. It is recommended that only water be given in bottles after the evening feeding.  Some dentists recommend that juice never be given in a bottle. Introduce the cup at about 8 months and there is no need to offer juice until it can be taken by cup.

Other causes of decay

In that vein, avoiding sugary foods as much as possible is helpful. For the teeth, continuous contact with these foods is the problem so definitely avoid letting your little ones walk around the house with snacks all day or chew on sweet biscuits for hours at a time.

Bacteria is the main cause of tooth decay and this bacteria can spread from mouth to mouth. If the whole family has healthy teeth there is less chance that baby will have tooth decay. In any case you should not put toothbrushes, spoons or pacifiers from your mouth to the baby’s. Toys and pacifiers should be kept clean and the latter should be replaced frequently. To avoid problems of misshapen teeth, it is recommended that pacifiers be discontinued by about 15 months of age.

The dentist

The first dentist visit should be early if only to help the child become accustomed to going to the dentist. Some pediatric dentists recommend the first visit take place soon after the first tooth comes in. Others  recommend sometime between the first tooth and the first twenty, which means between 8 months and about 2 years. Around the first birthday is a good target for the first dentist visit. If you have older children, it is easy to bring the baby to a visit for one of the older children. The first visit rarely takes more that about 5 minutes unless you have concerns but it helps baby become comfortable about going and gives the dentist a chance to head off any tooth or mouth problems that may occur.

It is important to take the care of your baby’s mouth and teeth very seriously to lay a foundation for healthy habits and healthy teeth throughout life.