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Teething

Introduction

The baby's first teeth (also known as milk teeth or deciduous teeth) usually develop while the child is growing in the womb. These teeth then start to emerge through the gums when a child is 6-9 months old. This process is known as teething.

The teething process

Most babies start teething at around six months. However, all babies are different and the timing of teething varies.

Some babies are born with their first teeth. Others start teething before they are four months old, and some after 12 months. Early teething should not cause a child any problems, unless it affects their feeding.

A rough guide to the different stages of teething is:

  • bottom front teeth (incisors) – these are the first to come through, at around 5-7 months
  • top front teeth (incisors) – these come through at around 6-8 months
  • top lateral incisors (either side of the top front teeth) – these come through at around 9-11 months
  • bottom lateral incisors (either side of the bottom front teeth) – these come through at around 10-12 months
  • canines (towards the back of the mouth) – these come through at around 16-20 months
  • molars (back teeth) – these come through at around 12-16 months
  • second molars – these come through at around 20-30 months

Most children will have all of their milk teeth by the time they are two and a half years old.
 
Some babies show very few signs or symptoms of teething, while others find it painful. However, there are lots of ways you can make teething easier for your child, such as:

  • giving your baby something hard to chew on, such as a teething ring
  • using sugar-free teething gel on your baby if they are more than four months old
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Symptoms

Some babies do not experience any pain during teething, while others are more severely affected. The pain is caused by movement within the developing jaw bone, as teeth start to make their way through the gums.

Some teeth may come through easily, whilst others cause pain and discomfort. Once the teeth have emerged, the discomfort will normally stop.

Your baby may experience a number of different symptoms while they are teething, some of which are listed below.

  • A raised temperature - but not a fever, which is a temperature of 38C (100.4F) or above.
  • Facial rash – your baby's cheeks may be flushed
  • Reddened gums – the gums may be swollen and tender when they are pressed, and your child may rub their gums
  • Excessive dribbling - this may cause a red rash to develop on their chin.
  • Poor appetite - your baby may be more reluctant to eat as a result of the pain in their gums.
  • Chewing - you may find your baby starts chewing more - it may be toys or objects, or their fingers.
  • Restlessness and irritability - the pain caused by teething may also cause crying.
  • Disturbed sleep

Some people attribute a wide range of symptoms to teething, such as diarrhoea, and fever. However, there is no research to prove this, and it is important to be aware that not all symptoms are the result of teething.

You know your baby best - if their behaviour seems unusual, or their symptoms are severe or causing you concern, then you should seek medical advice. You can call NHS Direct Wales on 0845 46 47, or alternatively contact your GP.

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Treatment

There are several ways you can help make the teething process easier for your baby. Every child is different, and you may have to try several treatments until you find one that works for your baby. Some of the most common treatments are outlined below.

Teething gels

Teething gels often contain a mild local anaesthetic which helps to numb any pain or discomfort caused by teething. They may also contain antiseptic ingredients, which help prevent any sore or broken skin in your baby's mouth becoming infected.

Make sure you use a teething gel specifically designed for young children and not a general oral pain relief gel, which is not suitable for children (see below). Your pharmacist can advise you.

You will need to gently rub the gel onto your baby's gums using a clean finger. Always follow the instructions which come with the gel.

You should discuss with your GP the teething gel options for babies under four months old.

Teething rings

Teething rings give your baby something to safely chew on, which may help to ease their discomfort, as well as providing a distraction from any pain.

Some teething rings can be cooled first in the fridge, which may help to soothe your baby's gums. You should follow the instructions which come with the ring so you know how long to chill it for. You should never put a teething ring in the freezer, as if the teething ring becomes very hard or cold, it could damage your baby's gums.

You should also never tie a teething ring round your baby's neck, as it may be a choking hazard.

A useful alternative to a teething ring is a cold, wet flannel.

Chewing

One of the signs that your baby is teething is that they start to chew on their fingers, toys, or other objects they can get hold of.

Try and give healthy things for your baby to chew, such as raw fruit and vegetables. For example, pieces of apple and carrot are often ideal. You could also try giving your baby a crust of bread or a breadstick. It is best to avoid rusks because nearly all brands contain some sugar.

Avoid any items that contain lots of sugar as this can cause tooth decay even if your child only has a few teeth. Make sure you always supervise your child when they are eating, and stay close in case they choke.

Painkilling medicine

If your baby is in pain, or has a raised temperature, you may want to give them a painkilling medicine which has been specifically designed for children. These medicines normally contain a small dose of paracetamol or ibuprofen , to help ease any discomfort. The medicine should also be sugar-free.

You must always follow the dosage instructions which come with the medicine. If you are unsure, please ask  your GP or pharmacist.

Cool drinks

Cool, sugar-free drinks will help to soothe your baby's gums, and may also help if they are dribbling excessively. The best option is to give them cool water - just make sure it is not too cold.

Comfort

Comforting or playing with your baby can sometimes help to distract them from the pain in their gums. It may be that your baby is feeling too irritable or restless to play, but at other times, it may be a good way of getting them to concentrate on something other than their teething pain.

Preventing rashes

If teething is making your baby dribble more than usual, make sure you frequently wipe your baby's chin and rest of their face. This will help to prevent them developing a rash. You may also find it useful for your baby to sleep on an absorbent sheet.

Salicylate salt caution

In April 2009, The Medicines and Healthcare products Regulatory Agency (MHRA) issued advice regarding the use of oral pain relief gel containing an ingredient called salicylate salts in children under 16.

The advice was introduced as the salicylate salts have been found to have the same effect on the body as aspirin. Aspirin should not be given to children under 16 because it can potentially increase their risk of developing a rare but serious condition called Reyes syndrome (which can cause serious liver and brain damage). 
 
It is recommended that you check with your GP or pharmacist before buying a teething gel, to make sure that it is suitable for your child and does not contain salicylate salts.

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Recommendations

When should I start brushing my baby's teeth?

You should start cleaning your baby's teeth as soon as they start to appear. Your baby's teeth can still be affected by harmful decay, even at a very young age.

You should be cleaning your baby's teeth twice a day. At first you may find it easier to use a piece of clean gauze or cloth wrapped around your finger.

As more teeth appear you should use a toothbrush specifically designed for babies. These toothbrushes have soft, small heads, which will help prevent any damage to the gums. Make sure you gently massage around the teeth and gums with the toothbrush.

You only need to use a tiny amount of fluoride toothpaste when your child is a baby. There are several toothpastes specifically designed for babies and children.

A toothpaste with a fluoride level of at least 1,000 parts per million is suitable for babies and children up to three years old (the fluoride levels can be found on the toothpaste packaging).

Dummies, teething rings and bottles

Never dip your baby's dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars. These can expose your baby's teeth to harmful acids, which can attack the newly formed teeth and cause decay.

You should also never add sugar to bottle feeds or use sugary drinks. Milk and water are the best drinks for teeth.

Bottle-feeding with drinks containing sugar can lead to 'bottle caries' (tooth decay). Your baby will not be born with a sweet tooth and will only have a taste for sugar if it is given at an early age.

Dental check-ups

Your dentist will be able to advise you about when to take your baby for their first dental appointment. You may want to take your baby with you to your own dental check-ups, as this may help your baby get familiar and comfortable with the surroundings.
 

Most babies visit the dentist for the first time at around six months of age or from the age that the teeth start to appear.  

See the Encyclopaedia A-Z topic Dental care for babies and children for more detailed information about caring for your baby’s teeth.

 

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