Baby teeth and teething: caring for your child's teeth early

Parents often ask when teeth will appear, what teething feels like and how to protect small teeth from decay. This article answers these questions using guidance from the NHS and the US National Institute of Dental and Craniofacial Research (NIDCR).

1. Introduction

The NHS says most babies start teething around 6 months, though some start before 4 months and some after 12 months, and a few are born with their first teeth ^[1]. The NHS stresses that decay is common in children, so good habits should start early ^[5].

2. When teeth appear

The NHS gives this approximate order ^[1]:

• Front middle teeth (central incisors): around 6 months
• The teeth beside them (lateral incisors): around 8 months
• First back teeth (first molars): around 12 months
• Pointed teeth (canines): around 18 months
• Second back teeth (second molars): around 24 months

Lower teeth often come through before the matching upper ones, and most children have all of their baby teeth by 2 to 3 years old ^[1]. These are approximate ages, and as the NHS notes, teething can start before 4 months or after 12 months ^[1]. If you are unsure about your own child, ask your doctor or dentist.

3. Signs and symptoms of teething

The NHS explains that some babies have no discomfort or only mild symptoms lasting a few days. Others may have ^[1]:

• Sore, red gums where a tooth is coming through
• A slightly raised temperature, below 38 degrees Celsius
• A flushed cheek or a facial rash
• Ear rubbing
• More dribbling than usual
• More chewing or gnawing on things
• Being unsettled or sleeping poorly

The NHS notes there is no evidence that teething causes diarrhoea ^[1]. The NHS advises getting advice if any symptoms worry you, because you know your baby best. You can call NHS 111 or contact a GP in the UK, or contact your own doctor elsewhere ^[1].

4. Starting tooth care

The NHS advises starting to brush as soon as teeth start to come through, using a baby toothbrush and a tiny smear of fluoride toothpaste ^[2]. Sitting your baby on your knee with their head against your chest is the easiest way to brush. Some children resist brushing, so keep trying. Making it a game or brushing your own teeth at the same time can help ^[2].

• Brush at least twice a day, including at bedtime ^[2].
• Use a very small smear of toothpaste for children under 3, and a pea-sized amount for ages 3 to 6 ^{[2, 3]}.
• Make sure children do not swallow toothpaste. Spit out afterwards, but do not rinse with water ^[2].
• Keep helping with brushing until your child can brush well alone, normally until at least age 7 ^{[2, 3]}.

The NHS suggests taking your child along to your own dental appointments so they become familiar with the idea ^[2].

5. Drinks, food and decay

The NHS explains that decay depends on how often and for how long teeth are exposed to sugar, not only how much is eaten. Lollipops and sweet drinks in a feeding bottle are especially harmful because they coat the teeth in sugar for long periods, and acidic drinks such as fruit juice and squash can also damage teeth. Sugars naturally found in whole fruit and milk are less likely to cause decay ^[2]. Practical steps include ^[2]:

• Use bottles only for breast milk, formula or cooled boiled water, and not for juice or sugary drinks.
• From about 6 months, offer drinks from a free-flowing cup.
• At bedtime and overnight, give only breast milk, formula or cooled boiled water. The NHS says plain milk and water are the best drinks for young children.
• If fruit juice is given, dilute it well, keep the amount small and offer it only at mealtimes.
• Check baby foods, rusks and drinks for hidden sugar, and do not give honey before age 1.
• Never dip a dummy in sugar, jam or anything sweet.
• Choose non-food rewards such as stickers instead of sweets, and ask a pharmacist or doctor about sugar-free medicines.

NIDCR describes early childhood caries, sometimes called baby bottle tooth decay, as decay that usually starts in the front teeth and can spread to the back teeth ^[4]. Dentists can also apply sealants to the chewing surfaces of permanent teeth to protect them ^[4].

6. Special groups

NIDCR and the NHS explain that early decay can be reversed with fluoride treatment from a dentist, such as varnish or mouthwash ^{[4, 5]}. The NHS notes that NHS dental care for children is free, but that not every dentist takes new NHS patients ^[2]. Check what dental services are available where you live.

7. When to see a doctor

Seek medical advice if teething symptoms worry you. The NHS suggests calling NHS 111 or contacting a GP if you are concerned ^[1]. See a dentist as soon as possible if you think your child has decay, which can show as white, brown or black marks on a tooth, or if your child has toothache ^{[4, 5]}. NIDCR notes that an abscess, a pocket of pus, can cause pain, facial swelling and fever ^[4], and the NHS says a dental abscess needs urgent dental treatment ^[6]. Go to a hospital emergency department or call for emergency help if your child has trouble breathing, speaking or swallowing, significant swelling inside the mouth, or cannot open their mouth ^[6].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Most babies start teething around 6 months, and most have all their baby teeth by 2 to 3 years. Start brushing with a small amount of fluoride toothpaste when the first tooth appears, help your child brush until at least age 7, and keep drinks and snacks low in sugar. Regular dental visits and advice from your doctor or dentist help keep children's teeth healthy.