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Ask Dr. Sears: Toothless Ten-Month-Old

Q. My 10-month-old hasn't started teething yet, but I can see the beginning of 2 teeth -- one on top and one on the bottom, just barely under his gums. It's been about a month now, and they still haven't completely come through. He's eating several table foods now, and doesn't seem to be in any pain. Should I be concerned about his toothlessness?

A. When the first teeth appear is as variable as when babies take their first steps. Some babies teethe sooner, others later, but the average baby shows the first nubbins of pearly whites around six months old. Also, the timing of teething tends to be hereditary. Ask your own mother: if she kept a developmental milestone book of your babyhood, you may discover that you were also a late teether! Gender plays a slight difference as well -- girls tend to teethe earlier than boys. When they do come in, usually lower teeth appear before the uppers and often teeth appear two by two -- two lowers and then two uppers. Expect an average of a new tooth a month until a full set of twenty baby teeth erupt by two and a half years of age.

Having observed thousands of teething babies over my 35 years as a pediatrician, I have the general impression that late teethers tend to be more painful teethers. This is possibly because a bunch of teeth tend to punch through those tender gums all at once, rather than one or two at a time.

During teething time, expect the following teething nuisances:

Excess drooling. It collects around the lips and chin, especially at night, causing a "drool rash" on the cheeks. Wipe the excess drool off baby's face as frequently as you can, and lubricate the sensitive skin with an emollient, such as Soothe and Heal by Lansinoh, that acts as a barrier between drool and skin. "Drool diarrhea" can also occur, since excess saliva acts as a laxative. This is normal and harmless. During teething, some babies produce saliva faster than they can swallow it, leading to a drool cough and sputtery sounds due to the excess saliva collecting in the back of the throat.

Fever and crankiness. When those little teeth twist and turn their way through the gums, they cause inflammation of the tissue, which produces pain and a low-grade fever (rarely more than 101°F). Letting your baby gnaw on something cold, such as a frozen banana or a homemade 100-percent-juice popsicle, can ease teething pain. If the teething pain and fever is enough to cause him to wake at night, an appropriate dose of acetaminophen given right before bedtime may help.

Bothersome biting. Expect your baby to gnaw on his favorite "pacifiers" (your knuckles or even your nipples if you are breastfeeding) to ease teething discomfort. This temporary nuisance subsides once a few teeth have erupted and may start up again with the next set of teeth.

So, don't worry that your baby doesn't yet have teeth. He was actually born with a full set of teeth; all babies are. They're just hidden inside the gums, and they will appear. Just as there are normal late walkers and late talkers, there are normal late teethers.