A toothless smile brings many Ahh moments but there is no comparison to the excitement of the first tooth, and then the second and the third… Teeth formation is a gradual process – it takes up to 13 years (and much longer for wisdom teeth). But how does it all begin? Since February is Children’s Dental Health month, we decided to dedicate this feature to the subject.
BEFORE BABY
Your baby will develop the first tooth buds in utero – starting from 6 weeks into your pregnancy and continuing into your second trimester, until 20 weeks. At birth, each tooth is already formed but they will remain in hiding underneath the gums until later. That is why it is very important to consume enough calcium during pregnancy to ensure strong bones for your baby, including strong teeth. A good multi-vitamin, which your doctor will likely prescribe, should help with other essential nutrients. Make sure to eat a healthy diet and plenty of fruit and vegetables during pregnancy.
BABY TEETH TIMELINE
Baby teeth will come in gradually over the next 6 years and will be replaced later by permanent teeth. Girls’ teeth usually come in earlier than boys, and lower teeth usually come in before uppers, but every baby is different, so these ages are estimates.
6-8 months: Get your camera ready – the first tooth usually makes an appearance at 6 months on the bottom front (called the central incisor) and is quickly, if not simultaneously, accompanied by a twin friend right next to it (called lateral incisor).
Then, expansion continues to the side of those front heroes – by 8 months your munchkin is likely to have 4 teeth on the bottom.
8-12 months: The top front teeth are usually out by 7½-8 months. Their neighbors to the right and left, upper lateral incisors, show up around 9 months. Your baby is now sporting a big 8-teeth grin. That’s something to smile about!
13-18 months: The first molar (4 teeth right or left from the front tooth) can come in as early as 12 months, but more frequently they start appearing anywhere from 13 to 18 months on both top and bottom.
Your toddler is likely to be a fast walker by the time the pointy cuspids (canine teeth) come in – usually anywhere from 16 to 18 months (some may be as late as 22 months).
19-33 months: The largest teeth – the second molars (5 teeth right or left from the front tooth) springs up in the back by the time your child is 2 years old. Now the full quota of 20 baby teeth is met.
6-13 years: Fairies alert! The first tooth falls out around the age of 6. Others quickly join the departing line, usually in the first-in, first-out order. Baby teeth are now being pushed out by the adult permanent teeth right below. Why the need for temporary/baby teeth? The answer is they are important to jaw and bone development and they save space for the permanent teeth. New, permanent teeth (typically molars) start coming in around the age of 9 and continue well into the early teens. By the time your child is 13, he is likely to have all 28 adult teeth. Wisdom teeth may or may not come in the next 10 years.
Keep in mind, as with everything in baby/child development, there is a wide variation. There are some rare cases when babies are born with one or more teeth, and there are some that have none until they are a year. These guidelines are pure estimates.
FIRST CHECK-UP
The American Academy of Pediatric Dentistry recommends the first dental appointment when your child turns 1. If you are not sure about regular dentist offices, find a pediatric dentist. Most dentists will not recommend a checkup until the child is 3, but pediatric dentists will be able to spot any plaque and decay much earlier.
Pediatric dentists are dentists with additional years in pediatric training and their offices and dental chairs are better suited for little ones. The first checkup won’t take long as the dentist will check baby’s teeth, mouth and throat for plaque and correct development. Your dentist can also discuss any concerns in oral health development, such as how to wean him off pacifiers and prevent thumb sucking. It is unlikely your toddler will sit still during the exam, so go when he is relaxed and happy (and fed) and tell him about the dentist and what happens during the visit before you go. Pediatric dentists recommend check-ups every 6 months, but some may want to see you more or less frequently.
TOOTH CARE
Cleaning teeth is a great preventive measure. Start early by using gauze to wipe your baby’s gums during bath time. Once the first tooth appears, begin brushing it with a small rubber pointed or soft bristled brush designed specifically for infants. There is no need to use toothpaste, since your baby is likely to eat it and too much of fluoride is a bad thing. Hold off on toothpaste until your child is 2 or 3 years old. Brush once a day at bedtime (or during bath). It’s a good idea to change the toothbrush every 4 months, as bacteria from the mouth will accumulate on the brush.
As more teeth appear, ideally by 14 months, try to establish a routine of brushing teeth twice a day – in the morning and at bedtime. Encourage your toddler to brush. Showing an example (and they love to emulate you) or creating a special brushing song is helpful. I sing the ABC song twice as we brush – this ensures we brush long enough, my baby learns the song and music always helps. Have your baby pick a toothbrush – with Elmo, Pooh, Dora, Spiderman or other favorite characters – this will make it more personal and him more likely to brush. You can start using toothpaste once your child is 2 or 3, but make sure it’s a pea-sized amount and supervise the brushing.
Tooth care is more than just brushing; it’s also about the food. As we all know, too much sugar causes cavities and babies are no exception. So try to limit sugar. Babies are not really programmed to like sugar (though breast milk is very sweet); they are trained to like it. Just see how many people will offer your baby cookies and ice-cream. However, toddlers are just as happy eating veggies and non-sugary fruits. All the flavor preferences are acquired; they are not innate. I am not suggesting throwing everything sugary out of the window; just use caution. And try not to share spoons with your child as you may transfer cavity-causing bacteria through your saliva. Remember to offer nutritious snacks and plenty of liquids. Sucking on a bottle is also known to be cause for tooth decay, so make sure your child never goes to bed with a bottle.
DEALING WITH TOOTHACHE
The first tooth will be painful; prepare for crying, redness of cheeks and overall fussiness. How do you help this? As with anything else, comfort your baby – there is nothing like mommy’s shoulder.
Toothache for baby means he will want to chew on everything – ensure that he has plenty of safe things to chew one and watch him very carefully since everything will now go in the mouth. Some good teething helpers are frozen teething rings, popsicles, cold spoons, frozen bananas, cold washcloth. If toothache persists and cold teethers won’t help, try a little Baby Tylenol. Consult your pediatrician for the appropriate dosage.
Teething is usually accompanied by drooling. Make sure you have a bib on hand to absorb the drool. Drooling is also the reason for baby’s skin getting read and chapped. Use some Vaseline or other baby-safe cream on the skin.
Teeth grinding is a frequent phenomena, and while it is not painful to the baby, it will make you shiver. Teeth grinding usually occurs for two reasons – either baby is overwhelmed and grinding his teeth helps relieve tension, or he is just discovering his teeth and enjoys the sensation. There is no cause for concern; the habit is quickly gone once it is no longer new. If, however, grinding persists for months, contact your pediatrician.
For older children, if toothache occurs and the area is swollen, rinse the irritated area with warm salt water. Then place a cold compress on the swollen area of the face and give child Tylenol. See the pediatric dentist as soon as possible. If your child participates in a lot of sporting activities, a soft plastic mouth-guard is a good idea to protect teeth, gums and lips. Your pediatric dentist can fit your child with a custom piece.
Final word – as with anything about your baby, don’t overreact. Enjoy the new developments and contact your pediatrician if you have any concerns.
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