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What a Smile!

When Shannon Allen's son, Connor, started teething at 5 months, he seemed to have had a personality transplant. "My good-natured baby became exceptionally fussy overnight," says Allen, of Garwood, New Jersey. "He'd cry and cry and just wouldn't stop."

So a year and a half later, when her daughter, Elaina, began teething at 6 months, Allen prepared for the worst. But this time the experience was lovely. "She was the exact opposite. You wouldn't even know she was teething. She giggled through the entire thing."

Welcome to Baby Teeth 101: No rules. Some baby teeth just sail right in, others arrive in a squall. Some are early, others late. On average, the first primary tooth comes in around 6 months, but some kids are actually born with a tooth or two, while others reach their first birthday with a toothless grin. By age 2½ or so, a child usually has 20 primary teeth -- 10 on top, 10 below. You'll want to take care of them: Baby teeth help jawbones and muscles develop properly, promote good eating and speech, and maintain space for the permanent ones. Just as important, preventing decay from setting into a baby's first teeth can help keep future cavities away.

Care should begin even when your infant's all gums. At bathtime, wrap your finger in a clean, thin, wet washcloth and gently rub it on the gums. It'll stimulate them and get you both used to daily cleanings.

Jan Sheehan writes about health for Family Circle and other national magazines.

How Teething Starts

The initial clue that the first tooth wants to emerge may be changes in your baby's behavior, such as unusual fussiness or sleeplessness. Then again, you may find there are no changes at all.

But you shouldn't blame diarrhea, a rash, or an earache on teething, say experts. Studies have found no such link. It's probably a coincidence: The first teeth often erupt around the time babies lose their inborn immunity and start to get colds and infections. And don't write off a fever over 101°F or any other symptom that lasts for a day or more; call the doctor. (Drooling's a coincidence too: Around 6 months, salivary glands begin to mature, but babies haven't become very good at swallowing yet.)

The teething process lasts about two years, but never fear: The first few teeth are usually the worst. Experts aren't sure why that is -- it could be that babies get used to what teething feels like.

Here Come Those Pearly Whites

Baby teeth tend to arrive in pairs, with the two middle teeth on the bottom showing up first, followed by the two middle ones on the top. Next come their neighbors, the lateral incisors; then first molars, followed by canines (the pointed side teeth), and, finally, the second set of molars. Each set arrives about four months after the last. Don't be concerned about the spaces between the teeth. This is perfectly normal -- the permanent teeth will be larger.

Baby teeth are quite susceptible to cavities, so it's important to make sure they aren't exposed to sugar too long. Avoid letting your child fall asleep while sucking on a bottle or sippy cup that contains formula, milk, or juice -- sugary liquid can pool around her teeth. This is especially bad at night, when she's producing less saliva, the mouth's natural rinse. If your baby needs something to help her fall asleep, offer her a pacifier or, if she's older than 3 months, a bottle with water. If you're breastfeeding, try not to let your baby fall asleep while she nurses.

Even during the day, don't let your child spend hours sucking a bottle or sippy cup. Let her drink when she wants, then take the bottle away when she's no longer thirsty.

Ready, Set, Brush

Once the first tooth appears, it's time to clean it. Try to get into the daily habit of rubbing both sides of each tooth with a cloth or a piece of gauze. A good time to do this is after the last feeding of the day.

When your toddler has about eight teeth, buy an infant-size toothbrush with a soft or medium bristle. At first, use only water or a bit of fluoride-free toothpaste, which won't be harmful if swallowed. (Too much fluoride can lead to fluorosis, a harmless discoloration of permanent teeth.) The best technique: Sit on the floor or sofa with your child lying faceup on your lap. You can keep his head stable that way -- and get a good view of the teeth.

At 18 to 24 months old, your child can start to hold a toothbrush and help. Choose a child-size, soft-bristled one, and use water or fluoride-free toothpaste until he's able to spit out; at that point, you can switch to a fluoridated brand. Even then, use only a pea-size amount. "Press it into the bristles," says Martha Ann Keels, clinical professor of pediatric dentistry at Duke University. "Some children will eat even a small amount off the brush and swallow it like candy." To teach your child how to brush:

  • Demonstrate how to make little circles on the teeth and gums with the toothbrush.
  • Make back-and-forth strokes on the flat biting surfaces in back.
  • Go around the racetrack: Be sure you complete the circuit through the whole track, including the corners!

After a few seconds, offer praise, then say "My turn!" Assume this will be a two-person job until around age 6. Your child will be ready to handle brushing all by himself about when he has the fine motor skills to tie his shoes. Aim for a brushing time of 60 seconds.

No need to consider flossing, for now. It only makes sense when the teeth start to touch -- usually at age 4 or 5, though some toddlers with "tight" teeth might need to floss. Do it for your child until he's about 8. Mouthwash isn't necessary, and steer clear of tartar-control or whitening toothpastes; these may irritate sensitive tissue inside your child's mouth.

The First Dental Visit

Your pediatrician will look at your baby's mouth and teeth, but it's a good idea to schedule a visit with a children's dentist about six months after the first tooth arrives -- or around the first birthday. He can tell you the best way to care for your child's teeth, examine her jaw, and let you know whether she'll need fluoride supplements. (She might if the local water supply isn't fluoridated, if you use well water or nonfluoridated bottled water, or if you have an in-home filtration system that removes fluoride.) He may also take an x ray to detect any hidden problems and confirm that the teeth are developing normally. Occasionally, permanent teeth will appear behind the baby teeth, causing a double row of "shark's teeth." When this happens, the baby teeth are sometimes pulled. (Sealants, which can protect the cavity-prone tops of permanent back teeth, are rarely applied to the primary teeth.)

Losing Teeth, Happily

Between 5 and 7, your child will begin to lose his baby teeth. (Generally, the earlier they come in, the earlier they're lost.) You can wiggle a loose tooth, but never tie a string around it and yank!

After it's out, have him bite down on gauze or a clean washcloth to stop any bleeding. And the tooth? It goes to the Tooth Fairy.