What are baby teeth

Babies are usually born with 20 baby teeth (also known as primary teeth, milk teeth or deciduous teeth). Baby teeth start to come through the gums at about 6 months and all the teeth have usually appeared by the time the baby is 2 to 3 years of age. This process is called teething. Baby teeth will fall out at various times during childhood.

Table 1: General guide of when baby teeth appear

Tooth type	Age
Central incisors	6 to 10 months
Lateral incisors	10 to 16 months
Canine	17 to 23 months
1st baby molar	14 to 18 months
2nd baby molar	23 to 31 months

Babies are born with the following teeth:

• 4 second molars
• 4 first molars
• 4 canine teeth
• 4 lateral incisors
• 4 central incisors.

There is one set on each side of the upper jaw, and one on each side of the lower jaw.

Baby teeth help your child to chew food easily and to pronounce words properly. They are also needed to hold a place in the jaw for the permanent teeth to come through later.

It is important to keep baby teeth clean. This will protect against infection, cavities and pain. Decayed baby teeth can damage the permanent teeth underneath.

Your child’s jaw will continue to grow and permanent teeth will start to replace the baby teeth when the child is around age 6.

The outer covering of baby teeth is made of thinner enamel than the enamel of permanent teeth and this makes the baby teeth look whiter. It also means they are more likely to get tooth decay.

Baby teeth also have shorter and different shaped roots from permanent teeth, making it easier for the roots to dissolve later and to allow space for permanent teeth to grow underneath them.

Babies can be quite uncomfortable when they are teething. Try chilled (not frozen) teething rings, wash cloths or dummies to ease the pain.

Usually teething doesn’t cause children too much discomfort, however, many parents can tell when their baby is teething. Babies may show signs of discomfort in the area where the tooth is coming in, the gums around the tooth may be swollen and tender, and the baby may drool a lot more than usual.

Parents can help ease teething pain by massaging their baby’s gums with clean fingers, offering solid, not liquid-filled, teething rings, or a clean frozen or wet washcloth. If you offer a teething biscuit, make sure to watch your baby while he or she is eating it. Chunks can break off easily and can lead to choking. Also, these biscuits are not very nutritious and most contain sugar and salt.

A baby’s body temperature may slightly rise when teething; however, according to a 2016 study in Pediatrics ¹, a true fever (temperature over 100.4 ° Fahrenheit or 38 ° Celsius) is not associated with teething and is actually a sign of an illness or infection that may require treatment. If your baby is clearly uncomfortable, talk with your pediatrician about giving a weight-appropriate dose of acetaminophen (e.g., Tylenol) or if over 6 months, ibuprofen (e.g., Advil, Motrin). Make sure to ask your pediatrician for the right dose in milliliters (mL) based on your child’s age and weight.

DO NOT use teething tablets, gels with benzocaine, homeopathic teething gels or tablets, or amber teething necklaces.

Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child’s pain, but the FDA has issued warnings ² against both due to potential side effects.

In addition, amber teething necklaces are not recommended. Necklaces placed around an infant’s neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace’s effectiveness.

Many children, however, will have no problems at all when their teeth come in.

Figure 1. Baby teeth

How many baby teeth?

Babies are usually born with 20 baby teeth.

What order do baby teeth come in?

The teeth in the center of the bottom jaw (the lower central incisors) often come through first, sometime between 4 months and 10 months.

Each baby is different so don’t worry if your baby’s teeth appear earlier or later. Talk to your dentist if you are worried.

Most babies will develop teeth between 6 and 12 months.

There is a wide range of variability of when a first tooth may appear—some babies may not have any teeth by their first birthday! Around 3 months of age, babies will begin exploring the world with their mouth and have increased saliva and start to put their hands in their mouth. Many parents question whether or not this means that their baby is teething, but a first tooth usually appears around 6 months old. Typically, the first teeth to come in are almost always the lower front teeth (the lower central incisors), and most children will usually have all of their baby teeth by age 3.

Figure 2. Baby teeth coming in order

Abbreviations: mos = age in months; yrs = age in years

How to care for baby teeth

Baby teeth can start to decay as soon as they appear in the mouth. Frequent exposure to sugary liquids can destroy baby teeth.

You should wipe your baby’s gums with a wet facecloth or a clean gauze pad after each feed. You can brush your baby’s first tooth as soon as it appears with a soft toothbrush and a little water.

Fluoride should be added to your child’s diet at 6 months of age. Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin him or her on solid foods (about 6 months of age). The American Academy of Pediatrics, along with the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay. Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water.

According to the American Dental Association, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

Older children should be supervised while they are cleaning their teeth. Children over 18 months can use a pea-sized amount of children’s low-fluoride toothpaste and should be taught not to swallow it. They should rinse with water after brushing.

To reduce the risk of tooth decay:

• never allow your baby to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquid
• don’t dip a dummy in sugar or honey
• clean the dummy before you give it to your baby
• visit your dentist by about 12 months.

If you are worried about your baby’s tooth development, call your dentist.

What if we live in a community where the water is not fluoridated? What can we do?

Check with your local water utility agency to find out if your water has fluoride in it. If it doesn’t, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

How else can my child get fluoride?

There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child’s development.

When should my child start using fluoride toothpaste?

The American Academy of Pediatrics and the American Dental Association recommend using a “smear” of toothpaste (the size of a grain of rice) on children once the first tooth appears and until your child is 3, especially after the last drink or food of the day. Once your child has turned 3, the American Academy of Pediatrics, the American Dental Association (ADA), and the American Academy of Pediatric Dentistry recommenda pea-sized amount can be used. When your child is able, teach him or her to spit out the excess toothpaste. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until he or she is around 7 or 8 years old. When your child can write his or her name well, he or she also has the ability to brush well.

References

1. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis Carla Massignan, Mariane Cardoso, André Luís Porporatti, Secil Aydinoz, Graziela De Luca Canto, Luis Andre Mendonça Mezzomo, Michele Bolan. Pediatrics Mar 2016, 137 (3) e20153501; DOI: 10.1542/peds.2015-3501 pediatrics.aappublications.org/content/pediatrics/137/3/e20153501.full-text.pdf
2. FDA warns about safety risks of teething necklaces, bracelets to relieve teething pain or to provide sensory stimulation. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm628932.htm