Teething

Definition
Teething is the time when new teeth begin breaking through a child's gums. The mild pain associated with this natural process can be eased with simple home treatments.

Causes/associated factors
Primary teeth, also called baby teeth, begin developing during pregnancy. Most baby teeth start to break through the gums at about 6 months. Some babies may begin teething as early as 3 months, however, and others are even born with a tooth. "Late teethers" may not have a first tooth until age 1. Timing tends to run in the family -- if you or your partner began teething early or late, your child may follow the same pattern.
Baby teeth erupt in the following order:

two lower incisors (bottom front teeth)
four upper incisors (upper front teeth)
two more lower incisors
four first molars (upper and lower back teeth)
four canines (cuspids or eyeteeth)
four second molars
Most children have all 20 baby teeth by age 3 -- 10 teeth on the top and 10 on the bottom. Except for the second molars, baby teeth typically begin to fall out around age 7. The primary teeth are lost in about the same order in which they appeared. By age 13, most children have a full set of permanent teeth. If the primary teeth don't fall out on their own, a dentist may need to take them out to make room for the permanent teeth.


Signs/symptoms
Teething may cause pain in the affected area, which can cause irritability. Other symptoms may include:
increased saliva production and drooling
chewing on things
increased thumb sucking
Call the doctor if your child has other symptoms, seems very uncomfortable, or you have concerns about teething.


Diagnosis
Based on symptoms, teething is typically diagnosed at home.

Treatment
To ease teething pain, massage your baby's gums with your finger and offer firm rubber teething rings. You may want to chill pacifiers or teething rings in the refrigerator, but don't freeze them. (Intense cold can damage your baby's gums.) Call your baby's doctor for advice about the use of analgesics, such as acetaminophen. As with all medications, follow the instructions on the label.
Avoid feeding your baby hard foods that may cause choking, such as raw carrots or apples. Also, stay away from teething gels. Many contain benzocaine, which can numb your baby's throat and tongue and lead to choking. Benzocaine, in particular, has been found to have a higher incidence of side effects than other local anesthetics.


Complications
Sometimes, delayed teething can indicate a medical problem. If your child hasn't started teething by age 1, consult your child's doctor or dentist.

Prevention
To prevent plaque buildup, clean your child's teeth with a small soft toothbrush every day, preferably before bedtime. Early exposure to good dental habits will help establish long-term healthy behaviors. Do not put your baby to sleep with a bottle. Formula, milk or juice from a bottle can pool around the teeth and cause serious tooth decay. Talk with your child's doctor about the connection between tooth decay and continued use of the bottle after ages 12 to 15 months. Finally, don't coat pacifiers or teething rings with anything sweet. The taste may encourage your child to suck on the object, but the risk of tooth decay from long-term sugar exposure is significant.