A Baby's First Tooth

A baby's first tooth is an important milestone.

Teething Can Be Unpleasant

Baby teeth, also called primary teeth, usually start to appear between the ages of six months and one year. As the new teeth erupt or appear in the mouth, babies may have sore or tender gums that can cause them to be irritable and fussy. Babies may experience other unpleasant symptoms such as loss of appetite, sleeplessness and excessive drooling. While teething, it is not normal for a baby to have diarrhea, a fever or a rash. If you notice these conditions in your teething baby, you should consult your doctor.

The side effects of teething, which can make a baby uncomfortable, can also be unpleasant for parents as some extra time and patience may be required to comfort their infant. To help soothe a baby with irritated gums, parents can try to give the child a clean teething ring to chew on. Gently rubbing your child's gums with a small, cool spoon or a wet, cool clean washcloth may also help. Parents can also rub the baby's gums gently with a clean finger or wet gauze pad. If discomfort continues or seems excessive, parents should consult their dentist or pediatrician.

The Importance of Baby Teeth

Although the process of teething can be a bit unpleasant, those tiny new teeth can play an important role in your baby's healthy development. Even though they eventually fall out and are replaced, baby teeth can be just as important as adult permanent teeth.

• Primary (baby) teeth help children chew their food and speak properly.
• Healthy baby teeth also help keep a space in the jaw for permanent adult teeth.
• If a baby tooth is lost too early, crowding and misalignment may occur when it is time for the adult teeth to emerge (come in). This could result in crooked teeth and could require more complicated or expensive treatment as your child gets older.

When Will the Teeth Appear?

Newborn babies typically have a partially developed set of teeth that are not yet visible. Parents will usually start to see their baby's first teeth erupt or appear in the mouth around six or seven months of age. Although, in some cases, baby teeth may already be visible when a baby is first born.

The first teeth to erupt or appear in the mouth are usually the two bottom front teeth, called the central incisors, between six and ten months of age. These are usually followed by the appearance of the four upper front teeth, the central and lateral incisors.

Typically, the lower lateral incisors will appear next. After a baby's first birthday, the first molars may begin to appear, followed by the canine (cuspid) teeth and the second molars. Although the rate and timing of when teeth begin to show may vary, by the time a child is three years old, all 20 of the primary teeth have usually erupted. Children typically keep all of their baby teeth until around the age of six years when they will begin to fall out and the permanent teeth will begin to replace them.

Keep Those New Teeth Healthy

Baby teeth are susceptible to decay as soon as they appear, so special care should be taken to keep them healthy. Tooth decay that occurs in infants is usually called baby bottle tooth decay or early childhood caries. This occurs when baby teeth are frequently exposed to liquids containing sugar.

Among these liquids are milk, formula, fruit juice, sodas and other sweetened drinks. An increased risk of tooth decay is also associated with on demand nighttime breastfeeding after eruption of the child's first tooth, and with use of pacifiers that are frequently dipped in honey, sugar or syrup. When children are allowed to drink sugary liquids from a bottle or sippy cup, the sugars can pool around the teeth and gums and feed the bacteria that cause decay. Unfortunately, by the time a parent notices signs of decay in baby teeth, it may be too late to save the teeth.

Parents of babies that are born prematurely may want to pay special attention when the baby teeth begin to erupt. Premature babies and low birth weight babies may be more likely to have dental complications. Many premature babies could have enamel hypoplasia or "preemie teeth." This can cause the teeth to look brownish and be more prone to decay. Premature babies may also experience delays in the appearance of their baby teeth. Parents of a prematurely born baby may want to talk to their dentist as soon as the first baby tooth erupts to help prevent any complications.

Prevent Baby Bottle Tooth Decay

• Do not allow your baby to fall asleep with a bottle containing sugary liquids, juice, formula or milk, or provide on demand nighttime breastfeeding after the eruption of the child's first tooth.
• If your child needs a pacifier, use one recommended by your dentist or physician. Never give your baby a pacifier dipped in honey or another sweet liquid.
• A baby's gums should be wiped gently with a clean gauze pad after feeding. As soon as a child's first tooth appears, parents should begin brushing with a soft infant toothbrush.
• Parents and caregivers should consult a dentist or healthcare provider before introducing a child under two years old to fluoride toothpaste. For children under the age of six who use fluoride toothpaste, place no more than a pea-sized amount of toothpaste on the toothbrush. You should help brush the child's teeth (recommended particularly for preschool-aged children) or supervise the tooth brushing, and encourage the child to spit excess toothpaste into the sink to reduce the amount of fluoride swallowed.
• For children, flossing should begin when there are two teeth in the mouth that touch together. Parents can help floss children's teeth until they are able to floss by themselves.
• Continue to clean and massage gums in areas where teeth have not yet emerged.
• Parents who use reconstituted infant formula from powdered or liquid concentrate, as the primary source of nutrition for infants, should consider using purified (e.g., "distilled," "deionized," "demineralized" or "reverse osmosis") water without fluoride added rather than tap water to mix the formula. This is the easiest way to ensure that infants do not exceed the Institute of Medicine's recommended daily intake of fluoride.
• If your local water supply does not contain enough fluoride ask your physician or dentist if your child needs additional fluoride and how your child should get it.
• Encourage children to drink from a cup by the time they reach their first birthday.
• Schedule a visit to the dentist by your child's first birthday to find any early dental problems and to establish a good oral care routine

Although teething can be a difficult phase of your baby's life, it is the first step toward a beautiful smile that can bring joy for years to come. Parents can use baby teeth as a way to start teaching young children about good oral care that will give your child a healthy smile for a lifetime.

Sources: American Academy of Pediatric Dentistry: www.aapd.org; American Dental Association: www.ada.org; Academy of General Dentistry: www.agd.org