Your baby's adorable toothless grin will soon show little teeth. But even before she gets her first tooth, you need to start thinking about dental care to ensure she develops a healthy set of pearly whites. Here, answers to your questions about your child's oral health, from babyhood on up.
When will my baby get his first tooth?
Most babies get their first tooth around 6 months, but it can appear as early as 3 months or as late as 14 months -- so don't worry if your baby hits the 1-year mark without his first chomper. Typically, babies get teeth in pairs and they generally emerge in this order:
- The bottom front teeth (incisors)
- The top front teeth (incisors)
- The bottom side teeth (incisors) and the upper side ones
- The first molars (grinding teeth at the back of the mouth)
- The canines (pointed teeth next to incisors)
- The second molars
But every child is different. It's not uncommon to see a baby with four bottom and no upper teeth, or the reverse. It's even possible for the lateral incisors to come in first, creating a snaggletoothed look. By age 2 1/2, most children will have about 20 teeth.
Soothing your teething baby
Cutting a tooth doesn't always go hand in hand with discomfort and sleepless nights. Many parents scarcely notice their child is teething until they spot a tiny pearl poking through their baby's red gum. But some babies provide plenty of warning that teeth are on the way. Common symptoms in the weeks before teeth sprout include excessive crankiness, frequent crying, a change in appetite, lots of drooling, gnawing, and even ear pulling. Swelling in the gums is the source of the pain.
You can alleviate your baby's discomfort by providing something to chomp on -- a chilled washcloth, cold teething toys, or rings filled with water (the coldness numbs sore gums). Distraction can work, too: Give her a little extra one-on-one playtime, and lots of cuddling. (For more teething soothers, see our Teething guide.)
If none of these tactics works, ask your pediatrician about using infant acetaminophen. You should also call her if your child is inconsolable.
Pacifiers and teething
A Binky can be very soothing to a teething baby. But sucking on a pacifier past age 3 can make a bad overbite or cross bite worse. Also, some experts think that children with speech impediments (like lisps) should avoid pacifiers altogether since they may aggravate the situation. To figure out what's best for your child, talk with your doctor.
Brushing baby teeth
Even though baby teeth eventually fall out, it's important to take care of them, as they are important for speech development, eating, and ensuring proper placement of permanent teeth.
Before teeth appear: Clean your baby's gums with a damp cloth a couple of times a day (ideally either after feedings or before sleeping) to get him used to the feeling.
Once the first tooth appears: Gently rub the tooth with a washcloth twice a day. Never put your baby to sleep with a bottle -- the sugars in milk can cause tooth decay.
When your baby has several teeth: Start brushing with a soft-bristled toothbrush.
A word on toothpaste
There's no need for toothpaste initially, but toddlers -- who want to imitate their parents -- often love it. If you do use toothpaste, use only a tiny amount of non-fluoridated paste (a blob smaller than a pea, since infants and toddlers often swallow it). Keep using the non-fluoridated variety until your child can spit it all out, because swallowing too much fluoride can cause fluorosis, a discoloration of future permanent teeth.
Helping kids brush
The twice-a-day rule can seem like a lot to a kid. And until he's 5 or 6, your child won't have the fine motor skills to maneuver the brush himself. You'll have to brush for him (you'll also be the one flossing for him once a day until he's around 10 or so). When he's about 3, you can try placing your hand over his as he brushes. Some general tips for making brushing time easier:
Give him some control. Set up his own caddy -- with toothbrushes, a colorful cup, a timer (1 minute for the top teeth and 1 minute for the bottom), and a mirror. He can choose the brush, set the timer, and watch himself.
Turn it into a game. As you brush (using circular motions), tell your child you're scrubbing the upstairs and downstairs teeth, the front door, and the rooms in the back. Or that you're chasing cave monsters around his mouth. Or tell him you'll brush for the length of a favorite song. This should enable you to brush his teeth for the recommended two minutes.
Consider buying an electric toothbrush for kids over 3. They've been shown to do a considerably better job of removing plaque than manual brushes do.
Visiting the dentist
The American Academy of Pediatric Dentistry recommends that you take your child in for an initial dental visit at around 12 months. Other experts recommend waiting until she's closer to 2. Talk with your pediatrician about what's best for your child. Once she starts going to the dentist, you should aim for a checkup twice a year. Just remember: The main goal is establishing good habits early.
Making dental visits less scary
If your child is old enough to understand about going to the dentist, there are several things you can do to ease anxiety:
Give a sneak preview. Take her with you to your next checkup to get her used to the sights and sounds, and let her watch you as you have your mouth probed and teeth cleaned. She'll see that though the tooth polisher is noisy, it doesn't hurt.
Choose a kid-friendly dentist. Pediatric dentists are trained in child development and understand how to make kids comfortable. Besides having an upbeat, patient manner, the dentist should add kid-friendly elements to the exam. Some provide sunglasses to block out the bright examining lights and toys to keep their minds off their mouths. Others use puppets to teach proper brushing, and offer post-exam treats like stickers. Ask your pediatrician for a referral, or check out aapd.org to find a pediatric dentist near you.
Role-play. Starting a week or two before your child's appointment, take turns being the dentist and the patient. Examine each other's teeth with a mirror and use fingers to count them. This way,she'll be familiar with how it'll likely feel when the dentist does it.
Go when you and your child are well rested. If you need to rush back to work or she's tired, the visit will be off to a bad start before you even arrive.
What to do about a knocked-out tooth
A knocked-out baby tooth looks worse than it actually is. While it can't be reimplanted like permanent teeth can, it's unlikely that your child's future teeth will be affected. Ditto for his speech development. He may have a lisp for a little while, that's all.
If it looks as though your child has injured more than just his tooth, go to an emergency room, where a doctor can check his face, mouth, and gums. Otherwise:
- Apply direct pressure to the gum with a clean washcloth or rolled-up piece of gauze. If he's old enough to understand, have him bite down on it gently.
- Find the missing tooth and put it in a small plastic bag. Even though it can't be reinserted, your dentist may still want to see it.
- Call your dentist. Depending on the injury, he may simply advise you to put your child on a soft diet for the next 48 to 72 hours. He may also suggest that you bring your child in for an x ray. This will help him determine whether there's been damage to the nerve or to a secondary tooth, or whether there are missing tooth fragments, which can cause adult teeth to come in crooked. If a baby molar gets knocked out, the dentist may put in spacers to guide in future teeth.
If your child knocks out a permanent tooth, that's an entirely different story. These can and should be reimplanted, a process that's successful if you act fast:
- Rinse the tooth in water (don't scrub it)
- Put it back in your child's mouth (or, if you can't, in a glass of milk).
- Take your child and the tooth to the dentist or, if it's off-hours, the emergency room.
Kids and teeth grinding
Though teeth grinding (also called bruxism) can hurt little teeth, most kids outgrow it before any harm is done. Unlike adults, who grind their teeth during sleep due to subconscious tension, children usually do it out of habit, or for a physical reason. For instance, teeth grinding is often linked to allergies or fluid in the middle ear. When fluid fills the tiny tube that connects the throat to the middle ear, pressure builds up. Your child may attempt to relieve it by moving her jaw in a grinding motion. See your pediatrician if you suspect either of these as a cause.
If your child grinds her teeth during the day, pay attention to what triggers it: Is she overly tired, bored, or upset? If so, discuss strategies with your dentist. For example, you may want to get her involved in a fun activity that gets her mind off her teeth, or help her substitute teeth grinding with some harmless habit.
Dental care is a key component of your child's overall health. Even before your baby cuts his first teeth, make sure you start practicing good oral hygiene, and check in with your pediatrician and dentist regularly.